I can get my Social Security abroad, so why not my Medicare?

Editor’s Note: Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in “Ask Phil, the Medicare Maven.” Send your questions to Phil.

Medicare rules and private insurance plans can affect people differently depending on where they live. To make sure the answers here are as accurate as possible, Phil is working with the State Health Insurance Assistance Program (SHIP). It is funded by the government but is otherwise independent and trains volunteers to provide consumer Medicare counseling in state and local offices around the country. The non-profit Medicare Rights Center is also providing on-going help.

Moeller is a research fellow at the Center on Aging & Work at Boston College and co-author of “How to Live to 100.” Follow him on Twitter @PhilMoeller or e-mail him at medicarephil@gmail.com.

Many readers seem to access Ask Phil from cruise ships, the Orient Express, grape-crushing sessions near Châteauneuf-du-Pape, and other similarly idyllic locations. This conclusion is based on the many, many reader questions about overseas health care expenses. And what many people, such as Steven from Oklahoma, want to know is why the @#$&%^ does Medicare not cover them outside the U.S.?

I can see a philosophical objection to allowing Americans to fork over U.S. dollars to foreign health care providers. I also can see that there may have been substantial concerns when Medicare was enacted 50 years ago that the quality of foreign medical care was just not up to Marcus Welby standards.

But that’s hardly the case these days. Check out international health care rankings. Look at the surge in medical tourism, driven not only by lower costs but also by quality.

By comparison, people can get their Social Security benefits sent to them anywhere. Presumably, these folks spend their dollars on foreign goods and services. Somehow, the nation has survived. Why not Medicare? Here’s how Steven put it, and I can’t improve on his logic:

Why should there be such resistance to using American benefits abroad? I understand that American insurance companies and the federal government say that they have designed their service to use networks of doctors and hospitals with whom they have agreements, to reduce costs. But my experience over the past 30 years, in the UK and France, has been that health care costs are far lower in these countries that have adopted national health services than they are in the U.S., with our fee-for-service philosophy. As I look to retirement, I am not anxious about using medical services here in France, and I expect that the costs that I will pay will be far less than what providers in the U.S. will charge. And if I were able to have Medicare pay me what they customarily pay providers in the U.S. for the same services, I might not see any cost at all. If that is the case, why wouldn’t both the government and private Medicare supplemental insurance companies welcome expatriate customers? The more Americans drew on less costly services abroad, the greater the reductions would be for U.S. payments for retiree health care.

Ever curious, I asked the good people at the Centers for Medicare & Medicaid Services (CMS) for more background. Here is what a spokesman said:

Medicare does not pay for medical care provided outside the United States, with certain specific exceptions. The exceptions are when a beneficiary is traveling between the contiguous states to Alaska by the most direct route; when a beneficiary requires emergency care while near the U.S.-Canada border and the nearest emergency care is located on the Canadian side. Beneficiary is not covered otherwise when in another country. Also not covered when aboard a ship of foreign registry that is within 40 miles of a U.S. port.

Now, Social Security does far more than simply send payments to beneficiaries outside the U.S. Through bilateral agreements with many nations, the earnings of Americans who work in foreign countries can be credited to the earnings records on which their Social Security retirement benefits are based. Would it really be so hard to make Medicare similarly responsive to those beneficiaries who live and travel overseas? Providers of health care services in the U.S. might not be so happy. But if the customer here is the Medicare beneficiary, is there any doubt that he or she would be better off? Or that in the process, federal spending would be reduced?

I’m laughing even as I write these words because the prospect of Congress doing anything so helpful and logical these days is such a non-starter. And this reality, of course, is no laughing matter at all.

Not so coincidentally, the federal government has lots of employees around the world. The Federal Employee Health Benefits Program that insures them does not require people to come back to the U.S. for their health care needs. How silly that would be, right? It does operate an extensive program of overseas health insurance that somehow has managed to include things like networks of foreign health care providers, mail order pharmacies for drugs, and the like.

In the meantime, there is some private insurance help for foreign health care needs. Read the next two questions:

Dan – Pa.: I will turn 65 this year and will enroll in Medicare as well as take out a Medicare supplement plan. I intend to keep working for the foreseeable future. My work involves a fair amount of international travel, and I have an emergency medical evacuation service. However, I wonder what I will need to do to be insured for any urgent or emergency medical expenses while I am outside the U.S. Are there supplement plans that cover medical expenses outside the U.S.? If not, what other options are there (short of traditional medical insurance)?

Karl — France: I will be 65 in not too many years. I have a second home in Nice, France. I know that Medicare doesn’t cover treatment in France. What must I do to be able to spend time there while having medical coverage? Do I have to buy a temporary private policy?

Phil Moeller: Six Medicare supplement coverage plans, also called Medigap plans, offer emergency coverage for foreign travel. But the benefits are modest, according to SHIP: 80 percent of Medicare-eligible expenses with a $250 annual deductible. Beyond this, you may need to seek non-Medicare insurance including — depending on how much time you spend outside the U.S. — a policy issued by an insurer in a specific foreign country. And there are health care options in travel insurance policies for shorter trips.

Monica — Ind.: I’ve just relocated to Bloomington, Indiana, from Dublin, Ireland. I was not eligible for a Part D drug plan while in Dublin. As soon as I returned, I applied for Part D. Now they want to charge a penalty, but since I was not living in the United States, when I would otherwise have been eligible, I was not eligible. Do you know how I can avoid the penalty?

Phil Moeller: Did I mention that the way Medicare interacts with the health care needs of people in other nations is in need of a bypass operation? Oh, well. I think your relocation qualifies as a life-changing event that should entitle you to a special enrollment period and exempt you from this kind of penalty. But my opinion counts for naught here. Try getting in touch with the Indiana SHIP office and see if they can help. And please let me know if the forces of logic prevail here and give you the relief you so clearly merit.