Medicare Advantage Coverage When Out of Country

[mnocket]

I have AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS) plan.

 

I'd always heard that Medicare doesn't cover you when out of country, so I've always bought travel insurance (medical & evacuation).  Now I've learned that many Advantage plans, including mine, do offer some coverage when out of country.  It seems I still need to purchase medical evacuation coverage, but does anyone know if the medical coverage of this plan is adequate, or should I still buy medical insurance (e.g. Geoblue) when I travel out of country?

[Jersey42]

26 minutes ago, mnocket said:

does anyone know if the medical coverage of this plan is adequate, or should I still buy medical insurance

Call the plan and ask how they pay for service out of the country.  Is it treated as any other out of network claim? Usual and customary charges? Deductibles? Co-pays? No one here will know unless they live in your area of Colorado and have the same exact plan. Medicare advantage plans (even those marketed through AARP) are localized, although how local they are depends on the plan and where you live.  For example in Florida, Advantage plans from the same company can differ by county.

Edited October 10, 2023 by Jersey42

[GeezerCouple]

2 hours ago, mnocket said:

I have AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS) plan.

 

I'd always heard that Medicare doesn't cover you when out of country, so I've always bought travel insurance (medical & evacuation).  Now I've learned that many Advantage plans, including mine, do offer some coverage when out of country.  It seems I still need to purchase medical evacuation coverage, but does anyone know if the medical coverage of this plan is adequate, or should I still buy medical insurance (e.g. Geoblue) when I travel out of country?

 

As Jersey42 already mentioned, the bottom line is (always!) to read the terms and conditions of *your* specific policy.  It doesn't matter what "many" or even "most" policies provide; it only matters for your care what your policy provides.

 

Many people mention that there is a $50k *lifetime* coverage for foreign care.  Note that's what "many people mention", but does *your* policy offer that?
Additionally, if it does, there is that lifetime cap, full stop.

 

One way around that is to get third-party travel insurance that is PRIMARY, meaning it does NOT require that one first file with other insurers, which would include a Medicare policy.  (In fact, for those who do have Medicare, if one doesn't have that primary coverage, many insurers will first require that you apply under Medicare, get the denial - if that's what it is, or up to the cap - and only then would they pay.  That can slow down payments that are going to be paid.  If one has *primary* coverage, there's no need to first apply to Medicare.  That could speed up the private coverage payment, and also, importantly, not use up any of the $50k.  (That could then be used for some last minute trip where one didn't make full plans including separate insurance, such as to visit a friend briefly overseas or such.)

 

GC

[PirateWife]

Having recently gone through the experience of having a medical emergency while on a cruise, I can give you some insight. Medicare A & B do not pay anything if you are out of the US. We have supplemental insurance through AARP which paid 80% of medical expenses after $250 deductible. Plan D did not pay for any medications bought out of the US. I first had to submit claims to Medicare and supplemental before applying to travel insurance carrier for medical expenses. I received responses from Medicare and supplemental insurance after filing in about 3 weeks. I applied to travel insurance company for additional travel costs--flew home 10 days after original flights--and that was reimbursed promptly. I was glad to have the travel insurance. We were fortunate to have credit cards that could cover the cost of hospitalization, surgery, prescriptions, extended hotel stay, food, and flight home. If you are wondering, my husband had a heart attack. He was and still is in excellent physical condition.

[SimplyAlbert]

DH is on Medicare and we always buy travel insurance with primary coverage now.  Our coverage outside the country with both Medicare A & B and our supplemental was not great so I wanted the peace of mind of having primary coverage without having to submit everything to Medicare first.

[Crusin till Im Dead]

PirateWife & SimplyAlbert,

Any recommended companies to buy Travel Insurance through?  I know, buyer (me) do my own research, and I will)...  
My wife and I are both on AARP/UHC and I did call and ask the questions, and was told Yes, I would be covered for an emergency.  However, I am apprehensive about how well it would work.
AND
Second question -- As a Cruiser, do you only buy 'A' Policy for One Trip?  Or is it perhaps benificial to buy an Annual plan... that would cover multiple trips ?  Seems as if the cost for the Annual plan is less than double of the individual plan.  Does that sound right?

 

Kirk

[klfrodo]

2 hours ago, Crusin till Im Dead said:

PirateWife & SimplyAlbert,

Any recommended companies to buy Travel Insurance through?  I know, buyer (me) do my own research, and I will)...  
My wife and I are both on AARP/UHC and I did call and ask the questions, and was told Yes, I would be covered for an emergency.  However, I am apprehensive about how well it would work.
AND
Second question -- As a Cruiser, do you only buy 'A' Policy for One Trip?  Or is it perhaps benificial to buy an Annual plan... that would cover multiple trips ?  Seems as if the cost for the Annual plan is less than double of the individual plan.  Does that sound right?

 

Kirk

I'm not one who you asked this question to but let me share my experience if I may.

 

I reached out to my insurance company and asked some very specific questions such as

1. Can I have the out of country hospital bill you direct? No, you pay up front and then file for reimbursement.

2. Will you do an emergency upfront loan or letter of ability to pay if I don't have the funds to pay upfront? No

3. After I have been evacuated to an emergency facility and lifesaving treatment has been completed, will you pay for me to be evacuated back home for continued care? No

4. Will you completely reimburse me at full rates charged for services received? Policy is to reimburse at Usual and Customary.

5. If I die, will you reimburse for repatriation of my remains? No

 

 

With the answers to these questions, I have decided that my best interest is served if I purchase a Travel Insurance policy that pays as "Primary" and keep my Medicare policy as a backup plan.

 

I purchase all my travel insurance plans thru Steve at Get the Best Trip Insurance Details, Advice (tripinsurancestore.com)

Edited October 19, 2023 by klfrodo

[Crusin till Im Dead]

Klfrodo,

Thanks -- exactly what I wanted to find out...
I too called my company, UHC... and was told they would cover an Emergency; but I lack solid evidence, and the person wasn't 100% convincing.
So, I've checked with Tripinsurancestore and got a quote for their Annual plan; as well as Allianz Travel, and Sqauremouth.

I've never bought extra coverage, but feel for peace of mind, worth it.

Thanks

[Hlitner]

Some confusion in this thread.  There are various iterations of Medicare Part C (so-called Advantage Plans) with some covering world-wide Emergency and Urgent Care.  But folks should carefully read their policy and call their Advantage Carrier if they have any questions.  There are limitations.  Like nearly all international plans, you will need to pay (our of pocket) for your care and later seek reimbursement.  There are a few private policies that MAY be able to do assignment (which means you would not have to pay out of pocket) but that is never guaranteed.  One example is GeoBlue where they do have an out-of-country network (of sorts) where a hospital or physician may accept assignment (where they are paid directly by GeoBlue).  

 

But there is a reality on networks.  Since we are generally talking about emergencies, it is most likely that you will have little say in where you get your care....much less have time to check the network list and ask the hospital and/or physician about them taking direct payments.  The best way to be prepared is to have 1 or more major credit cards with very high limits!  

 

By the way, we have had to file a few claims with GeoBlue...and we also have a Medicare Part C Plan (Aetna PPO) that does give us worldwide coverage.  GeoBlue, who is aware of our Medicare coverage, still paid the claims as Primary and made no attempt to coordinate the claim with Aetna.  Since GeoBlue (and most private policies) have a deductible (it can vary) we also submitted to Aetna to recover the deductible.    I would just caution folks that all this took months (meanwhile we had to cover the claims),,,,,and I did work in the industry for over 30 years so had some knowledge in how to submit a claim.  

 

Hank

[sabreline]

On 10/19/2023 at 3:24 PM, Crusin till Im Dead said:

Klfrodo,

Thanks -- exactly what I wanted to find out...
I too called my company, UHC... and was told they would cover an Emergency; but I lack solid evidence, and the person wasn't 100% convincing.
So, I've checked with Tripinsurancestore and got a quote for their Annual plan; as well as Allianz Travel, and Sqauremouth.

I've never bought extra coverage, but feel for peace of mind, worth it.

Thanks

UHC ABSOLUTELY will pay if you are admitted via the Emergency Room. My husband was hospitalized for 11 days in Paris, admitted as an emergency, and UHC paid all but $250 of the bill. We paid it when we returned home and then filed a claim and they paid within 30 days. Out travel insurance policy paid us the $250 copay, as well as the ENTIRE amount for the air ambulance we had to charter, and our missed cruise.

[dmrbmr]

Has anyone heard of or used Assist America through UPMC for Life?

[klfrodo]

37 minutes ago, dmrbmr said:

Has anyone heard of or used Assist America through UPMC for Life?

Just a quick research on Assist America. My opinion only is that they appear to be a competitor of Medjet Assist. They don't provide travel insurance or any medical coverage, they are there to you for assistance in finding medical care or to assist you after medical care has been received, to include translation services and transportation back home if required. The above poster Saberline could have been greatly served with such an add on service had they been a member. Myself? I have Medjet Assist.

The biggest issue with having this additional membership is remembering you have it when you find yourself in a medical emergency and your mind is going 1000 mph with the current situation going on with yourself or a loved one.

[sabreline]

3 hours ago, klfrodo said:

Just a quick research on Assist America. My opinion only is that they appear to be a competitor of Medjet Assist. They don't provide travel insurance or any medical coverage, they are there to you for assistance in finding medical care or to assist you after medical care has been received, to include translation services and transportation back home if required. The above poster Saberline could have been greatly served with such an add on service had they been a member. Myself? I have Medjet Assist.

The biggest issue with having this additional membership is remembering you have it when you find yourself in a medical emergency and your mind is going 1000 mph with the current situation going on with yourself or a loved one.

Actually I DO have Medjet Assist and my husband has Global Rescue!! Unfortunately, Global Rescue ruled that he had a pre-existing condition.......which it turned out he DIDN'T.....and which Nationwide disagreed with...so it was no help to us and he has not renewed his membership. That's the problem with those memberships.....you need them IMMEDIATELY and you don't have the time to appeal their decisions!!!-