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Foreign Travel With Medicare May Be Problematic

Do you travel a lot? If so, make sure you check whether or not Medicare is in force when you are abroad.

Read over your insurance policy and find out what it does and does not cover. If, at any point you do not understand what the document encompasses, talk to a qualified insurance agent and have them walk you through your policy before you start to travel with Medicare.

You may not know that Medicare Advantage Plans and Original Medicare do cover urgent or emergency medical services anywhere in the United States and its territories. So if you have a Medicare Advantage Plan, you are getting urgently or emergency medical care that:

  • Limits on how much the plan bills you by being out of network
  • Must cover follow-up care in relation to the emergency if delaying it puts your health in danger
  • Your plan cannot demand you see an in-network provider
  • You can appeal if your plan denies care costs
  • You do not need a referral
  • That if the condition was not an emergency but looked/felt like it was, Original Medicare/ Medicare Advantage must cover care

What happens if you are denied coverage of an urgent or emergency medical assistance because you went to an out-of-network provider without an OK or a referral? Appeal the denial and get the physician to provide the appropriate documentation that the medical services rendered were urgently needed or in response to an emergency. Your State Health Insurance Assistance Program can help you in putting together an appeal.

Medicare does not cover medical costs while you are travelling outside of the United States. However, the plans must cover care in certain circumstances, including: paying for care received on a cruise ship while that vessel is in U.S. territorial waters; paying for E.R. services in Canada while traveling a direct route between Alaska and another state and the nearest treating medical facility is in Canada; and in certain limited cases, Medicare may also pay for non-emergency inpatient care in a foreign hospital.

There are a few Medigap policies that offer coverage for travelers’ abroad and they include Medigap plans C through G, M and N and offer 80 percent of the cost of emergency care.

If you do not know what your plan does and does not cover, check your policy for specific rules, and if that is not clear, contact the insurance agent and ask them to discuss the relevant sections and what they mean when you are travelling outside the United States.

Posted on Friday, May 31st, 2019. Filed under Medicare.

More and Better Medicare Advantage Plans on the Horizon

Recently Washington, D.C. hinted that changes to Medicare are coming. Medicare is the federal health program for people 65 and older.

Medicare Advantage plans are becoming made available through private health insurers and include Medicare Part A, for hospital/catastrophic care, and Part B, doctor visits/routine medical care. They can address dental and vision insurance and prescription drug coverage. Currently, one in three Medicare beneficiaries out of a total of 19 million seniors has a Medicare Advantage plan. Between 2016 and 2017 enrollment in Medicare increased by approximately 1.4 million people.

The Chronic Care Act, one of the most welcome new acts affecting medical care for seniors, will boosts Medicare Advantage plans by adding more benefit flexibility for non-medical coverage — meaning items such as wheelchair ramps or grab bars for the bathroom. The act also makes more telehealth services available for seniors with Medicare Advantage.

Following the footsteps of the Chronic Care Act, the Centers for Medicare and Medicaid Services (CMS) announced the expansion of the definition of “health-related” supplemental benefits in Medicare Advantage to include compensation for physical impairments, reduce avoidable ER visits and reduce the impact of health conditions or injuries. That means the supplemental benefits in Medicare Advantage would include “additional service that increase health and improve quality of life.”

This is exciting news as it means Medicare Advantage would be able to offer services such as aides to help with daily living activities; home modifications; and home delivered, medically appropriate meals that are currently limited to a small number of conditions. Aging at home is something that a great number of seniors would prefer as opposed to living in a nursing home facility. Aging at home also means lower costs for Medicare and Medicaid. Medicare Advantage plans have 77 percent enrollment in the 65 to 84 age group compared to 71 percent for original Medicare.

Currently, Congress and the Trump administration support Medicare Advantage. With such support it appears that healthcare for seniors is not going anywhere.

According to a Congressional Budget Office study, 41 percent of Medicare enrollees are expected to choose Medicare Advantage by 2027 — a figure that looks like it may keep growing.

Posted on Tuesday, November 27th, 2018. Filed under Medicare.
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