Medicare coverage overseas?

[NMLady]

Thank you all for your prompt replies. We have a Medicare supplement so I'm going to look into its coverage.

 

I think you will find that most Medicare supplements do include foreign medical but it tops out at around $10,000. Not nearly enough. I have a Medicare supplement with that foreign medical insurance and I always buy a travel policy for higher coverage.

[Hlitner]

Medicare will not cover at all outside the US and her possessions. This includes onboard a ship. Perhaps they would cover if you were docked in a US port. EM

 

Having spent over thirty years working in government medical insurance we can assure you that the US Medicare does not give any coverage outside the USA with a few exceptions. You would have coverage in US Territories like the US Virgin Islands, Guam etc. You are also covered if you get sick while in transit between the USA mainland and Alaska. One other weird exception is that you are covered on a cruise ship that is within 6 hours of a US port, but how this is interpreted is open to questions.

 

As to Medicare supplemental policies, some do give you limited coverage outside the USA and others give you no coverage. So if you have a supplemental policy you should talk to the insurance company and find out if you have any coverage and get it in writing.

 

Hank

[sail7seas]

Some of the Medicare Supplemental Policies have lifetime limit.

I have heard $50,000 on some.

[Obi1]

Travel Guard has many different plans including primary medical and evacuation to hospital of your choice. We dont travel without it. I feel it is worth every penny, especially if anything would happen...you just never know.

[Jacs]

Medicare only would cover OP if she was from the US. It's a US program.

 

Actually Australia's Universal Heathcare program is called Medicare, so I can understand the questions.

[BridgeMates]

We were docked in Maui two years ago and needed to see the Dr. Needed a prescription filled and the ship sent a runner to get it. Medicare turned everything dow down as "outside of the U.S."

Huh????

Filed with trip insurance, which was paid in full.

Guess if illness occurs on-board, it's always out of the U.S. even if docked at U.S. port. I guess Maui is still a U.S. port. :rolleyes: Just not for insurance purposes......

[chengkp75]

We were docked in Maui two years ago and needed to see the Dr. Needed a prescription filled and the ship sent a runner to get it. Medicare turned everything dow down as "outside of the U.S."

Huh????

Filed with trip insurance, which was paid in full.

Guess if illness occurs on-board, it's always out of the U.S. even if docked at U.S. port. I guess Maui is still a U.S. port. :rolleyes: Just not for insurance purposes......

 

Hank obviously has the experience here, I'd like to ask him if the "exception" is maybe only for US flag ships within 6 hours of US ports? Perhaps has to do with whether Dr. is registered in US or not?

[Hlitner]

We were docked in Maui two years ago and needed to see the Dr. Needed a prescription filled and the ship sent a runner to get it. Medicare turned everything dow down as "outside of the U.S."

Huh????

Filed with trip insurance, which was paid in full.

Guess if illness occurs on-board, it's always out of the U.S. even if docked at U.S. port. I guess Maui is still a U.S. port. :rolleyes: Just not for insurance purposes......

 

Grrr. It makes me angry when we hear such stories because obviously the folks who handled the claim need a lesson in geography. We know of another case where a claim was initially denied for treatment in Alaska for the same issue. Medicare claims are processed by private companies (Fiscal Intermediaries) who have contracts with DHS to process Medicare Claims and provide support functions. The folks that do the actual work are human and they do err. Medicare does have a specific (and overwhelming) appeals process and this should have been appealed and resolved. Not only would a ship tied-up at a US Port be in the USA, but if within "6 hours" of that port it would also be considered in the USA.

 

The regulations that govern the US Medicare Program have evolved into manuals that fill 10s of thousands of pages. The folks that are charged with implementing and enforcing these rules normally do a great job, but there are also plenty of times when they are just wrong! Consumers should spend the time to review the claims related info they receive and not hesitate to question denials that just do not seem to make sense.

 

I should add that DW and I are covered by Medicare and a good supplemental program (that gives some international coverage). But we also purchase an "Annual" Travel Medical Policy (issued by GeoBlue) that gives us $250,000 of international med coverage and $500,000 of Trip Evacuation Service. That policy, which covers the first 70 days of any trip throughout an entire year, only costs us $349! However, this policy does not cover trip cancellation issues.

 

Hank

Edited February 18, 2015 by Hlitner

[chengkp75]

Grrr. It makes me angry when we hear such stories because obviously the folks who handled the claim need a lesson in geography. We know of another case where a claim was initially denied for treatment in Alaska for the same issue. Medicare claims are processed by private companies (Fiscal Intermediaries) who have contracts with DHS to process Medicare Claims and provide support functions. The folks that do the actual work are human and they do err. Medicare does have a specific (and overwhelming) appeals process and this should have been appealed and resolved. Not only would a ship tied-up at a US Port be in the USA, but if within "6 hours" of that port it would also be considered in the USA.

 

The regulations that govern the US Medicare Program have evolved into manuals that fill 10s of thousands of pages. The folks that are charged with implementing and enforcing these rules normally do a great job, but there are also plenty of times when they are just wrong! Consumers should spend the time to review the claims related info they receive and not hesitate to question denials that just do not seem to make sense.

 

I should add that DW and I are covered by Medicare and a good supplemental program (that gives some international coverage). But we also purchase an "Annual" Travel Medical Policy (issued by GeoBlue) that gives us $250,000 of international med coverage and $500,000 of Trip Evacuation Service. That policy, which covers the first 70 days of any trip throughout an entire year, only costs us $349! However, this policy does not cover trip cancellation issues.

 

Hank

 

Interesting to note, that nearly all US laws that apply to foreign ships only apply out to the 12nm limit, yet Medicare specifies a 6 hour limit. Wonder what speed they consider for the 6 hour radius?

[Hlitner]

Hank obviously has the experience here, I'd like to ask him if the "exception" is maybe only for US flag ships within 6 hours of US ports? Perhaps has to do with whether Dr. is registered in US or not?

 

You raise another all important issue. The Law does not require a physician to accept Medicare payments. So a ship's physician is generally under no obligation to accept payment from Medicare and the reality is that we have not heard of ships accepting Medicare. Many of the ship physicians are not even licensed to practice medicine in the USA and would not even be eligible for Medicare payment. So if you are docked in a US port and need medical care it is probably in your best interest to get to a local (shore-based) provider who is enrolled in and accepts Medicare payments. And if you have supplemental insurance you are even better off finding a local provider who accepts that supplemental insurance.

 

A good friend (my ex boss) used to tell folks that trying to deal with health insurance in the USA is akin to walking through a minefield wearing a blindfold :(.

 

And although we do not want to get into the political issue, another sad reality is that the Affordable Care Act created a reimbursement situation that has caused many US physicians to no longer accept any Medicare patients. Reducing physician reimbursement and substantially increasing the record keeping (and claims coding problems) has (and is) driving many physicians and group practices out of the Medicare program. We also know several physicians who have just totally given up and gone into early retirement or ironically took jobs working for insurance companies.

 

Hank

Edited February 18, 2015 by Hlitner

[Hlitner]

Hank obviously has the experience here, I'd like to ask him if the "exception" is maybe only for US flag ships within 6 hours of US ports? Perhaps has to do with whether Dr. is registered in US or not?

 

You raise another all important issue. The Law does not require a physician to accept Medicare payments. So a ship's physician is generally under no obligation to accept payment from Medicare and the reality is that we have not heard of ships accepting Medicare. Many of the ship physicians are not even licensed to practice medicine in the USA and would not even be eligible for Medicare payment. So if you are docked in a US port and need medical care it is probably in your best interest to get to a local (shore-based) provider who is enrolled in and accepts Medicare payments. And if you have supplemental insurance you are even better off finding a local provider who accepts that supplemental insurance.

 

A good friend (my ex boss) used to tell folks that trying to deal with health insurance in the USA is akin to walking through a minefield wearing a blindfold :(. Even my own family doctor (who is like Marcus Welby) was recently driven to sell his practice to a large Healthcare System because he was just overwhelmed with HIPPA requirements and the new claims coding requirements.

 

Hank

[chengkp75]

Yes, definitely you are going to have to front the money to the cruise line for the medical expense, and then there is no guarantee that the Medicare payment (if allowed) would match the charge.

 

Oh, insurance is a minefield alright, and Obamacare just increased the mine density. And my son works in the insurance industry!

 

It's a similar time to a couple decades ago when Ob/Gyn doctors were leaving the practice because of the cost of malpractice insurance. The system needs a complete "do-over" and not just a pooling of those who can and cannot afford insurance. Sorry, I don't want to get into the political thing either and sidetrack this thread.

[paul929207]

We have had several trips to the infirmary over the years. Fortunately nothing real serious. We had to pay the bill and submit a claim. None were in the US so Medicare was not involved. We submitted the claim to the Medicare supplement and then to the travel insurance. We had to get the payment and Explanation of Benefits from the Supplement to submit to the travel insurance.

[griffy116]

The problems with having an injury or illness on board a ship or a foreign port have zero to do with the ACA...and I worked in the insurance industry too.

[chengkp75]

The problems with having an injury or illness on board a ship or a foreign port have zero to do with the ACA...and I worked in the insurance industry too.

 

I don't think either of us was saying it did. We were just pointing out that the insurance business is getting more complicated rather than less.

[6rugrats]

We were docked in Maui two years ago and needed to see the Dr. Needed a prescription filled and the ship sent a runner to get it. Medicare turned everything dow down as "outside of the U.S."

Huh????

Filed with trip insurance, which was paid in full.

Guess if illness occurs on-board, it's always out of the U.S. even if docked at U.S. port. I guess Maui is still a U.S. port. :rolleyes: Just not for insurance purposes......

 

Did you have Part D coverage? As Maui is obviously in the US, if the drug was covered, the pharmacy a Medicare participating one and you had drug coverage, this was of course, denied incorrectly and should have been appealed. I work in this field, and cannot tell you how many claims are denied in error.

[DonnasMom&Dad]

Medicare only would cover OP if she was from the US. It's a US program.

 

 

Medicare, can be any social medical care program, which is government administered, the basic term is used in many languishes, in many countries, having socialized medicine. :rolleyes:

 

Cato :)

 

Completed Cruises !

 

Pre-cruise Days - The Big Red Boat, 1993 ??

1st cruise - Coral Princess, 19 November 2008, 10 day Panama Canal, FLL to ACA

2nd cruise - Coral Princess, 15 May 2009, 3 day Repositioning, Los Angeles to Vancouver.

3rd cruise - Sapphire Princess, 25 November 2009? 7 day Mexican Riviera.

4th cruise - Golden Princes, 12 June 2010, 7 day Alaska. (Golden Anniversary Cruise)

5th Cruise - Island Princess, 04 October 2010, Vancouver - Los Angeles, Repositioning

6th cruise - Sapphire Princess, 05 January 2011, 10 day Mexican Riviera. LA to LA.

7th cruise - Golden Princess, 11 May 2011, 3 day, LA to Vancouver, Repositioning

8th cruise - Sapphire Princess, 14 May 2011, 1 day, Vancouver to Seattle, Repositioning

9th cruise - Coral Princess 19 May 2011 2 day, San Francisco to Vancouver, Repositioning

10th & 11th cruises - Coral Princess 02 July to 16 July 2011, round trip Vancouver - Whittier Alaska, B2B

12th & 13th cruises - Sapphire Princess, x2, Cabins, 18 Sep. 2011, 1 day, Seattle to Vancouver, Repositioning

14th & 15th cruises - Golden Princess, x2, Cabins, 24 Sep. 2011, 1 day, Seattle to Vancouver, Repositioning.

We have now reached Elite status with Princess Cruise Lines :D

16th cruise - Oasis of the Seas, 26 Nov. 2011, 7 day, Western Caribbean, Ft. Lauderdale, Ret.

17th & 18th cruises - Crown Princess B2B, 03 - 10 Dec & 10 - 17 Dec 2011, 14 Days, South & western Caribbean

19th cruise - Grand Princess, 31 Mar. - 07 April 2012, 7 Days, Eastern Caribbean, FLL - FLL

20th cruise - Island Princess, 06-16 June 2012, 10 day cruisetour Vancouver - Wittier

21th cruise - Emerald Princess, 16 day, 10 - 26 Sep. 2012, TA, Copenhagen - New York

22nd cruise - Carnival Ecstasy 10 - 14 January, 2013, 4 Day Bahamas, Port Canaveral Ret.

23rd cruise - Sapphire Princess 30 March - 06 April, 2013, 7 Day Coastal LA - LA

24th cruise - Coral Princess, 19 May - 22 May, 2013, 3 Day Repositioning Cruise, LA - Vancouver

25th cruise - Royal Princess 16 June - 05 July, 2013, 19 Day Inaugural cruise, Southampton - Venice.

26th cruise - Emerald Princess, 06 - 16 October, 2013, 10 Day Canada - New England, Quebec city to New York

27th cruise - Royal Princess, 24 November - 01 December, 2013, 7 Day,Eastern Caribbean, Fort Lauderdale Ret.

28th cruise - Sapphire Princess, 20 - 24 Jan, 2014, 4 Days, California

29th cruise - Crown Princess, 03 - 10 May 2014, 7 Day, LA to Vancouver.

30th cruise - Pacific Princess, 05 - 12 Aug. 2014, 7 Days, Vancouver RT, Alaska

31st cruise - Golden Princess, 13 - 17 Oct. 2014, 4 Days, LA - Mexican Riv, RT,

32nd cruise - Crown Princess, 20 - 27 Dec. 2014, 7 Days, LA - Mexican Riv, RT.

[6rugrats]

Medicare, can be any social medical care program, which is government administered, the basic term is used in many languishes, in many countries, having socialized medicine. :rolleyes:

OP is from the US and is asking about US Medicare. Sometimes there is no need to go into the hundreds of other possibilities as this just mucks up the issue. She did not ask for the names of every single "Medicare" plan in the world.

But, thanks for the update.

[DonnasMom&Dad]

OP is from the US and is asking about US Medicare. Sometimes there is no need to go into the hundreds of other possibilities as this just mucks up the issue. She did not ask for the names of every single "Medicare" plan in the world.

But, thanks for the update.

 

Originally nationality was not mentioned!! :D

 

Cato :)

[Hlitner]

The problems with having an injury or illness on board a ship or a foreign port have zero to do with the ACA...and I worked in the insurance industry too.

 

Well, perhaps. But keep in mind that some cruise lines, such as HAL, have some ship physicians who are US licensed and practicing. For example, a friend of ours who spends most of his year working as a Board Certified Traumatologist in a hospital located in the USA, spends a few months of the year working on HAL ships (as the ships doctor). Theoretically, he could accept Medicare reimbursement for patients treated while the ship is in a US Port (or within 6 hours or a US Port). Of course the question would be whether that is within HAL's own rules and whether this particular physician is willing to accept Medicare reimbursement. And no he does not accept insurance when on a ship as his charges are billed directly to the patients via their onboard account.

 

The other related issue has to do with sick or ill patient evacuated from a ship to a US healthcare facility on land. It is possible that the receiving facility would not accept Medicare assignment or whatever insurance the sick/injured passenger happens to have. Having a fewer number of facilities and physicians enrolled in either Medicare or ACA plans can, indeed, cause a very expensive outcome for a cruiser. There are actually entire US hospitals (including some the best) that do not accept ACA insurance. This is one of those issues not well understood by many folks even though there have been many articles written on the subject. Here is a link to only one such article:

 

http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/top-hospitals-opt-out-of-obamacare

 

So one might ask how this relates to cruising and Cruise Critic. It is actually a huge issue for Americans, many of whom are not even aware of the issue. A cruiser, evacuated in an emergency to the closest US Medical facility, will always get the necessary emergency/urgent care. But if they are unlucky to be in a facility that does not accept their insurance they might later face hundreds of thousands of dollars in medical bills. Uncovered medical bills are the leading cause of personal bankruptcy in the USA! So, yes, the ACA really does impact cruisers in ways they cannot imagine.

 

 

 

Hank

Edited February 18, 2015 by Hlitner

[njhorseman]

Well, perhaps. But keep in mind that some cruise lines, such as HAL, have some ship physicians who are US licensed and practicing. For example, a friend of ours who spends most of his year working as a Board Certified Traumatologist in a hospital located in the USA, spends a few months of the year working on HAL ships (as the ships doctor). Theoretically, he could accept Medicare reimbursement for patients treated while the ship is in a US Port (or within 6 hours or a US Port). Of course the question would be whether that is within HAL's own rules and whether this particular physician is willing to accept Medicare reimbursement. And no he does not accept insurance when on a ship as his charges are billed directly to the patients via their onboard account.

 

The other related issue has to do with sick or ill patient evacuated from a ship to a US healthcare facility on land. It is possible that the receiving facility would not accept Medicare assignment or whatever insurance the sick/injured passenger happens to have. Having a fewer number of facilities and physicians enrolled in either Medicare or ACA plans can, indeed, cause a very expensive outcome for a cruiser. There are actually entire US hospitals (including some the best) that do not accept ACA insurance. This is one of those issues not well understood by many folks even though there have been many articles written on the subject. Here is a link to only one such article:

 

http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/top-hospitals-opt-out-of-obamacare

 

So one might ask how this relates to cruising and Cruise Critic. It is actually a huge issue for Americans, many of whom are not even aware of the issue. A cruiser, evacuated in an emergency to the closest US Medical facility, will always get the necessary emergency/urgent care. But if they are unlucky to be in a facility that does not accept their insurance they might later face hundreds of thousands of dollars in medical bills. Uncovered medical bills are the leading cause of personal bankruptcy in the USA! So, yes, the ACA really does impact cruisers in ways they cannot imagine.

 

 

 

Hank

 

Count me as another poster who spent decades working in the insurance industry...and my wife is a healthcare professional too, so I've seen and experienced the insurance-related issues from both sides of the fence. I even spent several years after my own retirement managing the back office insurance and patient billing for her practice.

 

There's nothing you're citing in your post, or in the linked article that didn't exist for years before the ACA became law. Hospitals and healthcare professionals have always opted out of certain private insurance plans and Medicare if they felt it was in their best economic interest to do so. While the ACA may have caused more to walk away, it's in no way an issue that didn't already exist. I can tell you that over her approximately 40 year long career, my wife was continually opting out of participating in insurance plans she accepted early in her career and she rarely opted in to a new plan when asked to become a participating provider. Actually, Medicare was probably the only insurance plan she accepted over the entire span of her career.

[BridgeMates]

Did you have Part D coverage? As Maui is obviously in the US, if the drug was covered, the pharmacy a Medicare participating one and you had drug coverage, this was of course, denied incorrectly and should have been appealed. I work in this field, and cannot tell you how many claims are denied in error.

 

Don't have Part D. This was on Holland America. All charges were put on our Cruise Card. I have Medicare and BC/BS. Once Medicare turned my claim down, everything went straight to the private trip insurance company which paid in total. This was only a couple of hundred dollars. I guess if it was $20,000+, it would have gone on the cc or they'd be calling me down to the Desk to provide additional funding before I could get off. We traveled without trip insurance for years when we were much younger. Then we heard about all the horror stories of people without insurance. Would never travel without it now.

[njhorseman]

Don't have Part D. This was on Holland America. All charges were put on our Cruise Card. I have Medicare and BC/BS. Once Medicare turned my claim down, everything went straight to the private trip insurance company which paid in total. This was only a couple of hundred dollars. I guess if it was $20,000+, it would have gone on the cc or they'd be calling me down to the Desk to provide additional funding before I could get off. We traveled without trip insurance for years when we were much younger. Then we heard about all the horror stories of people without insurance. Would never travel without it now.

 

If you don't have Part D, then rejection of the claim for the medication purchased in Hawaii was correct. Other than a very limited number of exceptions, medications are only covered by Part D...not by Medicare Parts A and B. Your medications wouldn't have been covered by Medicare regardless of where you purchased it.