Between 2007 and 2008, rumors and reports came out that U.S. Medicare coverage in the Philippines is possible. Generally, U.S. Medicare coverage is limited to all 50 states. Has Medicare gone portable at last? This article explores the truth behind the talks.

A Look Back

Sources estimate that out of the 4 million legally staying Filipinos in America in 2008, approximately 80 percent hold U.S. citizenship and a number are covered by Medicare.

Medicare is America’s federal health insurance program. It was first created in 1965 to benefit citizens aged 65 and older. In 1972, the program was revised, allowing younger people with Lou Gehrig’s disease, permanent disabilities and end-stage renal health complications to enroll.

Understanding the Structure

Medicare is a collective term that may include a number of plans:

  • original Medicare that provides hospital insurance and medical insurance
  • Medicare Advantage that provides both basic and extra healthcare services, as offered by private health maintenance organizations (HMOs) and
  • prescription drug plans that may or may not be tied to a Medicare Advantage plan

Additionally, there are Medigap plans to supplement what original Medicare does not cover. They are offered by private insurance companies.

The current policies are lettered C to J. However, in a fact sheet released by the Department of Health and Human Services of the U.S., new Medigap plans M and N will replace plans H, I, E and J starting June 1 of this year.

Off-Shore Medicare Coverage in Theory

Under the original plan, the circumstances that allow Medicare portability are limited. Coverage outside America is permitted whenever a foreign hospital is nearer than any other hospital on American soil. In rare emergency cases, those traveling “without unreasonable delay” through Canada may also avail of off-shore coverage – provided again that the Canadian hospital is much closer than an American hospital.

In March 2010, the Department of Foreign Affairs of the Philippines confirmed that under the original Medicare plan:

“… Residents of Guam and Saipan… are allowed to seek medical treatment… on emergency cases, availing of their Medicare benefits in Philippine medical facilities, due to the proximity of the Philippines vis-a-vis Hawaii, the nearest US state.”

This development is credited to the efforts of Madeleine Bordallo, congresswoman of Guam, and of Roberto Romulo, former Department of Foreign Affairs secretary, who lobbied that Philippine hospitals be allowed to issue Medicare reimbursements.

Off-Shore Medicare Coverage in Practice

My Philippine Retirement made a round of phone calls to check whether hospitals in the Philippines have already reimbursed Medicare benefits under the original plan. There were no recorded cases yet, the staff said. In fact, majority of the hospitals appeared to be unaware of “U.S. Medicare.”

They did supply the following list of honored international health insurance plans, some of which have tie-ups with Medicare Advantage plans:

LIST A.International Health Insurances Honored in Selected Luzon-Based Philippine Hospitals as of March 2010

  • (Allianz) Worldwide Care – Asian Hospital
  • AETNA – Asian Hospital
  • AETNA Global Benefit – Makati Medical Center
  • Alliance – Asian Hospital
  • Blue Cross International – Asian Hospital
  • Blue Shield – Asian Hospital
  • Calvo’s – St. Luke’s Hospital
  • CIGNA – Asian Hospital
  • GMC Services – Makati Medical Center
  • HTH World Wide – Makati Medical Center
  • IMA – Makati Medical Center
  • IMG – Asian Hospital
  • International Health Insurance of Denmark – Makati Medical Center
  • International SOS – Makati Medical Center
  • Net Care – Asian Hospital, Makati Medical Center
  • Pacific International – Asian Hospital
  • Prestige International – Makati Medical Center
  • StayWell – St. Luke’s Hospital
  • TakeCare – Asian Hospital
  • TieCare – Asian Hospital, Makati Medical Center
  • Vanbreda International – Asian Hospital, Makati Medical Center
  • William Russel – Asian Hospital

Availment of insurance benefits varies by health maintenance organization (HMO), insurance plan and servicing hospital. The insured must inquire about their Medicare Advantage benefits by HMO or plan name. Specific concerns may be sent to the respective customer care and credit/billing departments of the hospital.

LIST B. Contact Information of Selected Philippine-Based Hospitals that Honor International Health Insurances with Possible Medicare Advantage Tie-Ups

Impact on Philippine Retirement Decisions

The affordability of healthcare services in the Philippines is somewhat let down by the “pay-as-you-go” system, but a recent turn of events are changing the way potential retirees view the minor “cash first” inconvenience.

One such development is the direction that Medicare portability is headed. Statistical trends indicate that by 2011, Medicare expenditures will soon exceed the revenues generated from the trust fund. This can be prevented when cheaper off-shore facilities are used to deliver the same-quality healthcare services offered in the U.S., experts explain.

Another development is the health reform bill on patient protection and affordable care that U.S. President Barack Obama signed in March 2010. The current reform permits off-shore coverage and insurance of people with pre-existing health conditions. There will also be a minimum annual tax penalty of $695 for those who are unable to secure health insurance – now no longer just an option but a requirement.

Many U.S. tax payers are anxious that the latest health reform will come with a steeper price tag. “I’m anticipating my insurance premium (monthly payments) to increase from $100… to more than $500,” fears Terry who works for the federal government and hopes to retire in 2020.

Lesser take-home pay (and savings) combined with the fact that U.S. Medicare coverage in the Philippines is possible (mostly through Medicare Advantage plans) is prompting former Filipinos like Terry to reconsider the Philippines as a good place to get cheap but decent healthcare – yet the “best bang” for dollar earnings.*

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