Retire In The Philippines Without Good Medical Cover At Your Peril

[JJReyes]

Can you please elaborate on the Guam medicare comment for those of us who might see this as an option.

Once you are 65 years and Medicare qualified (you had contributed 40 quarters to the fund), Medicare Part A remains for the rest of your life. It is an 80/20 co-payment system. You still have to pay for part of the hospitalization, which is about $1,350 at the present time. Because Medicare benefits stops at the US border, the closest hospital to the Philippines that Medicare will reimburse is in Guam.

Now comes the fun part. Because the hospital in Guam was not very good, residents of Guam were permitted to fly to Honolulu to receive medical treatment that was covered by Medicare. The government of Guam successful argued that quality hospitals are also available in the Philippines. Since the Philippines is closer, residents of Guam can now go to Manila. Medicare will reimburse hospital care for St. Luke's, Medical City, Asian Hospital and several others that have been pre-qualified by the US government.

American doctors and hospitals scream and yell that Medicare reimbursement is not sufficient. For Phiippine doctors and hospitals, the amount is like manna from heaven. Medical City, which includes over 1,000 physicians, decided to construct a $200 million hospital in Guam. By special arrangement, it will be staffed by Filipino doctors and nurses. Once construction is complete in about another year, you can fly to Guam for Medicare reimbursed hospitalization by doctors and nurses who could have attended to your needs in the Philippines.

Some of the rules don't make sense. Please remember governments do not operate based on logic. So if you are an American in the Philippines who is Medicare qualified, hospitalization is not covered. If you are a resident of Guam, from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, the United States government will pay for your medical care in the Philippines.

[nor cal mike]

Can you please elaborate on the Guam medicare comment for those of us who might see this as an option.

Once you are 65 years and Medicare qualified (you had contributed 40 quarters to the fund), Medicare Part A remains for the rest of your life. It is an 80/20 co-payment system. You still have to pay for part of the hospitalization, which is about $1,350 at the present time. Because Medicare benefits stops at the US border, the closest hospital to the Philippines that Medicare will reimburse is in Guam.

Now comes the fun part. Because the hospital in Guam was not very good, residents of Guam were permitted to fly to Honolulu to receive medical treatment that was covered by Medicare. The government of Guam successful argued that quality hospitals are also available in the Philippines. Since the Philippines is closer, residents of Guam can now go to Manila. Medicare will reimburse hospital care for St. Luke's, Medical City, Asian Hospital and several others that have been pre-qualified by the US government.

American doctors and hospitals scream and yell that Medicare reimbursement is not sufficient. For Phiippine doctors and hospitals, the amount is like manna from heaven. Medical City, which includes over 1,000 physicians, decided to construct a $200 million hospital in Guam. By special arrangement, it will be staffed by Filipino doctors and nurses. Once construction is complete in about another year, you can fly to Guam for Medicare reimbursed hospitalization by doctors and nurses who could have attended to your needs in the Philippines.

Some of the rules don't make sense. Please remember governments do not operate based on logic. So if you are an American in the Philippines who is Medicare qualified, hospitalization is not covered. If you are a resident of Guam, from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, the United States government will pay for your medical care in the Philippines.

Thanks much for all that info JJR. I will certainly consider this option as opposed to keeping my stateside medical insurance.

[Jake]

Can you please elaborate on the Guam medicare comment for those of us who might see this as an option.

Once you are 65 years and Medicare qualified (you had contributed 40 quarters to the fund), Medicare Part A remains for the rest of your life. It is an 80/20 co-payment system. You still have to pay for part of the hospitalization, which is about $1,350 at the present time. Because Medicare benefits stops at the US border, the closest hospital to the Philippines that Medicare will reimburse is in Guam.

Now comes the fun part. Because the hospital in Guam was not very good, residents of Guam were permitted to fly to Honolulu to receive medical treatment that was covered by Medicare. The government of Guam successful argued that quality hospitals are also available in the Philippines. Since the Philippines is closer, residents of Guam can now go to Manila. Medicare will reimburse hospital care for St. Luke's, Medical City, Asian Hospital and several others that have been pre-qualified by the US government.

American doctors and hospitals scream and yell that Medicare reimbursement is not sufficient. For Phiippine doctors and hospitals, the amount is like manna from heaven. Medical City, which includes over 1,000 physicians, decided to construct a $200 million hospital in Guam. By special arrangement, it will be staffed by Filipino doctors and nurses. Once construction is complete in about another year, you can fly to Guam for Medicare reimbursed hospitalization by doctors and nurses who could have attended to your needs in the Philippines.

Some of the rules don't make sense. Please remember governments do not operate based on logic. So if you are an American in the Philippines who is Medicare qualified, hospitalization is not covered. If you are a resident of Guam, from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, the United States government will pay for your medical care in the Philippines.

Hmm.....very interesting: residents of Guam can now go to Manila. Medicare will reimburse hospital care for St. Luke's, Medical City.

I would assume that US citizens living in PI can also get reimbursement from the same hospital? For those of you willing to fly out to

Guam, the cost of round trip airfare is minimum $569 (PAL).

Would it be also a safe assumption that I can apply for Part A prior to my departure from US? Excellent topic JJR!

Respectfully -- Jake

[tiger31]

Mate, I've been looking all over inmy computer for what I copied and pasted about a week or so ago... What it was was the copy of the Republic Act, describing how a hospital MUST take you in, in an emergency AND give you all the appropriate treatment, wether or not one can pay any money or not, at the door so to speak... It is huge penalties and jail time from memory, for hospital staff and admimistrators, to deny medical treatment in an emergency...

phil although there is an act in place many hospitals still try it on with the money before admitance scheme and if your not clued up then relatives start to panic .and like one poster said you don,t wanna be in a public hospital during a life threatning situation.basically if you don,t have money you won,t get treated too well here.phil health only cover so much of the bill you still have to find the rest if your in long stay.

[tiger31]

name='Jake' timestamp='1346117892' post='75545']

Can you please elaborate on the Guam medicare comment for those of us who might see this as an option.

Once you are 65 years and Medicare qualified (you had contributed 40 quarters to the fund), Medicare Part A remains for the rest of your life. It is an 80/20 co-payment system. You still have to pay for part of the hospitalization, which is about $1,350 at the present time. Because Medicare benefits stops at the US border, the closest hospital to the Philippines that Medicare will reimburse is in Guam.

Now comes the fun part. Because the hospital in Guam was not very good, residents of Guam were permitted to fly to Honolulu to receive medical treatment that was covered by Medicare. The government of Guam successful argued that quality hospitals are also available in the Philippines. Since the Philippines is closer, residents of Guam can now go to Manila. Medicare will reimburse hospital care for St. Luke's, Medical City, Asian Hospital and several others that have been pre-qualified by the US government.

American doctors and hospitals scream and yell that Medicare reimbursement is not sufficient. For Phiippine doctors and hospitals, the amount is like manna from heaven. Medical City, which includes over 1,000 physicians, decided to construct a $200 million hospital in Guam. By special arrangement, it will be staffed by Filipino doctors and nurses. Once construction is complete in about another year, you can fly to Guam for Medicare reimbursed hospitalization by doctors and nurses who could have attended to your needs in the Philippines.

Some of the rules don't make sense. Please remember governments do not operate based on logic. So if you are an American in the Philippines who is Medicare qualified, hospitalization is not covered. If you are a resident of Guam, from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, the United States government will pay for your medical care in the Philippines.

Hmm.....very interesting: residents of Guam can now go to Manila. Medicare will reimburse hospital care for St. Luke's, Medical City.

I would assume that US citizens living in PI can also get reimbursement from the same hospital? For those of you willing to fly out to

Guam, the cost of round trip airfare is minimum $569 (PAL).

Would it be also a safe assumption that I can apply for Part A prior to my departure from US? Excellent topic JJR!

Respectfully -- Jake

which goes back to my original post you still need plenty of money if you end up in hospital even with health cover .some hospitals want payment in cash then you have to claim back from your insurance policy .

[JJReyes]

I would assume that US citizens living in PI can also get reimbursement from the same hospital? For those of you willing to fly out to Guam, the cost of round trip airfare is minimum $569 (PAL).

A US citizen living in the Philippines can get Medicare reimbursement by going to Guam. They cannot get the reimbursement by going to a hospital in the Philippines. A resident of Guam can get Medicare reimbursement by going either to a hospital in Guam or the Philippines.

[wombatphil]

Hey Phil, Try and find that. It could be handy to have a print out of that to show the hospital

Found the bastard!... Your wish is my command mate, here ya go...

Republic of the Philippines

Congress of the Philippines

Metro Manila

Tenth Congress

Republic Act No. 8344 August 25, 1997

AN ACT PENALIZING THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, OTHERWISE KNOWN AS "AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES"

Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled::

Section 1. Section 1 of Batas Pambansa Bilang 702 is hereby amended to read as follows:

"SECTION 1. In emergency or serious cases, it shall be unlawful for any proprietor, president, director, manager or any other officer, and/or medical practitioner or employee of a hospital or medical clinic to request, solicit, demand or accept any deposit or any other form of advance payment as a prerequisite for confinement or medical treatment of a patient in such hospital or medical clinic or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death or permanent disability: Provided, That by reason of inadequacy of the medical capabilities of the hospital or medical clinic, the attending physician may transfer the patient to a facility where the appropriate care can be given, after the patient or his next of kin consents to said transfer and after the receiving hospital or medical clinic agrees to the transfer: Provided, however, That when the patient is unconscious, incapable of giving consent and/or unaccompanied, the physician can transfer the patient even without his consent: Provided, further, That such transfer shall be done only after necessary emergency treatment and support have been administered to stabilize the patient and after it has been established that such transfer entails less risks than the patient's continued confinement: Provided, furthermore, That no hospital or clinic, after being informed of the medical indications for such transfer, shall refuse to receive the patient nor demand from the patient or his next of kin any deposit or advance payment: Provided, finally, That strict compliance with the foregoing procedure on transfer shall not be construed as a refusal made punishable by this Act."

Section 2. Section 2 of Batas Pambansa Bilang 702 is hereby deleted and in place thereof, new sections 2, 3 and 4 are added, to read as follows:

"SEC. 2. For purposes of this Act, the following definitions shall govern:

"(a) 'Emergency' - a condition or state of a patient wherein based on the objective findings of a prudent medical officer on duty for the day there is immediate danger and where delay in initial support and treatment may cause loss of life or cause permanent disability to the patient.

"(b) 'Serious case' - refers to a condition of a patient characterized by gravity or danger wherein based on the objective findings of a prudent medical officer on duty for the day when left unattended to, may cause loss of life or cause permanent disability to the patient.

"© 'Confinement' - a state of being admitted in a hospital or medical clinic for medical observation, diagnosis, testing, and treatment consistent with the capability and available facilities of the hospital or clinic.

"(d) 'Hospital' - a facility devoted primarily to the diagnosis, treatment and care of individuals suffering from illness, disease, injury or deformity, or in need of obstetrical or other medical and nursing care. It shall also be construed as any institution, building or place where there are facilities and personnel for the continued and prolonged care of patients.

"(e) 'Emergency treatment and support' - any medical or surgical measure within the capability of the hospital or medical clinic that is administered by qualified health care professionals to prevent the death or permanent disability of a patient.

"(f) 'Medical clinic' - a place in which patients can avail of medical consultation or treatment on an outpatient basis.

"(g) 'Permanent disability' - a condition of physical disability as defined under Article 192-C and Article 193-B and C of Presidential Decree No 442; as amended, otherwise known as the Labor Code of the Philippines.

"(h) 'Stabilize' - the provision of necessary care until such time that the patient may be discharged or transferred to another hospital or clinic with a reasonable probability that no physical deterioration would result from or occur during such discharge or transfer.

"SEC. 3. After the hospital or medical clinic mentioned above shall have administered medical treatment and support, it may cause the transfer of the patient to an appropriate hospital consistent with the needs of the patient, preferably to a government hospital, specially in the case of poor or indigent patients.

"SEC. 4. Any official, medical practitioner or employee of the hospital or medical clinic who violates the provisions of this Act shall, upon conviction by final judgment, be punished by imprisonment of not less than six (6) months and one (1) day but not more than two (2) years and four (4) months, or a fine of not less than Twenty thousand pesos (P20,000.00), but not more than One hundred thousand pesos (P100,000.00) or both, at the discretion of the court: Provided, however, That if such violation was committed pursuant to an established policy of the hospital or clinic or upon instruction of its management, the director or officer of such hospital or clinic responsible for the formulation and implementation of such policy shall, upon conviction by final judgment, suffer imprisonment of four (4) to six (6) years, or a fine of not less than One hundred thousand pesos (P100,000.00), but not more than Five hundred thousand pesos (P500,000.00) or both, at the discretion of the court."

Section 3. Section 3 of Batas Pambansa Bilang 702 is hereby repealed.

Section 4. Section 4 of Batas Pambansa Bilang 702 shall become Section 5 thereof and shall be amended to read as follows:

"SEC. 5. The Department of Health shall promulgate the necessary rules and regulations to carry out the provisions of this Act."

Section 5. This Act shall take effect fifteen (15) days after its publication in two (2) national newspapers of general circulation.

Approved: August 25, 1997

The Lawphil Project - Arellano Law Foundation

IMPLEMENTING RULES AND REGULATIONS OF REPUBLIC ACT NO. 8344,

OTHERWISE KNOWN AS "AN ACT PENALIZING THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, OTHERWISE KNOWN AS AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES"

WHEREAS, the Tenth Congress of the Republic of the Philippines enacted Republic Act No. 8344 on June 05, 1997;

WHEREAS, the President of the Republic of the Philippines signed into law R.A. 8344 on August 25, 1997;

WHEREAS, under Section 5 of R.A. 8344, the Department of Health (DOH) is mandated to promulgate the necessary rules and regulations to carry out the provisions of the aforementioned law.

NOW THEREFORE, pursuant to the provisions of R.A. 8344 authorizing the Department of Health to promulgate the necessary rules and regulations, the following are hereby issued:

1. Section 1 of said Act provides: "In emergency or serious cases, it shall be unlawful for any proprietor, president, director, manager or any other officer, and/or medical practitioner or employee of a hospital or medical clinic to request, solicit, demand or accept any deposit or any other form of advance payment as a prerequisite for confinement or medical treatment of a patient in such hospital or medical clinic or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death or permanent disability: Provided, That by reason of inadequacy of the medical capabilities of the hospital or medical clinic, the attending physician may transfer the patient to a facility where appropriate care can be given, after the patient or his next of kin consents to said transfer: Provided, however, That when the patient is unconscious, incapable of giving consent and/or unaccompanied, the physician can transfer the patient even without his consent, Provided, further, That such transfer shall be done only after the necessary emergency treatment and support have been administered to stabilize the patient and after it has been established that such transfer entails less risks than the patient's continued confinement: Provided, finally, That strict compliance with the foregoing procedure on transfer shall not be construed as a refusal made punishable by this Act."

2. For the purpose of implementing the above, the following definitions are provided:

2.1 Emergency - A condition or state of patient wherein based on the objective findings of a prudent medical officer on duty for the day there is immediate danger and where delay in initial support and treatment may cause loss of life or cause permanent disability to the patient.

2.2 Serious Case - refers to a condition of a patient characterized by gravity or danger wherein based on the objective findings of a prudent medical officer on duty for the day when left unattended to, may cause loss of life or cause permanent disability to the patient.

2.3 Confinement - a state of being admitted in a hospital or medical clinic for medical observation, diagnosis, testing, and treatment consistent with the capability and available facilities of the hospital or clinic.

2.4 Hospital - a facility devoted primarily to the diagnosis, treatment and care of individuals or other medical and nursing care. It shall also be construed as any institution, building or place where there are facilities and personnel for the continued and prolonged care of patients. The hospital shall be duly licensed by the Bureau of Licensing and Regulation of the DOH.

2.5 Emergency Treatment and Support - any medical or surgical measure within the capability of a hospital or medical clinic that is administer by qualified health care professionals to prevent the death or permanent disability of a patient. (In determining the capability of a hospital or clinic, the standards and the classification of these facilities set by the DOH Bureau of Licensing and Regulation shall be used).

2.6 Medical Clinic - a place in which patients can avail of medical consultation or treatment on an outpatient basis.

2.7 Permanent Disability - a condition of physical disability as defined under Article 192-C and Article 193-B and C of Presidential Decree No. 442, as amended, otherwise known as the Labor Code of the Philippines.

2.8 Stabilize - the provision of necessary care until such time that the patient may be discharged or transferred to another hospital or clinic with a reasonable probability that no physical deterioration would result from or occur during such discharge or transfer.

3. Transfer of Patients - Section 3 of R.A. 8344 provides: "After the hospital or medical clinic mentioned above shall have administered medical treatment and consistent with the needs of the patients preferably to a government hospital, specially in the case of poor or indigent patients."

3.1 The transferring and receiving hospital, shall be as much as practicable, be within ten (10) kilometer radius of each other.

3.2 The transfer of patients contemplated under this Act shall at all times be properly documented.

3.3 Hospitals may require a deposit or advance payment when the patient is no longer under the state of emergency and he/she refuses to be transferred.

4. All hospitals shall use a Uniform Discharge/Transfer Slip for cases covered by RA 8344 which shall include the following information:

4.1 Admission Form of transferring hospital.

4.2 Transfer Form of Transferring Hospital, to include but not necessarily limited to the following information:

4.2.1 Vital signs

4.2.2 Name of Attending Physician

4.2.3 Treatment given to patient

4.2.4 Name of receiving hospital

4.2.5 Name of contact person and approving official at receiving hospital

4.2.6 Consent of the patient or companion. In case of an unaccompanied minor or patient, they may be transferred without consent provided that the provisions of Section 1 of RA 8344 is strictly observed.

The hospital shall endeavor to use all forms of media to contact the next of kin of the unaccompanied minor or patient.

4.2.7 In case of refusal of transfer, the name of the hospital, the name(s) of persons who refused and the reason(s) for the refusal.

A copy of the Uniform Discharge/Transfer Slip is hereto attached as Annex A*.

5. Penal Provisions - any official, medical practitioner or employee of the hospital or medical clinic who violates the provisions of RA 8344 shall, upon conviction by final judgment, be punished by imprisonment of not less than six (6) months and one (1) day but not more than two (2) years and four months, or a fine of not less than Twenty Thousand Pesos (P20,000.00) but not more than One Hundred Thousand Pesos (P100,000.00) or both at the discretion of the court: Provided, however, That if such violation was committed pursuant to an established policy of the hospital or clinic or upon instruction of its management, the director or officer of such hospital or clinic responsible for the formulation and imprisonment of four (4) to six (6) years, or a fine of not less than One Hundred Thousand Pesos (P100,000.00), but not more than Five Hundred Thousand Pesos (P500,000.00) or both, at the discretion of the court.

6. In order to demonstrate compliance with the Act's provisions, all hospitals and medical clinics are instructed to institute the following measures:

6.1 A copy of the law and this implementing rules and regulations should be displayed prominently at hospital emergency rooms, hospital admission, counters and medical clinic premises.

6.2 Hospital and clinic managers shall establish billing and collection procedure for treatment or confinement of emergency and serious cases which shall not commence until the essential appropriate treatment of such cases has been completed.

6.3 Hospital and clinic managers shall instruct their personnel to provide prompt and immediate medical attention to emergency and serious cases without any prior requirements for payment or deposit.

6.4 It is clarified that the law and this administrative order covers only the provision of medical and surgical goods and services, and do not cover the provision of non-medical amenities which have nothing to do with the treatment of the emergency or serious case. The provisions of and payment for these non-medical amenities shall be subject to appropriate institutional business practice.

6.5 Alleged violations of the Act and this Order may be reported to the Bureau of Licensing and Regulations, Office for Standards and Regulations, Department of Health, Sta. Cruz, Manila, or to the nearest Regional Health Office which shall immediately conduct a fact-finding investigation. The findings shall be referred to the appropriate fiscal for criminal prosecution. Persons convicted of violation shall be punished in accordance with the Act.

6.6 At the instance of the Bureau of Licensing and Regulation, Administrative proceedings may also be pursued against erring clinics or hospitals that could lead to either suspension or revocation of appropriate licenses.

These Rules and Regulations shall take effect fifteen (15) days after publication in the Official Gazette or in a newspaper of general circulation.

Adopted: February 18, 1998

(SGD.) CARMENCITA NORIEGA-REODICA, MD

Secretary of Health

* Text Available at Office of the National Administrative Register, U.P. Law Complex, Diliman, Q.C.

[Beachboy]

A few additional thoughts:

(1) Some Medicare Advantage Plans will cover "urgent and emergency" care outside of the US and it's territories but most plans require you to maintain a residence in the plan's area of coverage and enroll in Part B (which costs $100 USD/mo)

(2) Key word is reimbursement- you pay up front, obtain documentation and submit to medicare provider.

(3) I'm not a tax attorney (and my opinion may be worth exactly what you pay for it ..haha) but transportation costs to and from a doctor can be tax deductible under US Tax code. Of course if you don't pay US federal taxes, this won't help.

(4) Fil-Am groups in the US are lobbying to allow all Medicare recipients to receive treatment in the Phils.

(5) Plan ahead for the worst-case scenario.

[i am bob]

I take 4 medications daily and for the rest of my life supposedly. I have been trying to find out what the cost of medications are in the Philippines without much success. Some people say they are lower while others say they are higher. Can anyone give me an idea or where I can look? I'm trying to decide if I should keep my current medical insurance (which will cover everything but the hospital itself and will triple in cost for coverage in the Philippines) or look at a different policy such as Blue Cross hospitalization only policy and pay for my own medications. My Dental policy will definitely be getting packed in!

[earthdome]

I think the cost and availability of medications is something you really have to do with boots on the ground. Perhaps your special someone could inquire at a few pharmacies if you provide her with a list of your medications.

Thanks for the post. It reminded me that I need to make that same inquiry when I visit next month.

I agree, I see no need to keep dental or vision insurance after I move. In addition I may change my health policy to one which just covers major medical expenses since many routine medical needs can be met in the Philippines at or below what my copay would be in the US.

I also like JJR's advice to establish a relationship with a hospital where you live before you need their services to ensure you can receive medical services in an emergency.