op11a

ACA American Citizens Abroad 5 rue Liotard, CH-1202 Geneva, Switzerland Fax: (+41-22) 340 0233 MEDICARE AND THE OVERSEAS AMERICAN A PROPOSAL TO DELIVER MEDICARE BENEFITS TO ELIGIBLE AMERICANS LIVING OVERSEAS MEDICARE AND THE OVERSEAS AMERICAN A PROPOSAL TO DELIVER MEDICARE BENEFITS TO ELIGIBLE AMERICANS LIVING OVERSEAS This paper discusses why Medicare benefits should be made available to overseas Americans who have paid for them. 1. Mending a Broken Promise: Many thousands of American citizens living overseas have contributed to U.S. Social Security programs throughout their working lives and have earned the right to receive Medicare benefits in the United States. Yet when they retire abroad, and need these medical benefits for which they have made all of the necessary contributions, these benefits are not delivered abroad. Their contributions have been for naught. Why is this the case?

2. A Legislative Impediment: Social security legislation currently prohibits payment for medical services or items not provided within the United States. There are limited exceptions in the case of Americans visiting Mexico and Canada, but the loss of Medicare benefits is total for those living elsewhere overseas.

3. The Alleged Obstacles: In a 1979 report to the Congress on issues of concern to the overseas American community, the White House explained: "There are two primary difficulties in extending Medicare services abroad: (1) determining reimbursement rates for foreign services; and (2) ensuring compliance with Medicare standards by foreign medical personnel and facilities." Another obstacle, mentioned in the same report was: "The current estimated cost of full coverage for the approximately 226,000 eligibles abroad would be $ 375 million. In view of the need to limit Federal expenditures, this cost is a major concern."⁽¹⁾

4. But, A Working Model to Deliver These Benefits Already Exists: In actual fact, the U.S. Government already funds and operates a very effective and efficient medical care system, using foreign civilian doctors and medical facilities for thousands of U.S. citizens living abroad. This system, formerly called CHAMPUS (Civilian Health and Medical Program for the Uniformed Services) and recently renamed TriCare is available to retired U.S. military personnel and their dependents. Eligible recipients submit forms to overseas processing centers and have most of their medical bills reimbursed by the U.S. Government. The problems of establishing rules and control procedures have already been addressed and resolved. It would, therefore, be possible to integrate a Medicare component into the existing overseas health care benefit system, if the government so desired.

5. Keep the Promise, Extend the Existing System: The U.S. Government should honor its commitments and deliver Medicare benefits overseas to eligible Americans who have earned them by contributing all of the required payments to the system. There is a well-functioning mechanism already in place.

Just as the overseas voting rights program for military personnel was extended to private sector Americans through the same office in the Defense Department, so too could a Medicare delivery program for eligible overseas Americans be grafted onto the existing Champus/Tricare system that already provides efficient health care services for overseas military retirees.

* * * * *

ACA
Geneva, Switzerland
31 January 2001

1. ¹ White House Report on the "Equitable Treatment of United States Citizens Living Abroad" submitted to the U.S. Congress on 27 August 1979.