General, HealthcareBy 2017-07-30T23:21:59+00:00 On January 27th, 20140 Comments


Seriously ill people must take their health insurance with them when they travel. But not all health insurance is portable and so continuing care and treatment away from home can be difficult.

Patients may have a bucket list to fulfill or be seeking alternative treatment or want to visit loved ones.  For many the risks of not having coverage are too great and could result in death or bankruptcy. Even healthy Canadians, for example, won’t cross the border to shop in the U.S. without buying travel medical insurance for just a day-trip to Costco because of their fear of American healthcare costs.

Even in the same state the same provider is not available in every county. In the nation, not every state offers the same providers. You can imagine what might be involved in foreign countries, but I will stick with the U.S. here.

In 2010 my terminally ill wife and I visited family in Palm Springs, CA where she needed a cancer chemo treatment during her visit. When I asked her Bellingham, WA chemo doctor’s office to arrange this for her I was told they didn’t do such things. When I asked my health insurer to make the appointment it said it didn’t do such things either, but offered me an 800 number for making an appointment myself. All that the 800-number offered was a list of healthcare organizations in the Palm Springs area that accepted my insurance. I was told I had to find a provider willing to accept a new patient, make the appointment myself, and arrange for my wife’s case file to be delivered to the provider before our arrival. This took about a month to accomplish and fortunately I had given myself three months to do the job.

Besides the time, effort and stress of doing this myself, there were other unsuspected problems a traveling patient and caregiver could encounter. As just mentioned just because you have private insurance doesn’t mean everyone will accept it nor does it mean that your insurer will reimburse those who do accept it.  Some providers don’t want to be bothered by one-time patients.

Instead of private insurance, if you had Medicare you could take it with you anywhere in the U.S. but if it were connected to an advantage plan you may face difficulties in other states and even in other counties in your home state. If you have an advantage plan, a private insurer manages your Medicare. To manage its costs and guarantee itself a profit, the insurer restricts its coverage geographically by contract. See footnotes for a description of Medicare Advantage Plans.

Traveling patients and caregivers tell me that a Medicare supplement plan is more portable and so more desirable, but don’t assume it will be trouble free. See footnotes for a description of Medicare Supplement Plans.

There are many choices and conditions affecting these plans, which are well documented in booklets, at state and federal government Web sites, and by community organizations and advisors. Washington’s State Health Insurance and Benefits Advisors (SHIBA) provide community offices to answer questions about Medicare and related plans.

When I first signed up for Medicare I attended an advantage plan seminar conducted by an insurer during the plan’s annual enrollment period from October 15 to December 7. I was surprised to discover that about half of the 40 to 50 attendees were already enrolled in the plan. Since the plan changed every year, experienced attendees had learned that the easiest way to find out what was new with their plans was to attend a seminar for enrolling new members. Because annual changes were so extensive was almost enough by itself for me to decide I didn’t want an advantage plan. What made my final decision easy was when I learned that advantage plans varied from county to county. Also, since advantage plan contracts were renegotiated annually my preferred provider might be dropped from the plan in any given year. Worse, the major local provider refused to sign the new contract, as a negotiating ploy, and patients were told they had to switch providers, which upset many advantage plan patients. Next, this advantage plan insurer yielded to the major provider’s demands and reinstated the provider as part of the plan after patients decided to either abandon the advantage plan or to seek a new provider.

Much later I discovered another reason why advantage plans were not for me: I discovered they were not portable, thus adding to their complexity and inadequacy. Supplement plans were more portable, perhaps because they were attached to your portable Medicare plan, although this portability may have its own limitations, but at least they were the same limitations as Medicare’s.

The advantage plan you have may drop coverage of your county because of unfavorable business circumstances while continuing in other near by counties. Knowing that your advantage plan is available in your state does not mean it is available in your county. Medicare’s Web site is a convenient place to learn what advantage plans are available year-to-year in your county.

With 3143 counties or equivalents in the 48 contiguous states there are potentially infinite advantage plans available. Of course the actual number of advantage plans is finite, but overtime the mix and confusion are nearly unlimited. Whatcom County, WA had 15 advantage plans available to residents in June 2013.  It is anyone’s guess how many advantage plans are offered in the U.S. or how many patients are annually affected by the need to change plans and review coverage when enrollment rolls around.

When I went to Medicare’s Web site while writing this posting I was instructed to enter my zip code to find advantage and supplement plans. On entering my zip code a message appeared telling me my zip code included multiple counties and instructed me to pick from a list the name of the county I resided in. Proof, if you needed it, that plans are county dependent.

When I went to the Health Insurance Washington Web site for Medicare Advantage Plans for 2014 I found 56 plans available in Washington State ranging in price from $0 to $326 per month that were available from 10 insurers in Washington’s 39 counties.

For more information in Washington State go to: insurance/medicare/what-is-medicare/medigap-plans/ or simply Google Medicare and follow the path to what you want.


                  Supplement Plans – Private companies sell individual insurance policies that fill gaps in original Medicare A and B plans, such as copayments, coinsurance, and deductibles.

                  Advantage Plans – The government pays a private insurance company you select to manage your Medicare A and B plans in return for your monthly Medicare premium and, perhaps, an additional premium. Advantage Plans may include drug coverage and vision, hearing, dental, foot, annual exam and wellness class coverage.



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