Health Insurance Coverage While Traveling in Canada?

[hankfolk]

What are US Citizens traveling in Canada using for Emergency Medical Coverage, while traveling in Canada?

Now that cross border travel is permitted, we would like to spend several months traveling Canada this Summer. Our one major concern is “Heath Care Coverage”. Neither Medicare or Blue Cross, Blue Shield provide coverage outside of the USA. 
We do have “Emergency Evacuation” coverage via FMCA and Coach Net. But want to have some form of Emergency hospitalization and medical coverage in addition.

Hank Folk

W5SZ

[Kirk W]

If you are covered by Medicare, supplements of either plan F or plan G cover medical issues when outside of the US. 

[agesilaus]

Quote

In general, Medicare only covers recipients while in the United States. This means that if you have Medicare and you travel to Canada, your healthcare costs will not be covered, even if the services or medications provided would normally be covered in the United States

 

I hadn't even thought of that issue before. Kirk may have the solution tho. I'm not sure what BCBS covers. But it looks like it may work in Canada. We have dual coverage since my wife isn't on Medicare yet.

Edited December 18, 2021 by agesilaus

[docj]

2 hours ago, Kirk W said:

If you are covered by Medicare, supplements of either plan F or plan G cover medical issues when outside of the US. 

The coverage exists but it's not as broad as some might think from your statement.  Plus it's limited to a $50k lifetime maximum and you have coverage for only ~60 days.  The summer when we spent 3 months in Canada we came back to Maine and documented that fact to make sure that we could restart the "60 day clock."

This is from a Medicare document:

Medigap plans C, D, E, F, G, H, I, J, M, and N pay 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year. These Medigap policies cover foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care. Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.

[hankfolk]

1 hour ago, docj said:

The coverage exists but it's not as broad as some might think from your statement.  Plus it's limited to a $50k lifetime maximum and you have coverage for only ~60 days.  The summer when we spent 3 months in Canada we came back to Maine and documented that fact to make sure that we could restart the "60 day clock."

This is from a Medicare document:

Medigap plans C, D, E, F, G, H, I, J, M, and N pay 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year. These Medigap policies cover foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care. Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.

Thanks.

In today’s environment $50,000. In medical expenses for an emergency is just the starting point.

We have exceptional BC/BS coverage and I was told it would not cover us outside of the USA. Thus my quest to find some form of emergency medical insurance. Enough to cover costs until you can be evacuated to the USA.

[docj]

11 minutes ago, hankfolk said:

We have exceptional BC/BS coverage and I was told it would not cover us outside of the USA. Thus my quest to find some form of emergency medical insurance. Enough to cover costs until you can be evacuated to the USA.

On our last trip to Canada I explored short-term medical plans for visitors.  Although I didn't purchase one that time, I think I might on future trips.  As I recall we could get acceptable coverage for 90 days and the costs I was looking at were ~$500-1000 each depending on which specific plan was selected.

One important advantage of buying a plan like that is that it pays "upfront" whereas Medicare Plan F or G would work only as reimbursement for your expenses.  I much prefer not to have to pay out of pocket and then have to fight to get my money back.

[Kirk W]

15 minutes ago, docj said:

As I recall we could get acceptable coverage for 90 days and the costs I was looking at were ~$500-1000 each depending on which specific plan was selected..........

I much prefer not to have to pay out of pocket and then have to fight to get my money back.

It may depend on your insurance carrier, but the one such claim that we have had was paid promptly once submitted. We have never stayed out of the US beyond 90 days and only once more than 30 days. Like any type of insurance purchase, you need to evaluate the degree of risk and your ability to deal with it.  For the short time that we are out of the US, $1000-$2000 premium is more than we choose to pay. 

[docj]

1 hour ago, Kirk W said:

For the short time that we are out of the US, $1000-$2000 premium is more than we choose to pay. 

That's precisely why we didn't buy insurance in 2019 when we were in Canada for ~80 days.  We needed to refill a prescription anyway so we drove from PEI back to Maine so we could do that and restart the 60 day clock with respect to Plan F benefits.   I called Medicare and the people I spoke with were confident that coming back to the US for even a moment would give us another 60 days of coverage.  

[whj469]

Starting on January 1st my Medicare Advantage plan will cover us for emergency care in a large number of Countries, including Canada.

[whatsc]

Hmm, I haven't been living in America for a long time, but I've heard that some insurance programs cover expenses outside the USA. But I know that there are special travel insurance policies. I am from Europe myself and I heard a story when a tourist in Germany or Austria looked at https://www.oebbfahrplan.com/de / schedule and realized that the train was moved. He decided to walk around the neighborhood and somehow wandered into the woods, where he was attacked by a wolf.  He managed to escape but needed treatment. His treatment was covered by travel insurance. I really don't know how true this story is, but I'm sure you can find something similar in the country where you are going to go.

Edited December 28, 2021 by whatsc

[LiveWorkDream]

We are not Medicare age. When we were in the Yukon in 2018, I double checked that Blue Cross would cover us in an emergency. Yes, they would, but their definition of "emergency" seems to depend on many factors too complicated to get into here. Your best bet is to pick up a medi-vac plan like MASA air ambulance services, in case the worst happens and you need extensive care.

This year we also plan on traveling around Canada. We have Kaiser health insurance now, and they've also guaranteed emergency coverage, to a point. We will have our MASA plan.

Maybe we'll see you up north!

[einmann]

The Medicare plans that I have seen (Advantage plans and Supplement plans) that provide coverage outside the USA only provide "emergency" coverage.  I wonder about the definition of "emergency". Who defines "emergency"? When does the emergency start (e.g. when you call 911?) or when you get to the emergency room? or when you are admitted as a hospital inpatient?

Then theres the question of when the "emergency" ends. Is it immediately after the (e.g. open heart) surgery? or is it when you are stable enough to be taken out of the ICU but stil need to continue hospitalization? or is it when you are discharged from the hospital? or is it when you are out of rehab? or is it when you are fit to travel home? What happens if the "emergency" is defined as over, but you still need to be hospitalized or to have rehabilitation? Is that covered outside the USA? Is it "fully" covered and if not, how much will be my financial responsibility? What if I'm not capable of driving my RV home for days or weeks after I'm discharged from all medical facilities? Are any of those costs covered?

Has anyone read the fine print? Who has some answers?

[Blues]

For what it's worth, the questions about what constitutes a covered emergency exist for non-Medicare people who are traveling within the U.S. and have a health insurance plan that provides only emergency care when they're outside their insurance provider's network.  And I've never found any guidance on the very questions you ask.

But I just checked a non-Medicare Blue Cross policy, and for definitions of "emergency medical condition" and "emergency services," it punts to the definitions in Section 1867 of the Social Security Act, which deals with hospitals being required to treat emergency patients.  I wouldn't be surprised if a lot of insurance policies do the same thing.

The definition of an emergency medical condition is about what you'd expect.

The Social Security Act requires only that people with emergency medical conditions be stabilized, and the Blue Cross policy also talks in terms of stabilization in emergency situations.  "Stabilized" is defined in the Social Security Act as: "no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility."

"Transfer" is defined as "the movement (including the discharge) of an individual outside a hospital’s facilities at the direction of ... the hospital."

But what does it actually mean?  I assume being discharged from the hospital definitely means the "emergency" is over.  But what if the patient needs more treatment but won't deteriorate during the time it takes for an ambulance to get him to another facility--is the emergency over once he's at that point?  Is the emergency over if he's at that point and isn't actually transferred but instead stays in the same hospital where he got emergency treatment?

I think/fear that all of these situations mean the emergency is over, which is bad news for the insured.  But who knows.  I assume the insurance companies decide this on a case-by-case basis and it's up to the insured to fight it if they don't like it.

So I guess my answer to question "Has anyone read the fine print?" is "Yes, I have."  And my answer to your question "Who has some answers?" is "Not me."

[docj]

12 hours ago, Blues said:

But what does it actually mean?  I assume being discharged from the hospital definitely means the "emergency" is over.  But what if the patient needs more treatment but won't deteriorate during the time it takes for an ambulance to get him to another facility--is the emergency over once he's at that point?  Is the emergency over if he's at that point and isn't actually transferred but instead stays in the same hospital where he got emergency treatment?

I think/fear that all of these situations mean the emergency is over, which is bad news for the insured.  But who knows.  I assume the insurance companies decide this on a case-by-case basis and it's up to the insured to fight it if they don't like it.

You raise some excellent points.  I'll add to the mix  the fact that Medicare only covers $50k of emergency treatment outside the US (per lifetime) and $50k is an amount that can be spent in far less time than one might imagine.

A few years ago my wife had a surgical stay in the hospital for a relatively minor condition.  When I was reading through her EOBs a few months later I noticed that the hospital had billed Medicare ~$75k for the surgery and the couple of day stay and Medicare had allowed and paid ~$55k of the charge.  That's an example of how little $50k really covers.

[Blues]

On 1/22/2022 at 8:17 AM, docj said:

I'll add to the mix  the fact that Medicare only covers $50k of emergency treatment outside the US (per lifetime) and $50k is an amount that can be spent in far less time than one might imagine.

At least it will be care outside the U.S., and therefore presumably a lot cheaper. 

And just a reminder--it's Medicare Supplement plans that cover emergency care in a foreign country if it's incurred in the first 60 days of a trip, and subject to a $50,000 lifetime limit.  And they pay only 80% of expenses.

Medicare itself will pay for emergency care in Canada, if you're "traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs."  And if this happened, presumably the Supplement would pay your coinsurance portion, so you'd be covered for 100%.

https://www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-States.pdf

On 12/18/2021 at 2:36 PM, hankfolk said:

We have exceptional BC/BS coverage and I was told it would not cover us outside of the USA.

Do you remember who told you that?  Have you looked at your policy?

I looked at an an Obamacare Florida Blue policy (from 2021), and it provides coverage outside the U.S. through the Blue Cross Blue Shield Global Core program.  In the policy language, I see no mention of a limit, or even language limiting it to emergencies. 

I have no experience with it, other than reading the policy and realizing Global Core existed, and then looking at the Global Core website.  But if I had a non-Medicare BCBS health insurance policy and was looking into coverage while traveling in Canada, I'd sure investigate.

[docj]

19 hours ago, Blues said:

And just a reminder--it's Medicare Supplement plans that cover emergency care in a foreign country if it's incurred in the first 60 days of a trip, and subject to a $50,000 lifetime limit.  And they pay only 80% of expenses.

A couple of years ago we spent nearly 90 days in Canada and we drove back to the US on our ~59th day so we could restart the "first 60 days of a trip" clock.  I had called Medicare and the person I spoke with said that the clock would restart by just returning to the US no matter how long we stayed there.  So we drove from PEI to Maine, got some Rx from Walgreens and drove back!