My First Experience with Medicare


“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.

When Expats go Where Medicare Doesn’t

Dealing with Medicare as an expat: When and how to enroll

Medicare coverage when living abroad

Getting Medicare While Traveling or Living Abroad 

Can Expats take their Medicare abroad?

 

 

 

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36 thoughts on “My First Experience with Medicare

  1. Will you be able to get samples for your eye drops? I was shocked that the list price was over $200 for each of the 2 mini-bottles the eye doc said I needed for my cataract surgery. I bought one (with insurance I paid $92 because it was a newish drug), but managed to get samples for the rest (including a round for the second eye). I was shocked at the prices and grateful the office people took pity on me without any groveling!?!

  2. This is an example of why I tend to get cross with the International Living flack who claims Nicaragua has first world health care at a tenth the US cost. For some things, Nicaraguan doctors are fine. I had a friend who was living in Matagalpa who faced surgery for a mass in her bowels. She had to decide whether to go back to the US or have the surgery in Managua. She went back to the US and had the surgery and chemo (it was cancer) there and was doing fine last time I was in touch with her.

    One poster claimed he could get into INSS (Nicaraguan comprehensive health insurance and old age pension program) while being a retiree here, but hasn’t said how he managed. All other information seems to support that INSS is only for citizens or foreign residents with a work permit.

    It would be nice if retirees who are legal residents could buy into INSS for health benefits, but until the man who claimed he did it explains how he did it, I tend to think it’s impossible, and buying into other country’s health programs is possible. The other alternative here is the free clinics and free hospitals, but while some are quite good, some aren’t.

    Coming to Nicaragua without some savings, a credit card with a decent credit limit, and a fall back plan is frighteningly stupid. Private care here for heart and blood pressure problems is about what your co-pays are, so Medicare there or private care here for similar things are closer to the same than Nicaraguan costs being 10% of US cost to people covered by Medicare or Medicaid.

    • Everything you said, Rebecca, verifies what I believe. We tried to apply for INSS, but we were told they don’t insure people over 60. So it can be done as a legal resident, however the insurance is not very good and the deductibles are high.
      Right now, I think we made the best choices for us. We are fortunate that we can return to the states for Medicare procedures, and grateful that we planned ahead for consideration of all medical emergencies. Thanks for your comments.

  3. miga amiga amiga! oh my, thank you for sharing your story, and i am glad that you have a plan and will soon be sporting bionic vision!

    i loaded this post on saturday night, read it offline at the cabana, and then the internet stayed ‘down’ until sometime today….

    am unable presently to do much ‘research’ for the who/what/when/why/how info, but i see your comment above regarding ‘age’ – ugh! i wondered if there might be a connection with the various viral curses those mosquitoes brought to your doorstep? chikungunya side effects have a visual -something, i don’t remember quite what…. no need to answer – i’m thinking outloud and just hope that you are soon back to norm….

    love
    lisa

  4. Debbie, I am sure that your eye surgery is going to be a complete success. I also celebrate your thoughts of gratitude at moments of adversity. You’re definitely one of a kind!!
    Thank you for the informative articles about health insurance and medicare
    Big Hugs!!

  5. Wow – your quote at the beginning of your post is a jaw dropper. I look at that statistic and then think of all the people who will just be completely screwed if the shameful bill just passed by the house ever becomes law …
    My husband has used his Medicare Part B a couple of times on visits back to the States and was quite pleased with it. Thankfully, our private insurance here in Portugal is inexpensive and more than adequate and one of many reasons why we’re now expats and living out of the US.
    Your post was definitely timely and full of great info for those considering making the jump to living outside the States. Good luck on your recovery Debbie and I’ll be adding my heartfelt wishes for a speedy recovery to your many other friends! Anita

    • Don’t get me started, Anita! Since I am in the states, I was going to go to a townhall meeting of my Congressman Phil Roe. By the way, he is a doctor and used to be my gynecologist! None of our reps are holding town halls on their recess! I am furious!
      I knew this piece would be timely. So far, my experience with Medicare has been good. But, who knows what will happen in the future. Hugs to you.

  6. That’s quite the odyssey Debbie and for somebody ‘not normal’ you made some very good decisions all around. To quote Robbie Burns ‘The best laid plans of mice and men often go astray’ Life is like that. Good luck with the surgery, Bruno

  7. Hola!!

    Well, thats an ””’eye opener””” ……. no pun intended, hahahaha…!!

    Happy to hear what a blessing it is to be so astute and together to have all so organized!!!!

    My moms 84 and here with me living in Lake Atitlan , she takes a very very small dose for high blood pressure ,,and thats it ,,

    me ,, I JUST take a super small dosage of synthroid , I’m 63…

    and the doctors all ask the same thing ,,,

    why are you not on more prescription drugs ? ahhhhh….duhhhhhh!!!

    I said why…??? at my last check up… and the nurse says:” so the enemy can make MORE MONEY ON THEIR RIP OFF BULl —-.”

    She laughed more and said …”so right on…..

    plus the doctors make so much money on the dummies that come in here that will listen and believe every thing they say ,,,,

    if he told them to jump off the bridge ,,,they would do that too..

    its amazing how gullible and stupid people are ,,,big ass suckers ,,,”

    and this was the nurse saying this to me…..

    OUCH ….in Miami !!

    Well, I said ,,,” thats super sad …. but Im not one of the suckers , thank God!!! ”

    And left.

    Seems the U.S. as great as a few things are ….. are just as bad in many other ways ..

    Anyway happy healing and good graces in Tennessee

    Light ,
    Heidi

  8. About two years ago I was struck from the rear by a motorcycle and thrown from my bicycle into a car. Luckily we have Ecuadorian insurance though IESS and my costs were covered completely. The reason I mention this here is that the person at the hospital in Guyaquil doing the admitting was amazed that I did not take any medications. She had a doctor who spoke more English come and confirm that. After he asked me about blood pressure, diabetes, heart meds, etc. he told me that I was the first old retired gringo he had ever met who was not on any meds. Good health is a rare blessing it seems.

    Sorry to hear about your bad eye, but Mary and I will be praying for a smooth and successful surgery. Take care! JandM

    • Yes, so true. Good health is a rare blessing. I read yesterday that Ecuador is changing the fees for foreign residents in their IESS health system. Apparently there was a meeting last week, in which the IESS representative said that the foreign residents are overwhelming the health system. They are now charging 17% of the yearly income of foreign residents enrolled in IESS. Have you heard anything about this? It makes sense to me and I think it is only fair to charge foreign residents more than locals for health care because of the income disparities.

  9. Another thanks for a good report. For some reason my copay varies but usually several hundred. Haven’t been back to states 12 yeas Next time the change comes around I will go back to basic free A only. Thanks for that info too I am too lazy to keep up on this stuff.

  10. So sorry to hear about your eye issue. We are looking at Nicaragua as a possible retirement location. My husband is stoked, but I’m hesitate due to possible health care complications. I’m really leaning towards Colombia as it seems to have very good health care. Good luck with your surgery. Good info to know about medicare. Isn’t it ironic that you were told you weren’t normal because you are in good health? In doing research on Central and South America as retirement locations, I am focused on infrastructure and healthcare. We are both in good health, but that can change in a heartbeat.

    • Corn fed, ( I love that name by the way), Nicaragua has made tremendous advances in healthcare. Many of the doctors are trained in Cuba, and they can provide excellent services. Vivian Pellas Metropolino hospital and the Militar hospital in Managua are state of the art. It depends on the procedure that one needs to have. For me, I feel more comfortable in the states for my eye surgery because my husband had a similar surgery with the same doc for a detached retina.
      We love Colombia, too and plan to return to visit more of the country. I kind of like being a world traveler for healthcare. With our international insurance, we can choose a hospital of our choice in 182 countries. Thanks for your sweet comments.

      • I’m glad you like my name, I’m from Indiana so I thought it was fitting. Thanks for the info. How much is the international insurance? It’s really shame that you get penalized for not taking Medicare when you can, especially since I’ve been paying into it for over 40 years. So it sounds like you have to pay into Medicare and have a international policy? That is one of the reasons we are looking at that part of the world to retire.

        • Cornfed, an approximate cost of our international health insurance is $250 mo. for both of us together. We thought about dropping it because we haven’t used it, but when we do have a health emergency where we can’t fly back to the states, we will need it. Better safe, than sorry. Yes. We pay into Medicare and have an international health insurance that excludes the U.S. If we bought the health insurance that covered the U.S. too, it would be outrageously expensive.

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