Does Medicare cover ship Dr. treatment in US waters?

[erdoran]

Was wondering - we have Geoblue Trekker in case of medical issues on our cruise, but that’s only for outside the US.  If we are cruising in the US, say Alaska, or the cruise we are about to take - leaving from NYC and stopping at Port Canaveral - if we were to get sick or have a medical problem, do we have a coverage gap or would Medicare pick it up?  Or if we were off the US coast between NYC and Port Canaveral, or something like that, would that be considered “outside the US” and covered by Geoblue?  TIA

[smplybcause]

The ship will undoubtedly be out of network. So however your supplement handles that. Not sure on the position of the ship vs insurance deciding if it's in the US though. 

Edited January 4, 2020 by smplybcause

[17cruisesnsl]

https://www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-Stat.pdf

 

the above link will take you to Medicare's coverage outside the US, including cruise ships. The main question is below but there are exceptions and billing information included in other questions within the document.  Don't worry, the link should take you to a 4 page document not a huge billing manual.    

 

Basically, the coverage is minimal 

From the document:

0. Will Medicare pay for medically necessary health care services I get on a cruise ship?

   Medicare may cover medically necessary health care services you get on a cruise ship in these situations:

   • The doctor is allowed under certain laws to provide medical services on the cruise ship.

   • The ship is in a U.S. port or no more than 6 hours away from a U.S. port when you get the services, regardless of whether it’s an emergency.

     Medicare doesn’t cover health care services you get when the ship is more than 6 hours from a US port

[Visigoth]

Here is the Medicare Publcation covering your question:

 

https://www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-Stat.pdf

[erdoran]

Thanks, guys!  That’s great info.  I’m new to Medicare and wasn’t sure about this specific scenario.  That says to me that Alaska cruises are also covered with Medicare - no idea about Advantage plans, but the regular Medicare.

[ready2cruzagain]

Even though our supplemental insurance covers us on a cruise or out of the country we still purchase trip insurance through insuremytrip dot com.  I worry about medical evacuation and needing to be air lifted off of the ship.  That is expensive and costs start at around $30,000.  We just came back from a 21 day cruise and our trip insurance cost us $140.  Worth the peace of mind having it.  Look into it.

 

When getting estimates just make sure and cover the things that are not reimbursable, if you insure everything you are wasting a lot of money.  Such as do not include the prices of things that are refundable such as, taxes, port fees, refundable motels, etc.

Edited January 4, 2020 by ready2cruzagain

[erdoran]

3 minutes ago, ready2cruzagain said:

Even though our supplemental insurance covers us on a cruise or out of the country we still purchase trip insurance through insuremytrip dot com.  I worry about medical evacuation and needing to be air lifted off of the ship.  That is expensive and costs start at around $30,000.  We just came back from a 21 day cruise and our trip insurance cost us $140.  Worth the peace of mind having it.  Look into it.

 

When getting estimates just make sure and cover the things that are not reimbursable, if you insure everything you are wasting a lot of money.  Such as do not include the prices of things that are refundable such as, taxes, port fees, refundable motels, etc.

Yes, thanks for the reminder about evacuation.  I really was strictly thinking medical bills out of the US; wasn’t thinking about cancellation/delay type of things.  So the hole in my logic is the evacuation (which for us is covered by our Chase Sapphire Reserve card).

 

I was actually concerned about my upcoming cruise, where we leave Sunday, are in Port Canaveral Tuesday, and GSC Wednesday—so was concerned about the first two or three days in case of some sort of disaster.  Hmmm.....interesting question whether our Geoblue would cover medevac then, but I’m hoping never to have to find out!

[negn]

As 2 seniors, DH and I always get trip insurance for medical expenses.  The cost of medical evacuation is $$$$$ and not usually covered.   Peace of mind is worth the cost

[April42749]

1 hour ago, negn said:

As 2 seniors, DH and I always get trip insurance for medical expenses.  The cost of medical evacuation is $$$$$ and not usually covered.   Peace of mind is worth the cost

Ditto....I don't care what my insurance company says....I don't want to have to come back home and "fight about it".  The cost of the insurance is so minimal...and the peace of mind is astronomical.

[chengkp75]

2 hours ago, ready2cruzagain said:

I worry about medical evacuation and needing to be air lifted off of the ship. 

Helicopter, or even boat, evacuation from the cruise ship is done by national agencies, and is done at no cost to the patient.  Medical evacuation insurance covers your expenses from the hospital you are admitted to to the hospital of your choice at home.

[gooch47]

Six hours away?  By ship?  By air?  How fast is the ship moving?  I can see all kinds of "gotchas" with that kind of statement.

[cementhands]

I hate this.
But I’m gonna be 65 soon and on the Plan. Great information.

But I can’t stand getting older.

Plus side my fishing license is going to be half price.

[April42749]

47 minutes ago, gooch47 said:

Six hours away?  By ship?  By air?  How fast is the ship moving?  I can see all kinds of "gotchas" with that kind of statement.

Yeah...that's the point.  One of the travel plans I was looking at covered "sending you to the hospital of your choice" but that hospital couldn't be within a certain radius of your home.  I spent just a couple of dollars more....and got what I wanted. 

 

And, a few years back, while we were on a land trip in FL, DH got sick.  Our "medicare hmo plan" covered us...but it had to be to a facility on their list.  That would have been to an ER about 10 miles away.  And then I remembered our credit card had some kind of coverage.  The credit card insurance let us use the facility across the street, paid for an extra week at the hotel, all our meals, additional airline fees, taxis...anything and everything.  Unfortunately it takes an occurrence to make someone realize the importance of good coverage. 

[schmoopie17]

Our Medicare Advantage plan has worldwide coverage. Doctors are considered in-network for emergency treatment. Hospitals have a $90 copay.

[April42749]

So...I just called my Medicare Advantage info line (it's a new policy for us) and of course I would need to call back and verify several times before I believe it:

According to the rep...if I need a hospital world wide....and the ambulance take me there, it's covered.

If I get ill on the ship...and I get treated...it's covered (I gave him the example of when I ran up a $3500 bill on the Escape and he said it would have been covered).  He didn't say anything about "miles to shore" etc.

I didn't bring up emergency evacuation....lol...but when I call back to confirm...I'm gonna bring that up too.

Also...all urgent cares are covered....it out of network it's only a $40 co-pay (in network $30).

[SheSailsFL]

Surprising to read the last post.  I didn’t think Medicare would pay in general.  I believe as soon as the ship is 20 miles offshore it’s considered to be in “international waters” (the shops and casino open at this point).  Very short time in US waters.

 

That said, I was pleasantly surprised that the charges were quite reasonable for medical care aboard ship while cruising in the Mediterranean.  

Edited January 4, 2020 by caugh51654

[negn]

5 hours ago, chengkp75 said:

Helicopter, or even boat, evacuation from the cruise ship is done by national agencies, and is done at no cost to the patient.  Medical evacuation insurance covers your expenses from the hospital you are admitted to to the hospital of your choice at home.

Yes from the ship but once on land you pay.  And if you need/prefer to get home for treatment evacuation is your responsibility.  

[erdoran]

5 hours ago, chengkp75 said:

Helicopter, or even boat, evacuation from the cruise ship is done by national agencies, and is done at no cost to the patient.  Medical evacuation insurance covers your expenses from the hospital you are admitted to to the hospital of your choice at home.

people talk about how expensive medical evacuations from cruise ships are.  If the helicopter ride is free where is the cost incurred?  Most medevac coverage I’ve seen seems to be to the closest appropriate hospital, rather than home.  

[chengkp75]

8 minutes ago, erdoran said:

people talk about how expensive medical evacuations from cruise ships are.  If the helicopter ride is free where is the cost incurred?  Most medevac coverage I’ve seen seems to be to the closest appropriate hospital, rather than home.  

Having never purchased medevac insurance, and never having had to be evacuated, I have no idea where the cost is, or whether these folks are comparing apples to apples.

[ready2cruzagain]

6 hours ago, chengkp75 said:

Helicopter, or even boat, evacuation from the cruise ship is done by national agencies, and is done at no cost to the patient.  Medical evacuation insurance covers your expenses from the hospital you are admitted to to the hospital of your choice at home.

 

I know that medical evacuation is done by the Coast Guard by if you are international waters then the Coast Guard is not always a large presence. If you are in an area not usually covered by the Coast Guard, you may be liable for the cost of evacuation.

 

Here is article that explains it good and one of the places where I got the notion that I need to carry medical evacuation insurance.

 

cruisesafely.com/medical-evacuation-from-a-cruise-ship/

 

grrr... link is not working but it says this at one point:

 

The question is a complicated one with many variables. Let’s start with the situation that is foremost in peoples mind: evacuation by helicopter. Stories of the US Coast Guard performing medical evacuations at sea from cruise ships are common. On average, the Coast Guard does so about once a week. Some travelers believe it is their right to be evacuated from a ship, but that is not the case. The U.S. Coast Guard mainly operates in U.S. Waters and only minimally in international waters. So if you are in Mexican waters, they most likely will not assist.

 

 

I have seen this stated several times in several places.  I just don't want to take a chance.

 

Edited January 4, 2020 by ready2cruzagain

[chengkp75]

2 minutes ago, ready2cruzagain said:

The question is a complicated one with many variables. Let’s start with the situation that is foremost in peoples mind: evacuation by helicopter. Stories of the US Coast Guard performing medical evacuations at sea from cruise ships are common. On average, the Coast Guard does so about once a week. Some travelers believe it is their right to be evacuated from a ship, but that is not the case. The U.S. Coast Guard mainly operates in U.S. Waters and only minimally in international waters. So if you are in Mexican waters, they most likely will not assist.

 

Sorry, but this is not correct.  Search and Rescue (SAR) (what medical evacuation is a part of) is set up by international agreement.  Certain nations agree to provide SAR functions in certain areas of the world's oceans.  The USCG has agreed to provide SAR in the Gulf of Mexico and Caribbean basin.  However, the article is correct that it is not a "right" to be evacuated, this will all depend on the decisions made by the ship's doctor, the ship's Captain, the USCG flight surgeon, and the flight crew, as to whether an evacuation is necessary, and also whether it is safe to accomplish (safe for the patient (risk v. reward), safe for the ship and crew, and safe for the flight crew).  The other factor is distance, and whether aircraft can reach the ship, or whether the ship has to divert to meet the aircraft, and after that amount of time for the ship to get where the aircraft can reach the ship, is the evacuation still a logical option.  Other nations provide SAR functions in other areas of the world.  All are done at no cost.  And, if you are in Mexican waters, most likely it is a shorter time for a Mexican CG boat to reach the ship for evacuation than a USCG aircraft, and the Mexican CG boat would be no charge either.

 

Do you think you can just call up an air ambulance company and request an evacuation from a cruise ship?  That's just not going to happen.  The air ambulance companies will not want the liability of landing on a moving vessel (they don't train for this, and it is about the most complicated maneuver a helicopter pilot can do), and the cruise line will not accept the liability for allowing a private company to approach the ship with a helicopter.  Does your insurance actually say it will pay for a helicopter to take you off the ship?  I doubt it.

 

Looked at your link, and it does bring up a lot of the limitations of evacuation.  Unfortunately, it merely mentions using a helicopter as to price, but it doesn't say that no helicopter ambulance company will do an evacuation from a ship at sea.

[ready2cruzagain]

12 minutes ago, chengkp75 said:

Sorry, but this is not correct.  Search and Rescue (SAR) (what medical evacuation is a part of) is set up by international agreement.  Certain nations agree to provide SAR functions in certain areas of the world's oceans.  The USCG has agreed to provide SAR in the Gulf of Mexico and Caribbean basin.  However, the article is correct that it is not a "right" to be evacuated, this will all depend on the decisions made by the ship's doctor, the ship's Captain, the USCG flight surgeon, and the flight crew, as to whether an evacuation is necessary, and also whether it is safe to accomplish (safe for the patient (risk v. reward), safe for the ship and crew, and safe for the flight crew).  The other factor is distance, and whether aircraft can reach the ship, or whether the ship has to divert to meet the aircraft, and after that amount of time for the ship to get where the aircraft can reach the ship, is the evacuation still a logical option.  Other nations provide SAR functions in other areas of the world.  All are done at no cost.  And, if you are in Mexican waters, most likely it is a shorter time for a Mexican CG boat to reach the ship for evacuation than a USCG aircraft, and the Mexican CG boat would be no charge either.

 

Do you think you can just call up an air ambulance company and request an evacuation from a cruise ship?  That's just not going to happen.  The air ambulance companies will not want the liability of landing on a moving vessel (they don't train for this, and it is about the most complicated maneuver a helicopter pilot can do), and the cruise line will not accept the liability for allowing a private company to approach the ship with a helicopter.  Does your insurance actually say it will pay for a helicopter to take you off the ship?  I doubt it.

 

Looked at your link, and it does bring up a lot of the limitations of evacuation.  Unfortunately, it merely mentions using a helicopter as to price, but it doesn't say that no helicopter ambulance company will do an evacuation from a ship at sea.

 

Thanks for the information, not the only place I have seen that is why I have always bought it. Still going to buy medical evacuation since for the cost it is worth it to me.  Of course I tend to over do everything any ways LOL.

[erdoran]

When I started researching trip insurance for cruising, I naively thought I only needed to worry about losing my fare in case of post final payment medical issues preventing us from cruising.  Reading these boards has really opened my eyes!  Having said that, probably the most frequently-stated point about trip insurance is that the cost of evacuation from a cruise ship/medical evacuation is staggering.  Numbers like $50k, $100k, ++ have been tossed out.  

 

I get that I can’t call 911 and request an air ambulance, that it would be done by a medical professional based on their judgment as to the medical necessity.  In a scenario where there is a medical emergency and the ship’s doctor believes evacuation is imperative, it still sounds to me like the cost of the helicopter/boat from ship to land is “free” and whatever cost is incurred is ambulance from dock to hospital, and then medical bills thereafter.  And of course the cost to get home.

 

We’ve been ultra cautious and have bought the Geoblue international medical coverage (I hadn’t even mentioned the cost of medical care since my question is about evacuation) which does have an evacuation benefit - home if medically necessary; otherwise to closest suitable hospital.  We also bought Medijet which pays to fly from local hospital to hospital at home, so we are really double covered.   I would never ever suggest anyone NOT buy whatever coverage they need for peace of mind but...

 

it is beginning to sound like medical evacuation coverage (if local hospital is acceptable) may really be a huge moneymaker for insurance companies, potentially without a valid existing risk.  Or do I misunderstand this discussion?

[cruisinmeme]

Cruise insurance is always a good idea. We recently had to cancel a cruise because my grown son had a brain hemorrhage. NCL refunded tax’s and port charges, insurance is refunding the cruise fee.

as far as getting a free ride on a helicopter with the coast guard I will have insurance and if it turns out free good and well. Not taking a chance on thinking the coast guard will come find me and say “sure no charge”

[julig22]

I just changed my medicare Advantage plan precisely because I have started to travel outside the US.  My new plan has a flex element that allows for out-of-network coverage, so I have coverage regardless of where I might be.  It also eliminates the $50,000 lifetime max for foreign travel that is attached to many policies.  It doesn't specifically say anything about evacuation but covers "emergency, urgent care and ambulance" - I might be naive but I would assume that emergency evacuation from a ship is an ambulance (just on steroids) and would be covered.