A Tale of Two Insurance Policies

[attilamom1217]

Please do not give blanket advice. Many say that medical insurance never covers foreign or cruise ship medical expenses. Not true. Mine does as primary. I didn't know that until I got sick on a cruise. I filed with my medical insurance expecting a denial to send to my travel insurance. Not only was I covered by my medical insurance but I was covered IN Network. I got a check for the entire amount I paid to the cruise ship medical team.

 

Check with your medical insurer before making false blanket statements.

 

Thanks

 

 

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[iamtrustworthy]

Please do not give blanket advice. Many say that medical insurance never covers foreign or cruise ship medical expenses. Not true. Mine does as primary. I didn't know that until I got sick on a cruise. I filed with my medical insurance expecting a denial to send to my travel insurance. Not only was I covered by my medical insurance but I was covered IN Network. I got a check for the entire amount I paid to the cruise ship medical team.

 

Check with your medical insurer before making false blanket statements.

 

Thanks

 

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That's remarkable since cruise ship medical claims are usually out of network. What insurance company was that? I'm going to call them and ask if it has anything to do with law chages under the ACA.

[JVilleGal]

Please do not give blanket advice. Many say that medical insurance never covers foreign or cruise ship medical expenses. Not true. Mine does as primary. I didn't know that until I got sick on a cruise. I filed with my medical insurance expecting a denial to send to my travel insurance. Not only was I covered by my medical insurance but I was covered IN Network. I got a check for the entire amount I paid to the cruise ship medical team.

 

Check with your medical insurer before making false blanket statements.

 

Thanks

 

 

Sent from my iPhone using Forums

 

 

 

I would hate to think your post would be taken by a newbie who may now believe their coverage in the US thru their employer will cover them out of the country or on the ship. While there are a handful that may cover, the great majority do Not.

 

Research and speaking with experts (not CC posters) and getting a policy to meet your particular needs is important.

 

 

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[iamtrustworthy]

Georgia.

 

Sorry for the delay answering you. I didn't get an update showing your response.

 

You originally wrote "Resurrecting this old thread to ask if there is, practically speaking, any real advantage to primary over secondary, and if so, could you characterize the advantage? If my company health insurance is accepted, because we're in (say) Alaska, then why wouldn't I want it to cover what it covers? Similarly, if my company health insurance isn't accepted, because we're in (say) British Columbia, then is there any real difference between primary and secondary? "

 

Here's the detailed answer (Btw, I didn't plagiarize / steal this info because I originally wrote it):

 

The only difference is the order in which the medical claims are paid. Primary (First Payer) isn’t better than Secondary (Excess), although it’s sold that way.

 

What Does Primary (First Payer) or Secondary (Excess) Medical Coverage Mean & How Do They Differ?

 

Primary (First Payer) Medical Coverage means your medical bills are paid from the first dollar. No “coordination of benefit” claim forms need to be filed. You need to know that many travel insurance plans with primary (First Payer) medical benefits will still ask on the claim forms if you have other medical insurance. If you answer “yes”, they will likely submit your claim to your other insurance first and process your claim as Secondary coverage.

 

Primary (First Payer) Medical Coverage works best if your medical claim is less than the coverage amount. That’s because your travel insurance will pay the claim up to its limit. But, when the Primary travel insurance benefits are exhausted, your other insurance won’t count your deductibles and co-pays as paid.

 

For example, here’s what happens if you have a $70,000 medical claim with a travel insurance plan that has $50,000 Primary (First Payer) coverage:

- You submit the $70,000 medical claim to the travel insurance. It pays $50,000 (its maximum)

- You submit the remaining $20,000 to your medical insurance plan. Let’s say it has a $5,000 deductible with a 20% copay.

 

Of this $20,000, your medical insurance plan pays $12,000 and you will be liable for at least that $8,000 ($5,000 deductible & $3,000 copay). You could be liable for more. Here’s how: Gayle B. says: “I work for Blue Cross Illinois. Please keep in mind if your travel insurance pays primary to the providers, those medical providers do not have to apply the Blue Cross discount so the billed charges may be quite higher. I would check carefully and call your Blue Cross customer service number on the back of your ID card before you make a decision”.

 

Secondary Medical Coverage means your medical bills are paid after any other coverage you have pays its share. This means that Secondary coverage will pay all deductibles, out-of-pocket expenses and co-pays up to its coverage limit. The only real drawback to a Secondary Medical plan is that it can be a lot of extra time-consuming paperwork, made worse by complicated prescription benefits.

 

For example, here’s what happens if you have a $6,000 medical claim ($5,500 medical & $500 prescriptions) with a travel insurance plan that has $25,000 Secondary coverage:

- You submit the $6,000 medical claim to your medical insurance plan. Let’s say it has a $1,000 deductible with a 20% copay and a $500 prescription deductible

- You get your medical EOB (explanation of benefits), but not your prescription EOB

- You get your prescription EOB

- You submit the amounts shown as “Patient’s Responsibility” to the travel insurance. Unless you already satisfied some or all your deductibles, you’ll be claiming payment for $4000 (80% of the remainder of this: $6,000 – $1,000 medical deductible & $500 prescription deductible)

 

Here’s a little detail that’s good to know: You probably will have to pay your medical bills yourself while on your trip. That’s because travel insurance plans are “indemnification” plans (you will be reimbursed – indemnified) after your trip by the insurance company. Travel insurance is not a “pay on behalf of” plan. You don’t just give the medical facility a card. In some cases, a few companies can advance payment to the medical facility, but it’s on a case-by-case basis.

 

Here’s another little detail that’s good to know: Secondary coverage assumes you have other coverage that’s Primary. If you have no other coverage Secondary, in effect, becomes Primary.

 

How Much Emergency Medical Coverage is Enough?

 

There are a few things you need to find out before you settle on an amount of Emergency Medical / Dental and Emergency Medical Transportation coverage.

 

- What other coverage do you have? If you’re a US Citizen & have Medicare, Medicare doesn’t cover you outside the USA. You’ll also find more detailed information on Medigap Policies C, D, E, F, G, H, I, J, K, L, M & N at the bottom of this page.

- If you have individual or group insurance, what are your deductibles & copays if you’re outside your provider’s service area? This is similar to “Out of Network” benefits. Here’s a good way to find out exactly how your regular insurance covers you.

- Will your current medical coverage pay before or after a Travel Insurance plan? If your current medical pays before other insurance you can then submit your out of pocket costs to the travel insurance for reimbursement. On the other hand, if your current insurance pays after a Travel Insurance plan (meaning the Travel Insurance is Primary), then you don’t have to wait for your current insurance to finish its claim before the travel insurance pays.

 

A common myth is that Primary plans cost more than Secondary plans. The actual cost of Travel Insurance is based on your age, trip cost and trip length. Some Primary plans are less expensive than Secondary plans at certain ages and vice versa for other ages.

 

One more thing to be aware of is that the emergency medical transportation portion of a policy doesn’t pay for the medical treatment. That’s covered under the emergency medical portion of the travel insurance policy.

 

Important Information About

Medigap Policies C, D, E, F, G, H, I, J, K, L, M & N

 

Your Medigap (Medicare Supplement) plan may provide worldwide coverage benefits for health care needs when you travel outside the United States. Medigap policies C, D, E, F, G, H, I, J, K, L, M & N provide Foreign Travel Emergency health care coverage when you travel outside the United States. Under these plans, Medigap policies pay for 80% of the cost of emergency care during the first 60 days of each trip after you pay the $250 deductible. Foreign Travel Emergency coverage with Medigap policies have a lifetime limit of $50,000.

 

You should check with your Medicare Supplement plan prior to traveling outside of the United States regarding your worldwide coverage benefits. Your Medicare Supplement plan will either tell you:

“We pay whatever Medicare won’t pay, subject to deductibles & copays.” or

“If Medicare’s not obligated to pay, we won’t pay either.”

 

Here’s why you’ll want to how your Medigap plan pays:

 

If your Medigap plan has a lifetime limit of $50,000 of medical benefits paid, I suggest you get a trip cancellation travel insurance plan that has Primary Medical coverage. That way if you have a medical claim you are not using part of your lifetime limit.

But, if your Medigap plan supplements (gives you more than the $50,000 lifetime limit), I suggest you get a trip cancellation travel insurance plan that has Secondary Medical coverage.

 

I hope this makes sense.

Edited July 16, 2017 by iamtrustworthy
Irrelevant information

[bUU]

Thanks for the excellent info!

 

This message may have been entered using voice recognition. Please excuse any typos.

[shipshape sam]

Lots of info here!

 

Recently went on Medicare and will check what my supplemental carrier offers as to coverage outside US. Would think if other companies offer the coverage and assume they make money, Medicare supplemental carriers could too as an 'extra charge' option.

 

Anyway, thanks for great info and direction. Now time for me to do my homework! :)