Offshore Health Insurance
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Gregory Shea
Hi all,
Maybe I can inject some real world experiences into the discussion and suggest some international health insurance mistakes to avoid.
Seven years ago I was a Mediterranean neophyte with my Sharki in the marina on the Isles de Frioul off Marseille. The Tramontane had been blowing 30 knots for three days, on the beam. I wanted to double up on my bow lines and had asked the harbormaster to help
me. I hurried back to the boat to ready the extra lines and non-Sharki owners may not know that the Sharki mizzen boom extends about two feet past the transom. In my haste to climb aboard, I was watching where my feet went, not where my head was, and I ran
into the mizzen boom, head first. At least that's what I think happened since my first recollection was "Why am in I this cold September water and why does my leg hurt like hell?"
To cut a long story short, fellow cruisers got me back on dry land and the paramedics called in a police patrol boat to get me back to the mainland. I was in excruciating pain and could not walk. That was when the medical mistakes started. I have Medicare C
but had no idea what it said about international coverage. I had no Green Card, the passport that entitles EU residents to universal medical coverage. Without a Green Card, the ambulance folks took me to the local, indigent hospital. In Marseille, you can
imagine what that was like. They X rayed my leg, announced nothing was broken and told me to buy a brace and walking stick and get lost.
I managed to get back to the boat, sailed her back to base, at the foot of the Pyrenees, buttoned her up, transited to Paris, hopped a plane home and got plugged int the US health system. This took about a month from the time of the accident, during which time
I had no idea what was wrong except that I needed a wheel chair to move around. An MRI found the problem, I had ruptured (doctor speak for snapped) my quadriceps tendon, the one on the front of your upper leg that enables you to flex your leg when walking.
Apparently, my knees had folded when my head hit the boom and as I went down, the tendon stretched to its limit and then broke. I found a surgeon who was competent to make the repair, had it done and settled into a year or more of recovery.
Lessons learned, lift the mizzen boom of a Sharki before entering port, it really saves a lot of agro.
Understand what your insurance covers. I have now talked to BCBS and studied their Plan C documentation at length. It is only good in the first 60 days and only covers debilitating conditions, which they define as loss of function in critical areas such as
limbs, sight, cognitive impairment etc. Coughs, colds, influenza and stubbed toes don't count as emergencies. If you are in a bad way, as I was, you qualify, but you have to know that. In retrospect, I should have insisted that the ambulance take me to one
of the first rate hospitals in Marseille. Sure, I would have had to pay and claim it back, net of deductibles of course, but a local MRI would have let me know what I was dealing with. I should have produced my BCBS insurance card and demonstrated that I had
insurance, if not the Green Card they expected, at least something that indicated that I was financially capable.
When these things happen you are usually disorientated because you are in a system that is not familiar to you, often with language issues. You are probably in shock and pain and the Admiral is probably no better, realizing the responsibility for the boat maybe
descending on her shoulders. Confidence in your medical providers is worth its weight in gold.
My summary is that overseas Medicare medical coverage, at least under C plans, is rudimentary, at best. If the time limit has not expired, and your problem is serious, you can afford to seek good medical help, but it won't be free. Find out where you stand
vis-vis your coverage and be prepared to use it. Based on my experience, the cost is well worth the peace of mind it provides.
I retrospect, I would have done a lot of things differently, had I known.
I hope that my experiences can help other sailors be prepared, in case they have the bad luck to find themselves in a similarly unfortunate situation.
Greg Shea
Sharki 133, Cap des Iles
Preveza
From: main@AmelYachtOwners.groups.io <main@AmelYachtOwners.groups.io> on behalf of Ben Driver <bddriver@...>
Sent: Wednesday, October 21, 2020 1:42 PM To: main@amelyachtowners.groups.io <main@amelyachtowners.groups.io> Subject: Re: [AmelYachtOwners] Offshore Health Insurance Eric
My agent says same; that is, both plan F and G will reimburse foreign medical expense. But I think I best to get another “expert” opinion and triangulate. I don’t trust insurance companies or agents. Also it may be insurance carrier specific; that is,
not mandated.
Ben
Ben and Gayle Driver
On Oct 19, 2020, at 3:43 PM, eric freedman <kimberlite@...> wrote:
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Ben Driver
Craig
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Kinda like paying vastly different amounts for same airline ticket. Nutty. Ben Driver
On Oct 21, 2020, at 6:01 PM, Craig Briggs via groups.io <sangaris@...> wrote:
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Ben
Medicare.gov says, "The cost of Medigap policies can vary widely. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage." That is, all supplemental plans with the same letter are identical and there are no insurance carrier specific differences. Stupidly complicated. You can pay more or less for exactly the same thing. Kind of like West Marine vs your local low cost chandler. -- Craig, SN68 Sangaris, Tropic Isle Harbor, FL
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Ben Driver
Eric
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My agent says same; that is, both plan F and G will reimburse foreign medical expense. But I think I best to get another “expert” opinion and triangulate. I don’t trust insurance companies or agents. Also it may be insurance carrier specific; that is,
not mandated.
Ben
Ben and Gayle Driver
On Oct 19, 2020, at 3:43 PM, eric freedman <kimberlite@...> wrote:
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Mark Pitt
From the medicare.gov website: Medigap coverage outside the U.S.If you have Medigap Plan C, D, E, F, G, H, I, J, M or N, your plan:
Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.
Mark Pitt, Sabbatical
III, SM#419
On 10/21/2020 10:18 AM, Ralph Caruso
via groups.io wrote:
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Ralph Caruso
Medicare parts A&B do not cover medical care outside the US. You may be covered by some Medicare Advantage plans (read the words carefully, because they may only cover emergency care), but the only that I KNOW covers care outside the USA is BCBS issued to current and retired members of the Federal Bureaucracy (I am a retired bureaucrat). You have to be a Federal Employeee or a retiree eligible to particulate in the Federal Employees Health Benefit Plan. It is one of the best plans in the USA (not quite as good as some union-sponsored plans for stuff like dental or glasses), and it covers you everywhere in the world, because lots of Fed employees work or travel outside the US. When we lived in France, we used to send our claims back to the US, and they would do the translations and currency conversions and send us a check in $US. BCBS has an entire large operation dedicated to foreign coverage. They can even provide you with attestations that you are covered, so that you can present them to foreign governments that require this as a condition for a residency card. (Been there, done that) Unfortunately, you would have to go back to work, for the US govt, for at least 5 years, in order to become eligible for a pension and FEHBP coverage at age 62, if you retire from the govt. Ralph Caruso
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Hi Pat, Yes, your post indeed said you did not file a claim. My point was simply that you'll learn what your coverage is if you do file a claim and that may be the most efficient way to find out.
Tom Peacock's post that it is confusing is so true and he pointed out that (Original) Medicare Parts A&B do not cover care outside of the US. To get any coverage outside the US you need either a MediGap Supplemental Plan like your Plan F policy (not any one) or a Medicare Contract Part C plan like Tom and I have (again, not any one). Teun says he has a "Platinum Rolls Royce" supplemental plan, but in actuality all Medigap Supplemental Plans - Plans A thru N - are standardized by the government and all providers offer exactly the same coverage for each plan (although they charge different premiums). Part C Plans, (not to be confused with Supplemental Plan C) must provide everything that Original Parts A&B cover but may add more, like different deductibles and MOOP's (my favorite acronym for Max Out of Pocket), dental and eye care, and out-of-USA, etc. and charge different premiums from $0 to hundreds a month (on top of the Part A/B premium. Finally, Tom's (or Teun's) point that all this is subject to an amazingly huge layer of bureaucrats interpreting what's covered or not makes giving an authoritative answer a bit of a fools errand. Our favorite bureaucratic interchange was in Greece, trying to get stamped out. After literally a two hour wait at the counter with people running about, the supervisor finally took pity on us, came over and most kindly apologized, saying, "I'm so sorry, but this is the first of the month and we have a lot of bureaucracy to do. Perhaps we should stick to lip seals and Lithium batteries! -- Cheers, Craig
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eric freedman
Thanks
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Typical government BS. Eric
On October 20, 2020 at 9:16 AM "Craig Briggs via groups.io" <sangaris@...> wrote:
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Patrick McAneny
Craig, I don't have a claim at this time, but was asking if anyone knew what the medicare policy is on covering a US citizen abroad, assuming they have one. I am having my wife/secretary look into our supplemental coverage and it's policy .
Thanks,
Pat
-----Original Message-----
From: Craig Briggs via groups.io <sangaris@...> To: main@AmelYachtOwners.groups.io Sent: Tue, Oct 20, 2020 10:58 am Subject: Re: [AmelYachtOwners] Offshore Health Insurance Hi Pat -
The best and perhaps only definitive answer is to submit your claim and see what they do. Craig
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Can confirm below – had Q4 2018 surgery in BANGKOK and upon return in USA MEDICARE refused to pay. I have (according to MAYO clinic) “platinum ROLLS ROYCE” supplemental but they originally also tried not to pay. Once I pointed out that they do have an international clause in their policy (one of the main reasons I selected this plan) they finally paid USD18K out of the USD28K.
It was not an emergency and, in hindsight, I should have purchased a roundtrip ticket to USA and have everything done by MAYO AND (even flying 1st class) still saved money 😊. Medical care would have been at the same excellent level; can highly recommend BUMRUNGRATD International Hospital in BANGKOK.
Best Regards Teun
A54 2009 #128 October 20, 2020 08:28:01
From: main@AmelYachtOwners.groups.io <main@AmelYachtOwners.groups.io>
On Behalf Of Thomas Peacock via groups.io
Sent: Tuesday, October 20, 2020 08:14 To: main@amelyachtowners.groups.io Subject: Re: [AmelYachtOwners] Offshore Health Insurance
As our president famously said after he was unable to come up with a new health insurance plan, “Who ever thought health insurance could be so complicated?”
I’m not trying to inject any politics into this forum, however; the forum is too precious for that.
In the US, health insurance certainly is complicated.
You will find many different opinions on what Medicare does and does not cover.
My best read on traditional Medicare (Parts A and B) is that costs incurred in foreign countries will not be reimbursed, unless you live by the Canadian border and the Canadian hospital is closer than your US hospital. Will not apply for problems in the Caribbean and elsewhere.
Many Part C (Medicare Advantage) plans will reimburse you for foreign expenses. Check your plan.
I will defer to Eric on Plan F, I know nothing. I read up on it on the internet, and came away even more confused.
Tom Peacock SM 240 Aletes Wintering well above the Tropic of Cancer
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Thomas Peacock
As our president famously said after he was unable to come up with a new health insurance plan, “Who ever thought health insurance could be so complicated?”
toggle quoted messageShow quoted text
I’m not trying to inject any politics into this forum, however; the forum is too precious for that. In the US, health insurance certainly is complicated. You will find many different opinions on what Medicare does and does not cover. My best read on traditional Medicare (Parts A and B) is that costs incurred in foreign countries will not be reimbursed, unless you live by the Canadian border and the Canadian hospital is closer than your US hospital. Will not apply for problems in the Caribbean and elsewhere. Many Part C (Medicare Advantage) plans will reimburse you for foreign expenses. Check your plan. I will defer to Eric on Plan F, I know nothing. I read up on it on the internet, and came away even more confused. Tom Peacock SM 240 Aletes Wintering well above the Tropic of Cancer
-- Tom Peacock SM 240 Aletes Chesapeake Bay
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Hi Pat -
The best and perhaps only definitive answer is to submit your claim and see what they do. Craig
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Patrick McAneny
Does Medicare reimburse for medical care in another country? We spent a few hundred in Guadeloupe and the doctor thought it would if we submitted a claim ,but we did not bother .
Pat
SM Shenanigans
-----Original Message-----
From: Craig Briggs via groups.io <sangaris@...> To: main@AmelYachtOwners.groups.io Sent: Tue, Oct 20, 2020 9:16 am Subject: Re: [AmelYachtOwners] Offshore Health Insurance Hi Eric - this is as confusing as what direction lip seals should face, but Medicare.gov says: Plan F "Foreign Travel exchange (up to Plan limits) Covers 80%", with an asterisk that says, " Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,340 in 2020 before your policy pays anything. (Plans C and F aren't available to people who are newly eligible for Medicare on or after January 1, 2020.)"
That sounds a different than what you were told by AARP. My advice would be to stay healthy so you don't have to find out what the coverage actually is! (and change your lip seals tri-annually) Cheers, Craig -- SN68 Sangaris, Tropic Isle Harbor, FL
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Hi Eric - this is as confusing as what direction lip seals should face, but Medicare.gov says: Plan F "Foreign Travel exchange (up to Plan limits) Covers 80%", with an asterisk that says, " Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,340 in 2020 before your policy pays anything. (Plans C and F aren't available to people who are newly eligible for Medicare on or after January 1, 2020.)"
That sounds a different than what you were told by AARP. My advice would be to stay healthy so you don't have to find out what the coverage actually is! (and change your lip seals tri-annually) Cheers, Craig -- SN68 Sangaris, Tropic Isle Harbor, FL
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eric freedman
I wish someone else would check this out and see if you are told the same thing as I was Told.
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Fair Winds, eric
On October 19, 2020 at 9:24 PM "Matt Salatino via groups.io" <helmsmatt@...> wrote:
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I hope you’re right. Wife and I have the same plan. It’s great in the states.
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~~~⛵️~~~Matt
On Oct 19, 2020, at 6:43 PM, eric freedman <kimberlite@...> wrote:
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eric freedman
HI, I just got off the phone with AARP. I have plan F supplemental. . According to them it covers 100% of the bills after a $250- dollar deductible out of the USA. I must pay the bill and then submit the bills for payment. I am just wondering if I was told the correct answer about this plan. Fair Winds Eric Amel Super Maramu #376
From: main@AmelYachtOwners.groups.io [mailto:main@AmelYachtOwners.groups.io] On Behalf Of karkauai via groups.io
Sent: Thursday, October 15, 2020 9:49 PM To: main@AmelYachtOwners.groups.io Subject: Re: [AmelYachtOwners] Offshore Health Insurance
Hi all,
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Kent,
I think you mentioned in the past you use Growie Insurance and their Jack-line policy. Check with them for offshore medical plans. If I recall correctly they represent IMG.
There are many
options available for international healthcare. We tend to shop outside of the
USA for international insurance since the policies are much easier to understand
and cost a lot less. Our international policy is more for catastrophic stuff
and has a high deductable. We pay out of pocket for most healthcare. We have
found outside of the USA, good affordable healthcare is readily available in
most countries and is about 1/5th the price of care in the USA. The
price for our $2M policy is about $1800 per year for both of us. The deductable
is US$5,000 each.
I think I deserve a cookie for restraining myself from going on a rant about the state of the USA healthcare system – {smile}
With best regards,
Mark
Skipper Sailing Vessel - Cream Puff - SM2K - #275 Currently cruising - Tahiti, French Polynesia www.creampuff.us
From:
main@AmelYachtOwners.groups.io [mailto:main@AmelYachtOwners.groups.io] On
Behalf Of karkauai via groups.io
Hi all,
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Thomas Peacock
Boy, Kent, you’ve opened up a can of worms, that fortunately non-Americans may not have to deal with.
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I don’t know if you have “traditional” Medicare, or the other privately administered plans. I’m not sure how “traditional” Medicare handles overseas illnesses. However, as Craig pointed out, if you have Part C (so-called Medicare Advantage), privately administered, overseas illnesses are generally paid for. All plans differ. My plan, Aetna Silver PPO, has a $7,550 out of pocket maximum for the year. So, if I were to get ill or injured overseas, I would have to pay the bill. Since it is “out of network”, it is likely that I would be responsible for the first $7,550. In addition, I would have to pay the hospital and doctors myself for the whole bill. However, Aetna would reimburse me for any expenses over the $7,550. When I crunched the numbers last year, it did not seem worth it to me to buy overseas insurance. Worst case scenario, I’m out $7,550. The premiums for extra insurance seemed too steep. I should add that my wife broke her arm in St Lucia. We chose to go a private hospital rather than the government run facility. The hospital bill was over $12,000. They would not admit her to the hospital until I paid in full (credit card). They wouldn’t even take an X-ray until I paid for that. After the deductible, her insurance paid the balance. Hope this helps. Tom Peacock SM 240 Aletes Chesapeake Bay for the winter, public health issues in the Caribbean just seem too iffy, especially with the second wave upon us
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Tom Peacock SM 240 Aletes Chesapeake Bay
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Hey Kent,
Know you're the Doc, but my Medicare Part C plan let's me get reimbursed for overseas care (yes, I've got to pay first and then submit for reimbursement, and it can't exceed "normal and customary" which is a rarity in other countries). Just a thought. Yes, US health care is WAY too complicated. I think I read that overhead costs - insurance companies and government - are much more than the actual health care itself. Glad you're a real Doctor, but you'd have an Amel 60 or maybe two if you had gone into health insurance! Cheers, Craig -- SN68 Sangaris, Tropic Isle Harbor, FL
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