Medicare/ARRP coverage when travelling

We just recently retired and went on Medicare with a United Health Supplement F which covers foreign travel. Since we are regular cruisers we thought this was a great idea. However a long time friend and cruiser in his late 70's says the United Healthcare supplement sold through ARRP will not cover anything overseas unless Medicare pays first and Medicare NEVER pay for medical care out of the country. In other words United Healthcare and ARRP are screwing us over. Anybody have a comment.

Read the travel policy carefully.

Does it state that the Medicare policy must PAY first?

(If so, then you don't need any other coverage, by the way!)

Or do you have to SUBMIT the claim first to Medicare, and THEN the other policy will pay whatever isn't covered by the first?

This is conventional, unless - in some policies - one pays extra for "primary" coverage.

Our TravelInsured policies add that for an extra $25 if we want the travel insurance to be "primary", so that there is not any need to first submit the claim to another insurer.

GeezerCouple

We use TravelSafe and they are primary. If you have questions and need help, I would suggest contacting Steve and TripInsurancestore.com. We always purchase from him and he is very knowledgeable and will help you get the coverage you need for your situation.

We just recently retired and went on Medicare with a United Health Supplement F which covers foreign travel. Since we are regular cruisers we thought this was a great idea. However a long time friend and cruiser in his late 70's says the United Healthcare supplement sold through ARRP will not cover anything overseas unless Medicare pays first and Medicare NEVER pay for medical care out of the country. In other words United Healthcare and ARRP are screwing us over. Anybody have a comment.

No one is screwing anybody.

Your supplement is secondary.

In other words, you MUST submit for reimbursement to Medicare first. Then, Medicare will deny the claim. THEN, after you receive the denial, you submit to you supplemental insurance and they will then reimburse up to covered amount.

Does it make sense? No, but you're dealing with the Government. If you expected it to make sense, your expectations were too high.

No one is screwing anybody.

Your supplement is secondary.

In other words, you MUST submit for reimbursement to Medicare first. Then, Medicare will deny the claim. THEN, after you receive the denial, you submit to you supplemental insurance and they will then reimburse up to covered amount.

 

Does it make sense? No, but you're dealing with the Government. If you expected it to make sense, your expectations were too high.

This is also the same with ANY other insurer (not just "the Government") when one has a policy that provides "secondary" coverage.

You pay a bit more if you want "primary" coverage, which means that you can submit the claim to the "primary insurer" FIRST, and don't need to wait to show any denied claim from another insurer, or that perhaps PART of the claim was paid by the primary, leaving less for the secondary to cover.

Does it take longer? Yes.

Does it cost the same? Usually, no. Usually "primary" will cost more, although not necessarily a lot.

And sometimes the "primary" aspect is bundled in with other types of coverage, so it's impossible to tease out "how much each separate part cost".

With TravelInsured, for some of their policies, one can change the "secondary" nature to "primary" for a one-time fee of $25.

GeezerCouple

Your issues with that United Health F policy are a lot more complicated. Keep in mind that it only pays ""Medically Necessary Emergency Care" which commences during the first 60 days of a trip. And the plan only pays 80% with a $50,000 Lifetime maximum. So you would generally be responsible for the $250 deductible plus 20%. And you would want to keep each of your trips to less then 61 days.

As to Primary vs Secondary, yes primary is better but with Medicare Supplemental Policies Medicare is always the primary payor. But since Medicare will pay zero for charges incurred outside of the USA (unless in transit to Alaska or within 6 hours of a US Port) the United Policy in a sense is the defacto primary policy. And it gets even more complicated if you purchase another travel medical policy. When I worked in the Health Care Insurance Industry the so-called "third party liability" issues drove everyone nutz and often delayed claims processing.

And do not forget the potential liability for "Medical Evacuation" which can be huge.

Hank

There is no way I travel outside U.S., where Medicare and my supplemental policy will pay, without travel medical policy. I don't insure the cost of the trip but always for emergency medical and evacuation/repatriation.

Medical travel policy premiums are very moderate. It is the trip interruption and cancellation that increases the premiums. The savings for not insuring dozens and dozens of cruises/trips for cancellation saved literally tens of thousands of dollars through the years and thankfully we never had to cancel after final payment. The price of the trip is a known amount; the possibility of uninsured medical care and evacuation can be huge.

Your issues with that United Health F policy are a lot more complicated. Keep in mind that it only pays ""Medically Necessary Emergency Care" which commences during the first 60 days of a trip. And the plan only pays 80% with a $50,000 Lifetime maximum. So you would generally be responsible for the $250 deductible plus 20%. And you would want to keep each of your trips to less then 61 days.

 

As to Primary vs Secondary, yes primary is better but with Medicare Supplemental Policies Medicare is always the primary payor. But since Medicare will pay zero for charges incurred outside of the USA (unless in transit to Alaska or within 6 hours of a US Port) the United Policy in a sense is the defacto primary policy. And it gets even more complicated if you purchase another travel medical policy. When I worked in the Health Care Insurance Industry the so-called "third party liability" issues drove everyone nutz and often delayed claims processing.

 

 

 

 

Thank you Hank, you appear to understand my question and I thank you for the insight

No one is screwing anybody.

Your supplement is secondary.

In other words, you MUST submit for reimbursement to Medicare first. Then, Medicare will deny the claim. THEN, after you receive the denial, you submit to you supplemental insurance and they will then reimburse up to covered amount.

 

Does it make sense? No, but you're dealing with the Government. If you expected it to make sense, your expectations were too high.

Earlier threads will show I posted often on Insurance, I suffered a stroke "out of the blue" ( I travelled solo)while on a cruise last October. I had medical Insurance and medevac Insurance.

The kick in the rear came claiming for medical costs on board $3,000, and Hospital cost in Belgium.

Medicare will not pay for any treatments outside the USA, but the Insurance required a letter of rejection , Medicare will not issue this until AFTER you have filled out about 12 pages of paper work. just getting the paper work takes weeks.

The questions are ridiculous, i.e time ships doctor inserted the drip line, time they tested my brain responses. Even worse they asked the ZIP CODE for the ships position !!! How do you give a ZIP CODE for a ship sailing in the ENGLISH channel!!!! Then Medicare wanted the Medicare BILLING CODE for the charges!!!

How I was supposed to answer these questions, after a stroke did not concern Medicare, leave a question unanswered and back come the forms. It took months to get a refusal from Medicare, before my Insurance would even begin to process my claim.

So my advice is

a/ Get Medevac insurance if you want to get home from "wherever"

b/ Get PRIMARY insurance for medical costs if you do not want to spend months dealing with the Government Red tape.

c/ Unless you have a spare $30,000 hidden in your socks you need insurance

In my case because it was a stroke, I lost my ability to speak, I could not use my left leg, arm and hand, I could not get out of bed even to go to the toilet, and none of the nurses at the hospital spoke English believe me it was a nightmare, seeing an American nurse when she arrived from Care International , and told me she would take care of EVERYTHING was a miracle.

Care International paid up front for the nurse to take care get me out of the hospital, and Business class flight from Belgium to my home town hospital in Florida

BTW, you do have pay at time of service on board, (the cruise line bills your credit card ) and at the hospital in the foreign country (in their currency/ and with a credit card they will accept - yes the hospital only accepted certain credit cards, they refused the first but I did have another they agreed to accept).

Your issues with that United Health F policy are a lot more complicated. Keep in mind that it only pays ""Medically Necessary Emergency Care" which commences during the first 60 days of a trip. And the plan only pays 80% with a $50,000 Lifetime maximum. So you would generally be responsible for the $250 deductible plus 20%. And you would want to keep each of your trips to less then 61 days.

 

As to Primary vs Secondary, yes primary is better but with Medicare Supplemental Policies Medicare is always the primary payor. But since Medicare will pay zero for charges incurred outside of the USA (unless in transit to Alaska or within 6 hours of a US Port) the United Policy in a sense is the defacto primary policy. And it gets even more complicated if you purchase another travel medical policy. When I worked in the Health Care Insurance Industry the so-called "third party liability" issues drove everyone nutz and often delayed claims processing.

 

And do not forget the potential liability for "Medical Evacuation" which can be huge.

 

Hank

I do not understand "within 6 hours of a US port"....can someone explain?

I do not understand "within 6 hours of a US port"....can someone explain?

Some people have been told that this time limit is what Medicare uses to determine if the patient is *in* the United States or not. How a time limit compares to a distance is variable; an airplane on its way to the U.S., a ship cruising to a port, a fisherman offshore in a small boat all could be the same time from a US port but of vastly different distances.

Some people have been told that this time limit is what Medicare uses to determine if the patient is *in* the United States or not. How a time limit compares to a distance is variable; an airplane on its way to the U.S., a ship cruising to a port, a fisherman offshore in a small boat all could be the same time from a US port but of vastly different distances.

that is exactly what I thought.....! Just now investigating insurance for our FL/Bahamas trip....and would love to know if we are covered...:confused:

that is exactly what I thought.....! Just now investigating insurance for our FL/Bahamas trip....and would love to know if we are covered...:confused:

Even if someone tells you yes, assume the answer is no and get third party insurance.

Now is not the time to be trying to save a couple of dollars.

Kind of like a car accident. You might have been in the right, but, you're still in an accident.

Even if someone tells you yes, assume the answer is no and get third party insurance.

Now is not the time to be trying to save a couple of dollars.

 

Kind of like a car accident. You might have been in the right, but, you're still in an accident.

Oh..I never travel without 3rd party insurance ..have bought it every time we cruise !...Actually just was curious.....as I had never seen this statement before...(and all it would affect is the medical coverage amount...as it varies so much among policies)

Some people have been told that this time limit is what Medicare uses to determine if the patient is *in* the United States or not. How a time limit compares to a distance is variable; an airplane on its way to the U.S., a ship cruising to a port, a fisherman offshore in a small boat all could be the same time from a US port but of vastly different distances.

The Medicare Regulations (based on Title XVIII of the US Code) specifically say "6 hours." As is too typical of many government regulations the interpretation is up to the technocrats (I did this work for 32 years at the State Level). I have no clue as to how the 6 hour rule works in practice. About 12 years ago (when I still worked) I actually asked one of my CMS (they run Medicare) contacts to explain that rule and she just laughed at me and said nobody in her office had a clue :).

I can tell you that if I was interpreting the 6 hour rule it would be based on being within 6 hours (based on the ship's schedule) of the port. But even this would not work if you were closer to a port that was not even on a ship's itinerary.

The other weird Medicare rule is that you are covered in Canada if in transit to or from Alaska. But this is another rule interpreted on a case by case basis and they would probably look at your route (especially if driving) to make a determination if its the most direct route and you do not have any unreasonable delays.

Since these decisions are usually made by the private company fiscal intermediaries they would probably just reject the claim (under both of these rules) and force you to deal with it in the lengthy appeals process.

These rules are another reason why we all "love" our government....and this stuff also drove me to an early retirement :).

Hank