I am not on Medicare yet…how do they define “emergency”. Is that the same across all states or facilities.
If I get Covid and need paxlovid, I may think it’s an emergency, but others may not. What about UTI? It’s not life threatening, but it’s super painful. I think when doctors are not certain if they’’ll get paid then they would be less likely to treat you.
Well, friend’s son broke his leg while at college in upstate NY. That was an emergency. His parents thought no big deal, he can get his therapy there too as they had Blue Cross. Nope, the therapy was not an emergency. Anything you can make an appointment for and come back tomorrow is not an emergency.
My daughter had a kidney infection while in Florida and went to the emergency room ( no no no, go to urgent care!). The bill was $18k (you read that right, $18k for a few tests in the ER, talking to a doc, and getting a prescription). She didn’t have her insurance card with her so we got the full bill, and before we could submit it had gone to collections. It did get paid, but what a mess.
On the other hand, there was a story in our paper a few years ago and a woman was getting treatments once a month on some kind of medicare plan (not sure which) and she was going to be in California at the time of a scheduled treatment so they arranged for her to have it is California. In Colorado it was not fully covered and she paid about $800/mo. In California it was fully covered! So she then just went to California once a month. The plane ticket was cheaper than the treatment.
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the definition should be the Medicare standard across all states. That said, Medicare uses different processing contractors in multi-state regions, so it would be surprising to hear that they interpret the Medicare standard differently.
Okay, I checked my ‘regular’ medicare book (they send you a handbook every year) and my MA (plan specific) book.
Handbook says medicare doesn’t cover foreign travel but to check to see if MA does.
My MA (Aetna) does cover emergency care worldwide, but does not cover evacuation travel back to the USA. It instructs me to get copies of bills, to let Aetna know asap if I have to have emergency services. It defines those as an average person feeling that medical services should be sought. As soon as a doctor says it is no longer an emergency, then you have to return to your regular doctor/specialist in the US. Examples were to preserve life or limb, pains getting worse, after an accident, anything to do with pregnancy (not many of those, but some children are on medicare if their parents are, like my friend’s son with Down syndrome).
Same would be true for medical care when traveling in the US. You might be able to arrange non-emergency care in the US. Dialysis is covered.
Wow, that’s interesting! Thanks for sharing.
That’s why regular Medicare is much safer!
This is all good info to try to find out before open season so you can choose the plan you believe will best meet your needs. We have reg medicare A&B plus a bcbs PPO and so far have had most bills paid well.
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For international travel, it seems like travel medical insurance is prudent with Medicare or MA.
For US travel, I would feel more at ease with Medicare. (Not sure it’s a deal breaker though since emergencies should be covered on MA)
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Some MA plans do cover out of country medical expenses but since plans vary so much, one must carefully check terms of the policy.
A friend told me his MA plan covers out of country medical and covered him when he was on international cruise and needed to see ship md because he was ill and it turned out to be covid. it would have been $5000 but his MA plan covered it all.
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I don’t know about all states, but when we were considering switch to MA plan (Kaiser CA), we asked “who defines emergency.” We were told that we (patient) define what is an “emergency.” In fact when you call Kaiser the prerecorded message states if you think you’re having an emergency, go to nearest hospital. W has had a couple of incidents where she ended up in a non Kaiser ER. She was treated and any out of pocket cost was same as if she went to Kaiser hospital.
while that might be Kaiser’s common sense approach, no way it is that of the Federal government (for Medicare):
“Emergency Care Services means inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health and, because of the danger to life or health, require use of the most accessible hospital available and equipped to furnish those services.”
per CFR
That said, Medicare is rather liberal in the interpretation as seniors just don’t flock to the ER unless they have a perceived need.
Per this article, non-US emergency care is not covered by Medicare or MA (except for a few exceptions - international water, or near Canada)
“If you want coverage for health care outside the U.S., you may want to enroll in Original Medicare and a Medicare Supplement Insurance (Medigap) Plan that covers overseas travel.”. That makes sense, since MA has no supplemental concept. For international travel, we purchase cancellation/travel insurance packages (usually approx 10% of trip cost), in case there are things not covered by my health insurance or husband’s supplemental plan.
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My friend has Kaiser HI. Their D was rushed to nearest hospital with knee or ankle tear/break due to ballet performance. Kaiser found it was not an emergency and refused to cover so the family was on the hook for whole very expensive charges. (She was in college, so no Medicare, but just illustrating different interpretation of emergency and costs for different Kaiser.)
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I don’t understand what you mean. Regular medicare does NOT cover foreign travel, while MA might and you have to check with your plan. My MA does cover foreign medical care in an emergency, but won’t cover evacuation back to the US so I have to have travel insurance for that.
Why is regular safer than MA?
I think the point may be that Medicare usually goes in combo with supplemental plan, some of which do cover international travel.
Because you can go to any provider anywhere who takes traditional medicare, but as you said, in other locations providers may or may not take other MA plans .
All MA plans are required to cover urgent and emergency care in the 50 states. Now, that does not mean that a local provider will accept them, but they do provide coverage in out of state locales.
Many MA plans provide coverage in other states, but sure, it’s always good to check first for states to which one frequently travel. Bcos MA plans can be a lot less expensive than a Medigap Supplement, any geographic restrictions might be worthwhile.
That is the key.
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My issue with advantage plans is twofold.
One the companies operate to make a profit. When they aren’t or are losing money, they need to make that up. One of those ways is to deny coverage or change providers.
The article I linked says that MA plans can pay 20% less than transitional Medicare. Medicare reimbursement is already very low in a climate where medical costs keep rising.
Could MA plans raise prices? They need to be profitable somehow?
Which raises the second question. And the biggest for me. Once you pick a MA plan, in many states you can’t switch back to traditional Medicare without underwriting. Who wants to change plans?, Ones that aren’t working with the medical issues you have now.
Because if you don’t have any medical issues, then what would be the reason to switch? The plan works for what you are experiencing now.
The problem is how it will work for you in the future.
Traditional Medicare gives more flexibility. Maybe not now but can we predict the future?
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I’m not sure we can predict the future of any health insurance plan at all…including Medicare.
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