How much medical insurance do I need?

[The Other Tom]

I'm looking for a comprehensive policy and medical coverage seems to range from $50K to $250K depending on the policy.  How much do I really need?

If it matters, this will be for a western Med. cruise, and we are seniors. 

[iamtrustworthy]

On 11/16/2022 at 3:53 PM, The Other Tom said:

I'm looking for a comprehensive policy and medical coverage seems to range from $50K to $250K depending on the policy.  How much do I really need?

If it matters, this will be for a western Med. cruise, and we are seniors. 

Hi Tom,

 

I've never seen a medical claim over $74,000 nor an evacuation claim for over $127,000.

 

In order to give you more accurate advice, are you covered by Medicare with a supplement you bought on your own, have Tricare or are on a former employers' retiree health plan? Or do you have Advantage plans?

 

Steve Dasseos

[The Other Tom]

2 hours ago, iamtrustworthy said:

Hi Tom,

 

I've never seen a medical claim over $74,000 nor an evacuation claim for over $127,000.

 

In order to give you more accurate advice, are you covered by Medicare with a supplement you bought on your own, have Tricare or are on a former employers' retiree health plan? Or do you have Advantage plans?

 

Steve Dasseos

Thanks Steve.

I am covered by Medicare and a former employer's retiree health plan, which is secondary.  Basically, if Medicare pays something, the employee plan pays the rest.  If Medicare pays nothing, the employee plan pays nothing.

[iamtrustworthy]

19 hours ago, The Other Tom said:

Thanks Steve.

I am covered by Medicare and a former employer's retiree health plan, which is secondary.  Basically, if Medicare pays something, the employee plan pays the rest.  If Medicare pays nothing, the employee plan pays nothing.

Hi Tom,

 

You need to call them and ask if this is true when you are traveling outside the USA.

 

Steve Dasseos

[The Other Tom]

On 11/19/2022 at 4:26 PM, iamtrustworthy said:

Hi Tom,

 

You need to call them and ask if this is true when you are traveling outside the USA.

 

Steve Dasseos

Thanks.  I'll do that

[donaldsc]

On 11/18/2022 at 5:35 PM, The Other Tom said:

Thanks Steve.

I am covered by Medicare and a former employer's retiree health plan, which is secondary.  Basically, if Medicare pays something, the employee plan pays the rest.  If Medicare pays nothing, the employee plan pays nothing.

 

I typed "does Medicare cover you if you are out of the us" and got this information really quickly.  Google is your friend.

 

"Medicare Coverage Outside the United States Medicare coverage outside the United States is limited. In most situations, Medicare won’t pay for health care or supplies you get outside the U.S. The term “outside the U.S.” means anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. This fact sheet explains some of the exceptions that would allow you to get coverage outside the U.S. under Medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance).

 

When does Medicare cover health care services in a foreign hospital?

 

There are 3 situations when Medicare may pay for certain types of health care services you get in a foreign hospital (a hospital outside the U.S.):

 

1. You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat your illness or injury.

 

2. You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury. Medicare determines what qualifies as “without unreasonable delay” on a case-by-case basis.

 

3. You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it’s an emergency.

 

Remember, in these situations, Medicare will pay only for the Medicare covered services you get in a foreign hospital. "

[Hlitner]

I think we need some clarification of the Medicare issue.  If you have basic Medicare (Parts A and B) and perhaps a supplemental, you are generally not going to have any out of country coverage (except in a few circumstances such as being enroute from the mainland US to Alaska and get sick/injured in Canada.

 

However, for folks that have Medicare Part C Plans (often called Advantage Plans) you may or may not have some out of the country coverage depending on your specific plan.  For example, our Aetna Medicare PPO Plan (a Part C plan) does provide coverage for emergency/urgent treatment outside the USA.  In fact, we recently collected on a claim that occurred while we were in Mexico.  Aetna paid our entire claim less their standard $100 Emergency Room deductible.

 

Hank

[donaldsc]

49 minutes ago, Hlitner said:

I think we need some clarification of the Medicare issue.  If you have basic Medicare (Parts A and B) and perhaps a supplemental, you are generally not going to have any out of country coverage (except in a few circumstances such as being enroute from the mainland US to Alaska and get sick/injured in Canada.

 

However, for folks that have Medicare Part C Plans (often called Advantage Plans) you may or may not have some out of the country coverage depending on your specific plan.  For example, our Aetna Medicare PPO Plan (a Part C plan) does provide coverage for emergency/urgent treatment outside the USA.  In fact, we recently collected on a claim that occurred while we were in Mexico.  Aetna paid our entire claim less their standard $100 Emergency Room deductible.

 

Hank

 

I guess that the answer should be to talk to your insurance agent before you purchase possibly unnecessary insurance and be sure to ask very specific questions and not the general "will I be covered?" question.

 

DON

[Hlitner]

16 minutes ago, donaldsc said:

 

I guess that the answer should be to talk to your insurance agent before you purchase possibly unnecessary insurance and be sure to ask very specific questions and not the general "will I be covered?" question.

 

DON

Absolutely!  I also suggest that if you told you are covered it is wise to ask for the written reference to the coverage.  The devil is in the details.

[iamtrustworthy]

5 hours ago, donaldsc said:

 

I guess that the answer should be to talk to your insurance agent before you purchase possibly unnecessary insurance and be sure to ask very specific questions and not the general "will I be covered?" question.

 

DON

Hi donaldsc,

 

Here's how you find out about Medicare's coverage outside the USA:

https://tripinsurancestore.com/medicare-does-not-cover-you-outside-the-usa/

 

Steve Dasseos