Retired and returning to the US from living abroad and have questions about Medicare

[HarrietS139838]

  I lived in Costa Rica for 20 years (thinking I would live there forever) but returned to the US when my health declined and it was impossible for me to continue to live alone.  I  began receiving Social Security benefits while living in Costa Rica but opted out of Medicare Part B because I was covered by the National Health coverage plan there.  

Now, Medicare wants to charge me penalties that, with the current premium, would be almost half of my monthly benefit.

Has anyone had this experience or does anyone know how to deal with this?  I have read that if you lived in a foreign country and were self-employed and had the National Health coverage, you wouldn't have to pay the penalty.  Any ideas?

Thanks for any help.  

[WebWiseWoman]

I don't want to seem negative, but why would you choose to return to the US now?

I've been investigating leaving, especially post-2024 elections, so curious why return?

btw, yes medicare b is EXPENSIVE and penalty is out of control. But no help in sight.

Thanks in advance for any advice!

[GailL1]

@HarrietS139838 wrote

I have read that if you lived in a foreign country and were self-employed and had the National Health coverage, you wouldn't have to pay the penalty.  Any ideas?

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Some links and sources for you -

AARP.org 06/17/2022 - Can I get Medicare if I live overseas?

There really isn't any special circumstances that are gonna help you,  I'm afraid - It is actually the Social Security Administration that is in charge of signing people up for Medicare.  

Were you getting a Social Security Benefit while living abroad?

Now as far as another country covering you while you are living there - I do not think that is coverage that SSA.gov considers to be an approved replacement for Medicare Part B.   SORRY!  

Medicare Interactives says this about living abroad and Medicare sign up.

Medicare Interactive.org - How to enroll in Medicare for those who first qualify when living abroad

If you do not enroll in Medicare Part B during your IEP (initial enrollment period), you may have to wait until the General Enrollment Period (GEP), which runs January 1 through March 31 each year, with coverage starting the first of the month after the month when you enroll. Make sure you are aware of the consequences of choosing not to enroll during your IEP.

Yes, the consequences are paying a Part B premium penalty that last forever.  And don't forget the Part D premium penalty too - another consequence.

However it goes on to say - (same Medicare Interactive link)

Note: If you do not qualify for premium-free Part A, you may only be able to enroll in Medicare if you live in the U.S. You will have a seven-month period around when you move back to the U.S. to sign up for Part B and premium Part A. This period includes the three months before, the month you establish U.S. residence, and the following three months. To qualify for this period, you must be a U.S. citizen, and you must have lived in a foreign country when you turned 65. You will not owe a late enrollment penalty if you enroll during this period.

The Medicare Interactive page discusses other matters of foreign living and Medicare so look around it for other matters that might apply to your situation but personally, from what you said, it might be pretty impossible to avoid the premium penalties unless there is one of those special circumstances like the one above concerning those NOT applicable for premium free Part A.

As far as employer coverage - that's more defined.  And it had to be Employer Group Coverage - 

SSA.gov - Do I need to sign up for Medicare Part B if I am working and have health insurance through...

You will have to complete CMS Form 40B 

IF you had employer coverage that Medicare considers to be comprehensive - meaning "credible" then you will have to go thru the process of proving that to them.  Here is the form:

CMS.gov CMS-L564: Request for Employment Information

Then Medicare will look back to see if you had Notices of Credible Coverage from your employer

Good Luck