“One quarter of Medicare beneficiaries have five or more chronic conditions, sees an average of 13 physicians each year, and fills 50 prescriptions per year.”
― Clayton M. Christensen, The Innovator’s Prescription: A Disruptive Solution for Health Care
I went to see my eye doctor in Tennessee the other day. When the nurse entered my information into the electronic files, she asked me, “Are you sure you don’t take any medications?” I replied, “Yes. Nothing.”
She couldn’t get over the fact that I had no pre-existing conditions, took no prescription medications, and had no medical history other than my appendectomy and tonsillectomy, which were removed when I was a teenager.
“I have to put something in the spaces,” she commented. “Do you take any vitamins?”
“Once in a while I take glucosamine,” I replied. With almost a sigh of relief, she asked me how many milligrams and how often I took glucosamine. “You are the best and easiest patient I have ever had,” she said. “But, you aren’t normal.”
From the quote above, I guess I am not normal. But, it isn’t something I ever gave much thought….until I saw the eye doctor. We had just returned to the states from a month in Mexico. My left eye was blurry and I described it as looking through Saran Wrap. I knew I had a cataract, and with Medicare I could have it removed and the lens replaced in a day.
I could have had my cataract removed for free in Nicaragua, but I felt more comfortable seeing a doctor that I knew and I could ask questions in English instead of my Spanglish. The doctor examined my eye and said, “Well, you don’t have a cataract. I have to run a few more tests.”
He diagnosed me with vitreomacular traction and adhesions of the left eye. In other words, my eye was really messed up and I needed surgery to try to correct my vision. He referred me to the retina specialist, and we walked across the street to his office.
They injected flourescent yellow dye in my arm, which somehow miraculously knew to travel to my retina in 30 seconds. Then, they flashed bright lights into my eye and took a lot of pictures. I felt like I was tripping!
When the results came back, my doctor showed me the comparison of my perfect right eye and my really messed up left eye. “We need to do surgery, although your eye is so bad, I can’t guarantee that we can restore your vision.”
After some very flourescent yellow tears, I agreed to the surgery and then the work began to figure out how my Medicare worked, how much I would have to pay out-of-pocket, rearrange our flights back to Nicaragua, and make sure our house sitter could stay at our house until I could return to Nicaragua.
If you are a U.S. citizen considering retiring in Nicaragua, you will have to decide if you want Medicare. I decided to take my free Medicare part A, and buy part B, of which $104 is taken out of my social security check every month. Medicare can only be used in the United States. Therefore, you have to decide if you plan on returning to the states for medical care, the cost of travel, the comparison of how much the medical treatment will be in Nicaragua, and if Nicaragua has the equipment and specialists to do certain kinds of procedures.
If you opt out of Medicare, yet want it at a later date, there is a steep penalty you must pay. I chose the Original Medicare, simply because it was easier and more affordable. I can use it anywhere in the United States.
The next step was to find out how much Medicare would cover for my surgery and what my cost would be. I called the Surgery Center. Medicare will pay for 80%, and I pay for 20%. My cost of the examination was $25. I have to pay $304 for the facility, $125 for the anesthesiologist, and $400 for the doctor.
The only medications I will need will be for pain, nausea, and antibiotic eye drops. I will probably only buy the eye drops. The Surgery Center is going to give me a card for a pharmacy because I don’t have any insurance for medicines. She told me I will get the medicines much cheaper because I am uninsured. Strange to me, but true. I am still confused about how that works.
Since they can’t do my surgery until June, I had to rearrange our flights because we were planning on returning to Nicaragua May 31st. I explained to a Delta representative that I had to have an unexpected surgery. Ormando was awesome in helping me. He deleted the $200 per ticket change fee and only requested the name of my doctor and his phone number. When my mother passed away and I had to cancel a ticket, they required her death certificate and an obituary notice from the newspaper. This change was easy!
We were flying on free vouchers, so the change didn’t cost a lot of money, but we had to buy a few new tickets. The additional cost was $1,300. It wasn’t a planned expense. Thus the need for emergency funds.
Would I have opted to have the surgery in Nicaragua? No. First, this is a very specialized surgery. They have to go into my eyeball, suck out all the vitreous humor, laser the scarred tissue off my retina, and replace the vitreous with either a gas or a silicon oil. If I opted for the gas, I couldn’t fly for two months, so I chose the oil so I can fly a few days after surgery.
Second, I know the doctor and am familiar with the eye clinic. It is one of the most innovative eye clinics on the East Coast. I doubt that Nicaragua has the equipment and that the doctors have the specialized training to successfully perform this surgery.
Third, I had to consider the cost. We have WEA international health insurance that excludes the United States, but is accepted in 182 countries. The cost of the insurance rises with age, so we keep increasing our deductible. Now our deductible is $2,500. Therefore we only use this insurance for catastrophic events.
Finally, I have Medicare. I am in the states visiting anyway. I feel comfortable and reassured because I know the doctors, can stay in our house in TN, and have loving friends and family to support me.
Did I make the right decision? Yes! Definitely. There are many factors to consider in choosing Medicare if you live abroad: the cost of traveling back to the states for medical care, the amount taken out of a social security check monthly, the comparison costs for procedures in Nicaragua vs the states, the type of procedure and the availability of equipment and training in Nicaragua vs the states, and most importantly for me…the sense of comfort and familiarity.
Life is still good! I am grateful for the choices I have in medical care, grateful for my family and friends who are taking care of my pets and home in Nicaragua, grateful that we have an emergency fund to cover unexpected expenses, and grateful for a perfect right eye that can compensate for my messed up left eye if the surgery is not successful.
Here are some links to help you decide if you want Medicare while living abroad.