Author’s Note: It’s been a pretty rough couple of years for me health-wise, but thankfully I am still here, having survived the latest close scrapes with death. Indeed, I am wondering when I may eventually run out of ‘cat lives’! After going off my bike and breaking my hip in March 2021, then surviving a blood clot in my lung (pulmonary embolism) that nearly killed me, and this past year 2022, dealing with an evolving kaleidoscope of strange and troubling systemic symptoms (suspiciously coinciding with my mRNA shots, which at the time I was grateful to get as my lung was still recovering from the embolism.) And just when I thought I could finally get national healthcare coverage in the USA (I turned 65 in January) the system was confusing and international mail was an issue, so my government health insurance was cancelled. But not before I ran up some horrendous medical bills while in the USA – all the time, being told I was covered, which, thanks to failed communication in a very complex bureaucratic system, turned out to be false! And yet, somehow, I survived – again!
As a retired American living in Asia for over 30 years, I routinely enjoy affordable state-of-the-art healthcare in Thailand, which has included life-saving procedures in some instances. Whenever I travel to the USA, I purchase medicine and medical supplies in Thailand, where the identical products are a fraction of the costs in the USA. Indeed, most travel insurance policies offer health care coverage globally, ‘except in the USA.’ So, when I turned 65 in January 2022, which is the eligible age for US government health insurance Medicare, I was excited to finally have guaranteed healthcare coverage in the USA, like my friends from countries all over the world take for granted.
The USA is the only industrialized country in the world that does not have some form of government-guaranteed or ‘universal’ healthcare coverage for all of its citizens. More than 30 million Americans don’t have health insurance and millions more are underinsured. 68,000 Americans die every year because they are uninsured or under-insured. Furthermore, even with insurance, medical costs are so high that medical bills cause bankruptcy for half a million people each year in the USA, the number one cause of bankruptcy . Even in Thailand, the government provides universal healthcare through the public health system to all of the country’s citizens. And healthcare costs in Thailand’s private hospitals, which are more like 5-star hotels than hospitals, are significantly less than the costs in the USA .
In early February 2022, shortly after I applied for Medicare coverage, I was contacted by the Federal Benefits Unit (FBU) at the American Embassy in Manila, Philippines, which provides services for the SSA and other benefit agencies to customers in over 40 countries in the Asia-Pacific region. They wanted to confirm my mailing address in Thailand, and informed me that all documentation had to be sent by postal mail from SSA headquarters in Maryland, USA. In the past, I have received an annual statement by postal mail from SSA headquarters in Maryland, so clearly, they had my correct mailing address.
By July, I was preparing to travel to the USA for seven months of seasonal work, and I still had not received any information from SSA to explain how my new Medicare coverage worked. I was, however, able to access my online SSA ‘Benefit Verification Letter’ which stated clearly that I was covered under both Part A (hospitalization) and Part B (medical). But even this online ‘verification’ letter made no mention of the required monthly premiums for Part B coverage, nor was there any mention of the 20% ‘co-pay’ responsibility for both Part A and Part B healthcare bills. Only Americans know what a co-pay is. In other developed countries where universal access to healthcare is the norm, this is unheard of! Given the extremely high healthcare costs in the USA, a 20% coinsurance expense can be a substantial out-of-pocket cost. The shocking racist origins of the 20% ‘co-pay’ requirements for Medicare are explained in “The Racist History of American Healthcare”  whereby the co-pay was intended to deny access to African Americans, who were deemed unlikely to be able to afford it.
Soon after arriving in the US, I contacted SSA to request information and documentation explaining about my new Medicare coverage, a Medicare card, anything – at which point they told me that my Part B coverage had been cancelled due to non-payment of the monthly premiums. I knew nothing of this – having received no invoices, nor the amount due, how and where to pay, etc. I wondered if this was because of my Thailand address, which was confirmed numerous times by email and telephone with the FBU field office at the US Embassy in Manila. I still, sixteen months later, have not received any documentation from SSA.
But the SSA representative told me not to worry and that Part A would cover any hospitalization, including ER visits (as this would be ‘technically entering the hospital’). Crucially, this advice turned out to be incorrect, and I found out only after I had run up thousands of dollars in ER bills at hospitals in New York and Colorado that this was covered only under Part B.
However, SSA informed me I could back-pay the Part B premiums for all of 2022 which would reinstate my coverage retroactively for the entire year. SSA cashed my check for $2,000 in October and my Part B coverage was finally reinstated (5 months later!) in March 2023. During this time, I needed some costly diagnostic tests (which I was told only a medical specialist could order – which, of course, added another layer of cost in the ‘for-profit’ American Healthcare System strategy). So, after three months waiting to see a medical specialist, I was told by that office that since my Part B was still not reinstated, I would have to pay the consultation fee of $472 (no testing included) cash up front. I was given the option to reschedule a later appointment when my Part B might be reinstated. But the next available appointment was another three months wait!! Thankfully, I was not dealing with an aggressive cancer – I would be dead, just waiting to get some medical attention!!!
So, after seven rather sickly months in otherwise enjoyable seasonal jobs at YMCAs in upstate New York and the Colorado Rockies, teaching yoga and meditation and supporting the international seasonal staff program as before, I was looking forward to ‘escaping’ from the USA – thanks to my nightmare dealings with the severely under-funded Social Security services , the ‘for-profit’ American Healthcare System and the terrifying and outrageously high costs of healthcare there.
Thank goodness I live in Thailand, where I have easy access to efficient and affordable, state-of-the-art healthcare (not to mention no mass shootings, natural, unprocessed foods, low cost of living, a respectful, non-confrontational culture, etc.) So, I left my job in Colorado sooner in order to return to Thailand to get the necessary (and affordable!) health care I needed. I contacted my personal physician in Bangkok who, within a single week or so, had arranged appointments with three top medical specialists, who scheduled the diagnostic tests, follow-up appointments, and treatment. All of this cost far less than the US coinsurance payments I would be responsible for, even after my Medicare coverage was reinstated. Seven months in the USA was more than enough for me. It was time to leave, and indeed a relief to return to Thailand.
Though I am still waiting for all of it to be resolved, the SSA employees I have contacted multiple times over these many months have been helpful, given the volume of enrollees. While I was fortunate enough to have had somewhere else to go for healthcare, I can’t help but wonder about the millions of Americans who don’t have any other options.
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