Travel insurance and Medicare

I have a question please. We just returned from a cruise. We bought the gold insurance. My household had to see the doctor and we paid the $95.00 doctor visit. We called the insurance so we can get the $95.00 when we received the claim it said that we had to send it to Medicare first and then to the insurance. So my first question is if there are any medical bills because sometimes they could be large if an accident happened during the cruise do Medicare pay? What if a person have HMO? While our bill was small it's not always the case. My second question is do we need to send the bill to Medicare? If yes than why do we get insurance other than able to cancel before the cruise. Thanks

We had the same thing happen. Most travel insurance you buy is 'secondary' meaning they only pay what your 'primary' insurer does not pay. That means they need to see proof that your primary insurer had denied the claim. Our bill, like yours was relatively small and we ultimately decided it wasn't worth any more effort. If it had been a large amount, we would have continued pursuing it.

The reason we get the insurance is to protect against the potential very large expense that would be incurred if you became very ill or injured in a foreign country, plus the 'medical transport' coverage for getting you home or to a place where you can be adequately treated.

I have a question please. We just returned from a cruise. We bought the gold insurance. My household had to see the doctor and we paid the $95.00 doctor visit. We called the insurance so we can get the $95.00 when we received the claim it said that we had to send it to Medicare first and then to the insurance. So my first question is if there are any medical bills because sometimes they could be large if an accident happened during the cruise do Medicare pay? What if a person have HMO? While our bill was small it's not always the case. My second question is do we need to send the bill to Medicare? If yes than why do we get insurance other than able to cancel before the cruise. Thanks

You need to send to your primary insurance provider and anything they don't cover your Princess insurance should pick up.

You might post this on the CC cruise/travel insurance board as well.

http://boards.cruisecritic.com/forumdisplay.php?s=&daysprune=&f=635

Medicare does not pay if you are outside the US. In any case, you have to send the bill to Medicare or your Medicare Advantage plan (HMO) because it is your primary insurance. When / if they decline to pay, send your Explanation of Benefits along with your bill and any other documentation required by your travel insurance claim. They will pay any remaining balance.

To avoid the extra paper work in the future, look for a travel policy that is primary. In other words, it pays first regardless of other insurance you may have.

By "gold," I think you mean you bought cruiseline insurance, not a third-party one. Travel insurance covers lots of things besides medical. People usually buy it because it provides comprehensive coverage for situations you may encounter while travelling, the most significant being evacuation and unusual medical expenses. In addition, third-party policies cover other non-refundable costs like flights, hotels, or shore excursions.

In my experience, you do not need to submit a claim first to Medicare for medical treatment outside the United States. The two insurance companies I have personally used (Travel Insurance International and Princess Vacation Protection) both understood that Medicare provided no coverage and did not require a denial from Medicare before paying my claims. This statement is based on my personal experience with multiple claims on three different cruises during the last six years.

If you have Medicare, I do not believe it is worth the money to purchase travel insurance providing primary medical insurance when traveling outside the United States, since secondary medical insurance is primary in that case.

Specifics of my experience follow:

On a January 2017 Viking Ocean cruise in the Mediterranean, I had secondary insurance from Travel Insured International, and DW and I each had small medical insurance claims for seeing the physician on board.

On a March 2016 Hurtigruten cruise in Norway, I had secondary insurance from Travel Insured International, and DW had a small medical insurance claim for seeing a physician on shore in Norway.

On a October 2012 Princess cruise to the South Pacific, I had secondary insurance from Princes Vacation Protection (Platinum upgrade). DW and I each had small medical insurance claims for seeing the physician on board. Also I had a small medical insurance claim for seeing a dentist in Hawaii.

My primary insurance in the United States is Medicare, which provides no coverage outside the United States. My secondary insurance in the United States is Tricare for Life, which provides primary coverage outside the United States while Medicare does not provide coverage. However United States law states that Tricare for Life is secondary to other medical insurance unless that insurance is explicitly sold as a Tricare supplement - even if the other insurance is sold as secondary.

Therefore for claims outside the United States my travel insurance from Travel Insured International or from Princess Vacation Protection was primary (even though it was sold as secondary), my Tricare for Life was secondary, and my Medicare provided no coverage. I also have dental insurance from Delta Dental of California which provides primary dental insurance, so my travel insurance was secondary for my dental claim.

For DW's and my medical claims with both Travel Insured International and Princess Vacation Protection, we did not have to submit first to Medicare or to Tricare for Life. When I listed those insurance carriers, the representatives for both Travel Insured International and Princess Vacation Protection recognized immediately that they were primary and accepted my claims without any documentation from either Medicare or Tricare for Life, and they both paid in full without any problems.

For my dental claim, I had to submit to Delta Dental first. Since I had the dental work done in port in Hawaii, there was no issue in coverage from them - especially since the dentist I saw happened to be a member of their network. Since my benefit year for my Delta Dental insurance was from October 1st through September 30th, I still had my full deductible to satisfy for my October claim. The travel insurance paid my full deductible and copayment after I sent them a copy of the EOB from Delta Dental.

By "gold" I mean I bought the platinum one for cancel for any reason before the cruise. We would have received credit to use for further cruise. Again we did this thinking that if we can not cruise after final payment date we would not have to bother with insurance. I'm so happy I asked the question because I was going to it any way without sending it to Medicare because of the small amount but we could have got in trouble I think I'm to forget it much easier. I will post the same in CC travel.

In the future, if you should purchase travel insurance, Travelex is a primary and not a secondary. We usually buy Travelex. Haven't needed it so far [emoji6]

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Our cruise was 7 nights west coast with one day in Ensenada

Our cruise was 7 nights west coast with one day in Ensenada

In this case, Princess Vacation Protection may well be the best coverage for the price - especially if you are Ruby or higher on Princess and get the Platinum upgrade at no cost. The cancel for any reason coverage (as long as you know you will be going on another Princess cruise) is better than you will get elsewhere without paying a lot more.

Princess Vacation Protection is not age-rated. Those of us who are on Medicare pay the same amount as the young kids. Most other travel insurance is age-rated, and older people pay more.

Some people prefer medical insurance with higher limits for medical care and/or for medical evacuation than Princess provides. However, this would not be an issue on a west coast cruise. It may be an issue if you were cruising in Asia, Africa, or South America - or even Europe.

The problem with a Medicare HMO is that it is primary, then Medicare, then your Princess insurance. While the Princess insurance company knows that Medicare doesn't pay, they don't know about your HMO (which also likely won't pay). Once you get the denial of payment from the HMO you likely won't need to wait for the Medicare denial (the HMO automatically forwards the claim, so you won't have to). You should get reimbursed by Princess, though.

There are Medicare supplemental plans that do provide coverage while traveling, but you can't have both the HMO and these. The supplemental plans pay after Medicare. Princess Vacation Protection pays after the supplementals.

We actually have the HMO because our doctors of 20 years take them but don't take regular Medicare. So we add a layer to NavyVeteran, with RockyMountainHMO, Medicare, Princess and then Tricare for Life. Deductibles and exclusions at every level as well.

Having spent over thirty years working in the government medical insurance field I will try to explain. The procedures for claim processing are complicated and very procedure-oriented. The basic procedure is that all claims must first be submitted to the primary insurer and processed. Once you get your EOB (Explanation of Benefits) back from your Primary Insurer...this document will show if the claim is rejected or paid (and how much is paid). You then submit a copy of this document (along with whatever else your secondary insurer requires) and then its the secondary companies turn :). If you have even more insurance (like a third policy) then it becomes really interesting :). The unfortunate fallout for the cruiser is that it can take many months to get a claim fully settled and paid.

Hank

Medicare does not pay if you are outside the US. In any case, you have to send the bill to Medicare or your Medicare Advantage plan (HMO) because it is your primary insurance. When / if they decline to pay, send your Explanation of Benefits along with your bill and any other documentation required by your travel insurance claim. They will pay any remaining balance.

In our experience they will cover the Doctor, they may or may not cover some of the supplemental charges (e.g. supplies), and will typically not cover drugs prescribed and taken outside of the US. On a recent submission, they paid everything except for a $35 "copay", which we then submitted to the Princess Platinum coverage carrier Aon Affinity. Depending on the clerk processing your primary insurance claim, they may deny other things (inconsistently in our experience).

While in some cases it may take a while to get your primary insurance to respond, the Princess insurance has come through like a champion every time we've used them, and we recouped all the medical and pharmacy charges.

So, submit a preliminary claim to Aon Affinity as soon as you can, which establishes a claim number and gives you a form with a list of required information to submit to them. In parallel, submit your claim to your Medicare carrier. Then when the primary responds, you will have all the information needed to submit to Aon Affinity immediately.

As has been posted already, Medicare Advantage plans often do provide emergency coverage because they are administered by insurance companies that offer benefits over and above Medicare. That is why they have an additional premium. Stand-alone Medicare does not pay outside the US.

I have Medicare as my primary and a supplement with United Healthcare thru AARP. I opted for the supplement that does provide some coverage when outside of theUS. Plus I always take the Princess insurance.

I have required medical services twice during cruises. The first time was when I fell while touring the Vatican on a private tour and did a face-plant. My upper lip was split and had a few facial abrasions. Staff on the grounds of the Vatican scooped me up into a wheelchair and took me to the infirmary on the grounds. The doc there wanted me to go to the ER at a hospital in Rome, which I flatly refused. I insisted that he clean up the lip and apply butterfly bandages to it, and went on my merry way, finishing the all-day tour. Upon return to the ship, I went to the medical center, where the ship’s doc sutured my lip, and obtained facial x-rays, as well as x-raying one wrist that was painful. Fortunately, there were no facial fractures,and the wrist was only sprained, and she applied a splint to that. That care added up to a bit over $600, and when I got home I filed a claim with the supplemental insurance, which paid a small amount of the total. I sent in the documentation to the Princess insurance of that filing, and received a check for 100% of the remainder of the costs.

The second time, I had somehow goofed when I packed my daily prescription medications and did not bring along enough of one necessary med to last thru the entire cruise. The onboard physician was able to provide a prescription for enough to get me thru, which was for a med that is fairly common, and it was able to be filled from the supply in the medical center. Between the charge for seeing the doc and the cost of the med, my bill was about $130. Again, I filed with the supplement,and then with Princess insurance, and it was 100% paid between the two.

In both instances, I did not bother to file with Medicare before submitting it to the supplement.

I'm so happy I asked the question because I was going to it any way without sending it to Medicare because of the small amount but we could have got in trouble I think I'm to forget it much easier. I will post the same in CC travel.

That's why the insurance companies make you jump through those hoops. They know a percentage will just say "forget it". $$ in their pocket and not yours.

That's why the insurance companies make you jump through those hoops. They know a percentage will just say "forget it". $$ in their pocket and not yours.

Neither of the two insurance companies I have used made me jump through hoops. I just submitted a signed form with copies of my medical statements from the ship or shore provider and said on the form that I had Medicare and Tricare for Life. Both of them paid me in full quickly and without problems - and without requiring a denial from either Medicare or Tricare for Life. The forms were simple and straightforward, and I couldn't have asked for better service from either company.

I have Medicare as my primary and a supplement with United Healthcare thru AARP. I opted for the supplement that does provide some coverage when outside of theUS. Plus I always take the Princess insurance.

 

I have required medical services twice during cruises. The first time was when I fell while touring the Vatican on a private tour and did a face-plant. My upper lip was split and had a few facial abrasions. Staff on the grounds of the Vatican scooped me up into a wheelchair and took me to the infirmary on the grounds. The doc there wanted me to go to the ER at a hospital in Rome, which I flatly refused. I insisted that he clean up the lip and apply butterfly bandages to it, and went on my merry way, finishing the all-day tour. Upon return to the ship, I went to the medical center, where the ship’s doc sutured my lip, and obtained facial x-rays, as well as x-raying one wrist that was painful. Fortunately, there were no facial fractures,and the wrist was only sprained, and she applied a splint to that. That care added up to a bit over $600, and when I got home I filed a claim with the supplemental insurance, which paid a small amount of the total. I sent in the documentation to the Princess insurance of that filing, and received a check for 100% of the remainder of the costs.

 

The second time, I had somehow goofed when I packed my daily prescription medications and did not bring along enough of one necessary med to last thru the entire cruise. The onboard physician was able to provide a prescription for enough to get me thru, which was for a med that is fairly common, and it was able to be filled from the supply in the medical center. Between the charge for seeing the doc and the cost of the med, my bill was about $130. Again, I filed with the supplement,and then with Princess insurance, and it was 100% paid between the two.

 

In both instances, I did not bother to file with Medicare before submitting it to the supplement.

Well, this is what we thought to do. We crossed we're it asked for the primary doctor's name and wrote that that princess is the primary insurance at the question why we didn't submit it to Medicare care. We were thinking it is to small and they should pay, but now after talking to all of you we have second thought weather to send it or just forget all about it.

As has been posted already, Medicare Advantage plans often do provide emergency coverage because they are administered by insurance companies that offer benefits over and above Medicare. That is why they have an additional premium. Stand-alone Medicare does not pay outside the US.

The key here is EMERGENCY. If you need immediate serious care, coverage is there.

You might have to pay the hospital upfront however.

We have United Health Care ( our medicare advantage carrier) write each of us a letter every year stating our coverage in and out of the country. We carry it along with id cards, whenever we travel for proof of coverage.

Have you ever had to use your letter? I'm asking because I don't think foreign providers or even cruise ships care whether you have insurance. They are going to bill you directly, not your insurance company.

The only way it might be useful is if you had to be hospitalized in a foreign country and could not pay the entire bill up front. In that case your insurance company would probably have to get involved beyond just a letter to prove ability to pay.

We have Kaiser Senior Advantage. I had a claim for $127 on the Grand in January. I started the process with Princess' insurer as instructed, then sent the claim to Kaiser. I fully expected it to be denied since we were out of the country. To my surprise the claim was paid in full with a month of our return. No hoops at all.

Cheers, Denise

I have a question please. We just returned from a cruise. We bought the gold insurance. My household had to see the doctor and we paid the $95.00 doctor visit. We called the insurance so we can get the $95.00 when we received the claim it said that we had to send it to Medicare first and then to the insurance. So my first question is if there are any medical bills because sometimes they could be large if an accident happened during the cruise do Medicare pay? What if a person have HMO? While our bill was small it's not always the case. My second question is do we need to send the bill to Medicare? If yes than why do we get insurance other than able to cancel before the cruise. Thanks

Let me preface what I'm about to say with the caveat that I've never filed a claim with Medicare for medical costs incurred on a cruise so I do not have any personal experience with this. That being said, I will say that I have been told that since the medical personnel on board may very possibly not be licensed in the US but in another country (e.g. Great Britain or the Bahamas or somewhere else, and if that is the case, Medicare may not pay for their charges, you might want to check with Medicare on whether that is the case or not. Hopefully, that is not the case.

Tom

Let me preface what I'm about to say with the caveat that I've never filed a claim with Medicare for medical costs incurred on a cruise so I do not have any personal experience with this. That being said, I will say that I have been told that since the medical personnel on board may very possibly not be licensed in the US but in another country (e.g. Great Britain or the Bahamas or somewhere else, and if that is the case, Medicare may not pay for their charges, you might want to check with Medicare on whether that is the case or not. Hopefully, that is not the case.

 

Tom

Medicare does not cover out of country. Once you board the ship, you're considered "out of country". Has nothing to do with where the doctor is licensed.

Now, if you're on an Alaskan cruise, and receive medical treatment onboard, that's not covered. But, if you are then transferred to a hospital in Alaska, any medical treatment there would be covered, since you're now back in the US.

Have you ever had to use your letter? I'm asking because I don't think foreign providers or even cruise ships care whether you have insurance. They are going to bill you directly, not your insurance company.

 

The only way it might be useful is if you had to be hospitalized in a foreign country and could not pay the entire bill up front. In that case your insurance company would probably have to get involved beyond just a letter to prove ability to pay.

Yes I was referring to a serious emergency requiring hospitalization. It would be helpful in a case that requires immediate surgery with a stay. Think a serious heart incident or stroke. Knowing the hospital and doctor bills will be tens and tens of thousands of dollars, having that little piece of paper might come in handy when talking payment to their business dept.

We have been billed on our ship account for minor respiratory illnesses and antibiotics on board. But that kind of stuff is not a big deal. It's the BIG stuff we like to be prepared for...including yearly evac insurance.

One simple secret I learned when filing a claim with any travel insurance when you have Medicare and Tricare for Life: Make a copy from their respective web pages that states they do not cover any medical bills outside the continental US, and file it with your claim. I've done this three times without any issues or filing to have the EOB state they won't pay - all three times I received full reimbursement for the medical costs on-board quickly.

One simple secret I learned when filing a claim with any travel insurance when you have Medicare and Tricare for Life: Make a copy from their respective web pages that states they do not cover any medical bills outside the continental US, and file it with your claim. I've done this three times without any issues or filing to have the EOB state they won't pay - all three times I received full reimbursement for the medical costs on-board quickly.

Great idea and I am sure it speeds things up a tad.