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What Expats In Mexico Need to Know About Medicare

By November 8, 2021Living Abroad, Medicare
Expats in Mexico - enjoying a folkloric dance in Puerto Vallarta

Many Americans have sought the paradise pastures and laid-back lifestyle of beautiful Mexico. Mexico is home to more than 1 million expats from around the world, including about 750,000 American expats.

Who’s blaming them? Expats in Mexico enjoy a land of sunshine, rich cultural traditions, historical heritage, lower living costs, and a slower, easier pace of living, Mexico has been a top expat destination for decades.

But there are some things expats to consider when living in Mexico or anywhere abroad, and that is healthcare.  Specifically, if you are a retiree – Medicare.  If you are retiring in Mexico, you should know that Medicare does not extend beyond U.S. borders. Expats have been actively trying to extend Medicare coverage to Mexico, but have not yet been successful. This article will explore some options for expats living abroad.

Expats In Mexico: What You Need to Know About Medicare in 2021

Medicare is really a two-part benefit program – and both programs can be used to help cover emergency medical costs for retirees in Mexico.
First, there is original Medicare, which is comprised of Part A (hospital coverage) and Part B (physicians and most other covered services). About 20 years ago, an important benefit was added as Part D to help Medicare beneficiaries cover the costs of prescription drugs.

In addition, a semi-official part of original Medicare is the Medicare Supplement program, which is also known as Medigap. it comes in eight alternatives specified by Medicare and offered by private insurers. Four of these plan types – D,G,M and N – offer emergency medical coverage.

Finally, there is Medicare Advantage, also known as Part C, which is a combined program including Part A and Part B coverage, frequently including Part D benefits, as well as a variety of benefits not included in original Medicare. Importantly for expats living in Mexico, it includes emergency care outside the U.S.

Medigap Travel Coverage Outside the U.S.

Medicare Supplement Plans D, G, M and N all provide up to US $50,000 (lifetime benefit) of coverage to travelers outside the United States on an indemnity basis, paying 80 percent of valid claims. This coverage is for emergency care coverage and will not apply for non-emergent services. These claims must be paid for first, and then claims presented back in the U.S. to the Plan provider. While $50,000 may not sound like much, it should cover almost all emergency care coverage in Mexico (accident, heart attack, stroke etc.) until you can get back into the U.S. This is really travel insurance, intended for trips up to 60 days in length.

For people retired in Mexico who return frequently to the U.S. Medigap coverage is terrific and eliminates the need for additional policies for travel anywhere in the world.

Let me use myself as a real-life example for cost and coverage.

My wife and I are covered by our Medicare Supplements while biking in Austria

My wife and I are covered by our Medicare Supplements while biking in Austria

My wife and I travel about one-third of the time from our home in Nashville, but most of our travel is domestic. The two downsides to Medigap plans are that they require fairly short trips abroad and are pretty expensive – in my case about US$100.00 per month for a G Plan (maximum coverage). To participate in Medigap plans, you must have Part B insurance, which is a very good idea anyway but costs US$148.50 per month. I also have a Part D plan, which costs around US$25.00 per month. So, in total, I pay around US$273.50 per month for great coverage in the United States and abroad.

The best thing about it is I can go to any doctor in the U.S. with extremely low annual out-of-pocket costs. I have over 60 G Plans to choose from where I live, and availability is dictated by geography. Purchasing a Medigap Supplement is great for young, active retirees, and once purchased can move around with you. Medigap Plans do require a physical address in the United States – not just a PO Box. Medigap Plans change very little year by year, but premiums do increase, typically based on age and inflation.

Living in Mexico?

Medicare Advantage Plans Provide Flexibility and Low Cost

Many Medicare Advantage Plans offer great offshore coverage for low-cost or no-cost in premiums – which applies directly to beneficiaries in Mexico. Medicare Advantage covers both Part A and Part B expenses (Part B participation is a requirement) and many Plans cover Part D benefits as well. Increasingly Medicare Advantage Plans are being offered with vision, dental and hearing coverage, and additional benefits such as transportation and meals that are less important to expats spending large amounts of time in Mexico.

Advantage Plans are issued based on very specific geography in the US – often at the county or even zip code level. Having a physical address is a requirement for all Advantage Plans, and the home address is the basis for the service area associated with each Plan.

These plans historically allowed a maximum of six months of time outside the U.S. service area, and coverage caps of US$50,000, just like Medigap Plans. And while this is still the case for most plans, this year we are starting to see plan offerings that expand coverage to US$250,000, some relief for Part B fees (around US$25 per month), and greatly relaxed residency requirements in the U.S. In fact, some plans do not have any residency requirement for certain market service areas.

These plans operate on some sort of managed care basis, so care in the United States is either within a specified network or is subject to increased utilization fees. Medicare caps the maximum annual out-of-pocket for Part C plans at US$7,550 for in-network services and US$11,300 for out-of-network, although many plans offer substantial reduction from these maximum amounts.

Using myself as an example again, I have 42 Medicare Advantage Plans available to me in Nashville TN, 39 of which offer coverage outside the U.S., and many with no premium. My total cost for purchasing this coverage would be only my Part B coverage cost, which is US$148.50 per month.

As noted above, we are starting to see plans in some markets where there is no residency requirement during the year of coverage – all 12 months out of the local US service market is OK. Medicare Advantage is a great alternative for those who spend a lot of time at vacation homes in Mexico or with family outside the U.S.

One important feature to remember is that you can expect great coverage and service from Medicare Advantage Plans when you return to the U.S. for care.

Make Sure You Can Get Home!

You will need to return to the United States after an accident or emergent illness, which is not covered by Medicare. We strongly suggest that you purchase emergency evacuation insurance if you need to get back to the U.S. for care. It is not terribly expensive, but well worth it!

Everybody’s Needs are Different – Let US Help Get You the Right Solution

After reading this, we hope you frame the range of alternatives and coverage available to you. Drop us a note or give us a call and let us help figure out the best solution for your needs.

¡Hasta pronto!

Wes Chapman

Wes Chapman was educated in Mexico and Spain, then had a 20-year career in investment banking in Latin America, finishing with 10 years as region director for Oppenheimer in Latin America. He spent the last 20 years in healthcare, focused on patient-centric, value-based care. He started Fortende to address the unmet needs of Medicare beneficiaries spending time outside the U.S.

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