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Health Plan For 65+

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IAHBOG2017
7/2/2017 22:21 EST

I am looking to retire to Latin America within the next several months. One of my big concerns is health care/medical insurance. I will be 67 in September and I notice that some national health plans will not accept anyone over the age of 65. I do plan on keeping my Medicare A and B as well as my Medicare Advantage program, which is based in Houston. It would be relatively easy to fly back to Houston for any kind of major procedure, even if I had to buy a Med Evac plan. My concern is for routine care (out of pocket?) and important but not critical procedures, or for a situation in which my condition was not stable enough for air evacuation. So my question is this: Is there a good national plan for someone my age in Nicaragua? Are there hospital-based plans that accept us older retirees? (For example, I have heard of one such excellent plan in Managua at Hospital Vivian Pellas.) I am aware that companies like Cigna offer international insurance but their quotes are pretty much out of my budget.
Thanks very much for any and all input!

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atz111
7/3/2017 01:57 EST

The answer can get complicated but here is what works for me....has a lot of your current thoughts in it.

Keep medicare A and B for any big stuff that may come along. Be aware that many plans require you to be in USA 6 months a year...not sure how they check or it they do.

Most, if not all allow/pay for emergency or urgent care outside the USA and will pay...you just have to pay and then file for reimbursement. So a broken leg or appendicitis is covered. Pellas hospital in MGA (one of the good ones) is on the Blue Cross (as well as other insurance company) list. Do not know if they means they bill directly as in USA, but in any case emergency is covered.

For the day to day stuff plenty of adequate docs here and a couple of decent hospitals in MGA. If I get to feeling bad like something really wrong a plane ride back to USA is the way to go. Complex procedures and mostly good diagnostics is a bit hit and miss here.

I used to have Global Rescue for medevac...really good and also expensive. Need it more other places than here so if going on th Amazon can buy for that trip. Means when here you have to look ahead a bit if you have some symptoms that might later may make travel tough.

There are some local insurance plans, but really will not make much difference if something big happens. Read the fine print. For the routine stuff...stuff even too small for the 'emergency care" provision of medicare treatment is good and cost low.

The foreign coverage plans for people in 60's is way too expensive.

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elduendegrande
7/3/2017 09:55 EST

As AZT above, plus do a search on this site for more info.

Also, be advised in Nic as you get into your 60s you are expected t die with dignity. Some plans self-cancel at age 70, read the small print..

Each country has different plans. Nic has a semi-free system open to all, your only real hope in the countryside. There is no medivac to mga, just maybe an ambulance but more likely a taxi or pickup truck.
A friend elsewhere in ca has an international policy with a low premium but a 10k deductible.

Carry a visa card with 5k disponible, it will get you thru most things that you are going to survive.

When I had a US policy I found that most of the time I could not get much done there in a 4 week trip, even when I made appointments for the day after arrival. referrals and lab work just delay things to long. Getting my bloodwork done here for 40 bucks and carrying to my US doctors helped a little, especially if they showed no change from the past year

Also, my experience was that my third world doctors in AZ did not hold a candle to my third world doctors in the third world! This goes double for the affirmative actions parasites that infest the VA.

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iguanalover
7/3/2017 16:03 EST

Keep in mind that medical care is delivered differently in Latin America. We have lived in more than one country. Prescription drugs, except for narcotics, are available without a prescription and you can buy one or 100. The farmacias are the most used part of the system. You can go into one, describe your problem and get what you need. We each take one drug which would be prescription in the US, I pay $20 for a six week supply and have been old that the same drug would cost $150 a month in the US plus doctor's office visits.

I picked up an intestinal friend on a trip and took a specimen to a lab. The labs are free standing. I got a letter with the results, took it to a farmacia and got meds. The lab test cost 80 cords, about $3 and the pills cost $6. No doctor involved and I was cured in two weeks. The cost of the problem in the US would have been extreme.

We pay about $20 to see a dermatologist. My husband had some dental work and paid about $20 a visit plus about $200 to fix one tooth. We probably paid about $750 total for medical expenses last year. The dental care brought up the cost. It is not something we worry about.

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atz111
7/3/2017 16:45 EST

In general all that is correct, but as they say, the devil is in the details.

Dental care definitely cheaper and if you choose well pretty good. The old time hacks are getting squeezed out. For some this is really importnat as even if you have a decent medical plan you are unlikely to have real dental so that $200 crown is a life saver.

The second detail is this is all great (or even better) if you are basically healthy. No big stuff and the little stuff you can hack yourself.

Meds are cheaper here for most. People tend to use the most extreme example...like 100 bucks in USA and 20 bucks here...and there are a few of those. But most is much closer but if you don't have insurance to cover it even 50% cheaper is good and in my case is better than my deductable on insurance. Of course, if you get diagnosed as having a disease that needs a $1,000 a month drug...and believe it or not you cannot get that for 50% here...maybe not even get it you go a problem. And, there are lots of those drugs lurking about if you get major type sick.

And if you do get major type sick (even healthy people have this happen) or smashed up really bad in a car crash treatment here will be in the $1,000's or 10's of thousands not the hundreds.

Sure you don't need to go to a doc to know you need an antihistimine....don't in the USA either but people do (one of the health care cost problems), but for many things the pharmacist is about same level as USA guy and not a doc. If you get to the real guy is better, but at most places you deal with a clerk who does not know the difference between zyrtec and benadryl or an NSAID and tylenol...for startrers so you self treat with some risk.

All this is not a reason to stay home...just advice to help decide how much you want to cover yourself...or need to.

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elduendegrande
7/4/2017 10:18 EST

True, just read about a "surfer/musician" with diabetes who was working in Nic. who got sick and went to the most expensive hospital (Pellas) and had to get 20 k in foreign aid to get out

Dentists are our of the national care system, and I have found several that speak English because they were educated abroad.Keep in mind if you are newly retired, if you had a plan that paid 50% of a $500 crown in the US and you pay cash here $250 you have gained nothing. Fix stuff in the US if you can while you still have insurance that covers dental

Another thing about labs here, they are quick and good. Poop in a hairbear jar, take to lab at 8am and by 3 am you have your results. The first several years I was here I had labs done here at the 6 month mark and then in the US at the 12 month mark and the results were always the same.

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IAHBOG2017
7/4/2017 17:32 EST

This is great info to know. Thanks!

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johnchip
7/5/2017 10:09 EST

If you think you can 'bring with you' the customs and standards of care, such as insurances, ambulance services, accessibility to advanced examination technologies, annual procedure interests, bilingual services, institutional or medical record keeping, you will be a busy man trying to find or make any of that happen, it is not the 'custom' here. Pharmacy, dental and emergency care services are inexpensive or free and easy to work with. But your interests seem to lie in the 'emerald city' of medical services here in the third world. You will be doing a lot of 'heel clicking' to find those expectations working for you here. As many here are on retirement pensions and social security we have our US medicare plans in place in case of dire need to return for services not provided here. But as noted before, it will often be very costly and time consuming to get care in the US with air, hotel, appointments and referrals, lab services just to get into the hospital room. I for one depend on all my services here for all my needs without expecting more than any local would receive. If I cannot receive the care here in my town there is the Military Hospital and Vivian Pellas in Managua, both fully serviced for advanced care. I also consider Cuba as an option for more advanced medical procedure options. Counting on medical insurance anywhere, let alone a foreign country for security is about as good as counting on the next promise by Trump or Bernie Madoff as to how it will work in your favor.

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emmajulia1
9/12/2017 11:42 EST

So, if my wife and I keep medicare A and B....we'd have to pay the monthly cost....somewhere around $130 each, correct ?....even though we are living and retired in Nicaragua...and that cost keeps going up...

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waltermboyleses
9/12/2017 12:17 EST

And then you have travel expenses to/from the US.
$130 premium (plus co pay) will buy you a lot of healthcare in NI, but there is no umbrella for the big stuff.
H2O 212F

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atz111
9/12/2017 12:19 EST

Medicare cost depends on your state of residence and the provider/plan you choose. It only pays for treatment in the USA.....generally in your provider's state and network of doctors which varies quite a bit by state and provider. Emergency and urgent care are exempt and you must pay where you get that care but it is reimbursed. Most if not all plans require you to be present in the USA for a minimum of six months of the year...I am not sure if that is really enforced. Health care plans for people 65 and over out of USA are extremely expensive. My Medicare A&B is $78 a month.

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johnchip
9/12/2017 13:54 EST

Medicare Part A comes with your social security at no extra cost. Part B is the one that is optional at about $130 mo. But if you chose not to take it at the onset there is a high-cost penalty to take it on later. It can be covered by your State if you qualify for one of its Medicaid programs. (basically, if your annual income is lower than x2 or x3 the NPL national poverty level in your State of residence). Plan C is totally optional and paid privately to an insurance company. Medicare currently will not cover expenses incurred outside the US.

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ricktee
9/12/2017 16:02 EST

You can opt out of plan "B" and then deposit that money in a separate account here in Nica. If you are sure you will not be going back to the states for medical care that is the best thing to do, if you don't opt out you will lose that money. If, after opting out you decide to return to the states you can always sign up for part "B" again during their normal sign up time.

Social Security checks are handled by the US Embassy and deposited into BAC. You will need to go to the bank to withdraw all, or some, of your money, it´s best to leave some in there and use your BAC debit card for payments. HTH, Rick

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ricktee
9/12/2017 16:19 EST

Your part "B" @ $260.00 a month would give you $3,120.00 dollars a year in the bank, plus interest. If you pay for minor procedures out of pocket you would be well ahead of the game

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IAHBOG2017
9/12/2017 20:17 EST

Thanks to those of you who brought this thread back to life! I am finding, as some of you have already noted, that private insurance in Nicaragua and other LatAm countries gets prohibitively expensive for folks in their 60's. Most national plans won't even accept you past 60. I'm turning 67 in a week. In Managua, Vivian Pellas' plan sounds mostly doable but I was planning to live in Estelí, in the northern part of the country. I have to admit I'm in a pretty good situation right here in the U.S. with Medicare A and B plus a Medicare Advantage plan that's subsidized by my former employer. Thanks to all for your helpful responses.

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mate31658649
9/15/2017 13:51 EST

Coincidentally, I live in Esteli and will be 67 next week. Currently, I am in Costa Rica and, next week, will be going to the US for a while. In most cases, medical care in Nicaragua costs less than your US health-care deductible. For the most part, I have been happy with the medical treatment I receive in Nicaragua. I suggest you keep your Medicare part B and the Medicare Advantage Plan. For any serious illness, you may wish to return to the US, but for routine medical care in Nicaragua, I don"t feel you need health insurance. Doctor visit $20. Lab fees $30. When you know when you are coming to Esteli, send me a PM and perhaps we can meet for lunch.

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IAHBOG2017
9/15/2017 15:25 EST

That's great info to have, thanks! As you can see, this post was started quite awhile ago and things have changed for me. I will most likely be staying in the states. However, I might be visiting my friends in Estelí next month and if I do, I will be sure to look you up. Thanks again!

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Edgenaples
10/11/2017 16:52 EST

The $260/month for part B...I just can't see paying for that year after year. I guess you never know, but we do not plan to live in the US again, once retired. If we get tired of Nicaragua, we'll try Thailand...or Ecuador...or....
I do like the idea of plopping that $260/month into an account for whatever may come up down the road.

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IAHBOG2017
10/11/2017 18:27 EST

If you are paying that much for Part B, you have an annual income in excess of $230,000. My question was addressed more to the 1%-ers like me. Thanks anyway.

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cedelune
10/11/2017 20:07 EST

That amount was for 2 people. Half that per person would be about average for Part B. No huge annual income.

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atz111
10/11/2017 20:46 EST

Pretty cheap coverage for what you get. You can cover all the small stuff out of pocket wherever you are but if something big happens you go back to states and that 50,000 procedure will cost you 3,000. The supplemental plans to fillin most of the plan B gaps can be low cost. Mine this year is zero extra cost. Was $78 last year. Plus, emergency and urgent care is covered even when outside the states.

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Edgenaples
11/1/2017 09:29 EST

$260/month for part B would be for my wife and I....$130/month each.

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Edgenaples
4/4/2018 16:37 EST

Forgive my ignorance....what is BAC ?

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paulmeister
4/8/2018 10:08 EST

TRICARE FOR LIFE does not pay in Costa Rica - does it pay in Nicaragua??

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