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Medical Insurance coverage while in SXM #319527
05/14/2024 05:36 PM
05/14/2024 05:36 PM
Joined: Aug 2000
Posts: 1,378
Hershey, Pennsylvania
Tom Offline OP
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Recently there has been conversation on TTOL regarding medical coverage for seniors while in SXM. Most of us know that Medicare won't cover anything out of the US. We just checked with our Advantage (supplemental) medical coverage plan and learned that they will cover most medical problems while we are in SXM. We are in our 70s and had thought that we might need medical evacuation insurance as well as medical and travel insurance to avoid potential $50,000 fees for evacuation. That is not necessarily accurate. I suggest that you contact your supplemental insurance carrier to get your coverage information. Understand that they won't replace travel insurance (usually only around $50) but may cover all standard medical and emergency evacuation when you cannot get the required medical attention you need in SXM. Some of us may save considerable $ with coverage we already have.

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Re: Medical Insurance coverage while in SXM [Re: Tom] #319528
05/14/2024 05:48 PM
05/14/2024 05:48 PM
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Posts: 82,887
Central Florida!
Carol_Hill Offline
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Tom--You have your terms totally crossway there. Medicare ADVANTAGE versus Medicare SUPPLEMENT plans are two totally different products. Also, it depends on what your definition of "MOST" medical problems is and how much they actually cover. Our supplement policy only pays 80%. 20% of $50,000 is still $10,000. The cost for a REAL travel insurance policy including medical evac is not that much, to me, versus the risk. We paid about $150 I think for our upcoming trip. When we were young, we NEVER bought travel insurance. Now? Sh*t happens when you're old.


Carol Hill
Re: Medical Insurance coverage while in SXM [Re: Tom] #319530
05/14/2024 06:14 PM
05/14/2024 06:14 PM
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Auburn, WA
SXMScubaman Offline
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I used to have medical evaluation coverage through DAN but now can't get it because of age 76 and state we live in. Best to really research it and get it all in writing.

Re: Medical Insurance coverage while in SXM [Re: Carol_Hill] #319531
05/14/2024 06:25 PM
05/14/2024 06:25 PM
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Kennys Online content
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Just had and a very good client of ours had to fly his Wife out on their cost and they still came back after a week abroad . God"s blessings .

Re: Medical Insurance coverage while in SXM [Re: Kennys] #319532
05/14/2024 06:47 PM
05/14/2024 06:47 PM
Joined: Mar 2009
Posts: 18,819
Auburn, WA
SXMScubaman Offline
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Difference being is if it was a private medical evaluation or just a commercial flight. Would be good to know the particulars.

Re: Medical Insurance coverage while in SXM [Re: SXMScubaman] #319535
05/14/2024 07:45 PM
05/14/2024 07:45 PM
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Kennys Online content
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The Wife had a Heart attack and survived , came back to the Island and finally just left today back home. Lots of his money spent .

Re: Medical Insurance coverage while in SXM [Re: Carol_Hill] #319543
05/15/2024 07:00 AM
05/15/2024 07:00 AM
Joined: Aug 2000
Posts: 1,378
Hershey, Pennsylvania
Tom Offline OP
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I don't claim to be an expert but our research on Medicare supplemental medical coverage (Medigap/Advantage/Supplement, whatever name an insurance company calls it) resulted in our learning that our coverage includes "normal medical care" that is available in SXM (broken bones, strains, sprains, dental and optical problems). It also offers cost support for life threatening medical conditions that cannot be provided by facilities in SXM. This includes medical evacuation to a facility that can provide such services. Our plan covers all of these via reimbursement after expenses are paid.

Look, my intent was to suggest that others look into their personal coverage so that they avoid getting something they already have. We were about to spend $600 for 2 weeks medical coverage in SXM because we were uninformed. Sometimes trying to help others goes unappreciated.

Re: Medical Insurance coverage while in SXM [Re: Tom] #319545
05/15/2024 07:15 AM
05/15/2024 07:15 AM
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Beverly MA (Boston's North Sho...
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I usually get the medical evacuation insjurance. The basic medical care on the island seems to be pretty good and fairly inexpensive vs. US prices.

Re: Medical Insurance coverage while in SXM [Re: Tom] #319546
05/15/2024 07:39 AM
05/15/2024 07:39 AM
Joined: May 2007
Posts: 791
East Texas
Jaybird Online content
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We use Geo Blue. Cost for one week was $129 including $500,000 medical evac. They offer cheaper options. I cannot comment on how good they are because thankfully we have not had to use it.

Re: Medical Insurance coverage while in SXM [Re: Jaybird] #319551
05/15/2024 08:16 AM
05/15/2024 08:16 AM
Joined: Mar 2009
Posts: 18,819
Auburn, WA
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Half a million is a lot of coverage. You planning an iner galactic trip? jester

Re: Medical Insurance coverage while in SXM [Re: Jaybird] #319553
05/15/2024 08:46 AM
05/15/2024 08:46 AM
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Kennys Online content
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Thanks for the figure and just spoke to our friends about this for their next trip to our Island.

Re: Medical Insurance coverage while in SXM [Re: Tom] #319559
05/15/2024 09:18 AM
05/15/2024 09:18 AM
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Posts: 82,887
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Carol_Hill Offline
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Tom--again, there is a HUGE difference between ADVANTAGE and SUPPLEMENT. You need to know the difference. If you choose an advantage plan, h*ll, you often aren't covered inside the US for things, if you go to the wrong provider. And even if you are technically covered outside the US, that doesn't mean that you don't have a HUGE co pay. COVERAGE is one thing. Coverage with no co pay is a whole different thing. People should look into their personal coverage, yes. But even in your own case, I don't think you went far enough.

Plus "reimbursement after expenses are paid"?? Again, you have to shell out $50K for a medical evac on your credit card and wait 6 months or a year for them to pay you back?

And you don't need to spend $600 for two weeks. That's crazy. We normally can get what we need for about $150 for 10 days. If you're looking primarily at the medical end of it, compare the policies, like on Insure My Trip, and you can get a good deal.


Carol Hill
Re: Medical Insurance coverage while in SXM [Re: Carol_Hill] #319579
05/15/2024 12:14 PM
05/15/2024 12:14 PM
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Peaceful Eastern North Carolin...
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Even in the US, the advantage plans are not the best option. Providers here are always happy when we say we have a supplement and not an advantage plan. Those extra benefits that the advantage plans tout aren't really worth what you pay for them.

Re: Medical Insurance coverage while in SXM [Re: Tom] #319581
05/15/2024 12:28 PM
05/15/2024 12:28 PM
Joined: Oct 2023
Posts: 107
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TJTrippe Offline
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Tough crowd here some times but you started a worthy discussion primarily to make sure you know what you got and do research.

I’ve learned some Medicare stuff here but as with all govt stuff so many scenarios and ins and outs to minimize your losses in the game of healthcare.

We too skipped over trip insurance by rolling the dice. No more.

Everyone absolutely needs repatriation medevac insurance to your home base hospital, not just some random Miami hospital.

I don’t know how the travel insurance companies make money as we have had many trip interruptions with baggage, hotels, clothing. Nothing big medical or medevac.

Most travelers must be honest chaps.

I just leaned there are to R’s in the word interruption thanks to TTOL spellcheck.

Re: Medical Insurance coverage while in SXM [Re: TJTrippe] #319585
05/15/2024 01:14 PM
05/15/2024 01:14 PM
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Kennys Online content
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Our friend flew to Guadaloupe and back to St.Maarten $ 21,000.00 of his own money .

Re: Medical Insurance coverage while in SXM [Re: Carol_Hill] #319588
05/15/2024 01:48 PM
05/15/2024 01:48 PM
Joined: Aug 2000
Posts: 1,378
Hershey, Pennsylvania
Tom Offline OP
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Tom  Offline OP
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Carol,
Some clarification is appropriate here. I summarized our personal medical coverage.
We asked our insurance company for specific medical coverage in Sint Maarten. Their response was clear. If we required medical treatment of a basic nature while on vacation in SXM, it would be covered as if we were in the US, (we pay no copay for doctors or specialists) as there are no in network providers in SXM.. As stated earlier, any serious medical emergency that exceeded the capability of SXM medical personnel, our insurance representative stated that when contacted by the SXM doctor/hospital, preauthorization would be made and we would be evacuated to the nearest in network facility in the US that offered the required services. No $50,000 evacuation fee which has so many people concerned. I am aware that medical plans vary from state to state in the US.
Yes, even we were surprised at our emergency coverage and that is why I suggested that others contact their insurance provider to learn more about their personal coverage and potential to save money.
TG

Re: Medical Insurance coverage while in SXM [Re: TJTrippe] #319630
05/16/2024 06:55 AM
05/16/2024 06:55 AM
Joined: Aug 2000
Posts: 1,378
Hershey, Pennsylvania
Tom Offline OP
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TJTrippe
Agree with most of your reply except the medivac part. For me, I care a lot more about someone knowing how to save my life and a lot less about where that saving happens.

Re: Medical Insurance coverage while in SXM [Re: Tom] #319653
05/16/2024 11:02 AM
05/16/2024 11:02 AM
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Posts: 3
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Brad_Va Online content
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An underlying theme here is managing gaps and redundant coverage. We use SquareMouth (www.squaremouth.com) to find policies with the specific features we need. Zipling in Costa Rica versus pub crawling in London include very different risk profiles. I have no interest in buying cancellation or interruption insurance because it’s already bundled with one of our credit cards. SquareMouth lets us toggle on & off the features we want without paying for something we don’t need.

Brad

Re: Medical Insurance coverage while in SXM [Re: Brad_Va] #319654
05/16/2024 11:26 AM
05/16/2024 11:26 AM
Joined: Aug 2000
Posts: 82,887
Central Florida!
Carol_Hill Offline
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Brad--sounds very much like Insure my Trip. You can customize exactly what you want to purchase.


Carol Hill
Re: Medical Insurance coverage while in SXM [Re: Carol_Hill] #319692
05/16/2024 06:14 PM
05/16/2024 06:14 PM
Joined: Dec 2003
Posts: 411
Greer SC
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bostonbob Offline
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Carol could you share where you got insurance for that price. We purchased insurance for our last two trips and paid more than you. Luckily we were insured last month when we had to cancel the morning of our flight. We had a check in hand within two weeks which totally amazed us.


Lived most of my life in Massachusetts
Re: Medical Insurance coverage while in SXM [Re: Tom] #319709
05/16/2024 11:42 PM
05/16/2024 11:42 PM
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TJTrippe Offline
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Your probably right if under life-threatening situation, but if stabilized and being repatriated from SXM, Europe or Asia, they may as well take us where we can navigate the health system and have a long-term network. Another few hours in the plane could make life a lot easier for recovery.

Re: Medical Insurance coverage while in SXM [Re: Tom] #319711
05/17/2024 06:25 AM
05/17/2024 06:25 AM
Joined: Apr 2002
Posts: 5,921
New England (home), St. Maarte...
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Your comment "but may cover all standard medical and emergency evacuation when you cannot get the required medical attention you need in SXM" may be subject to misinterpretation. I can tell you that (as a long time rep for a company providing medical evacuations) you MUST get to a hospital first for evaluation and emergency treatment. Before you can be evacuated by a proper, qualified company (mine is from Arizona), you must be declared "fit to fly" which says putting you on a plane will not endanger your health. And evacuations to the US now cost roughly $55,000 or more payable in cash in advance. That service is NOT normally provided in any health insurance policy. But if it is...check their fine print. For medical evacuations, it probably says they will "take you home OR TO THE NEAREST APPROPRIATE FACILITY" and their decision on the nearest appropriate facility may be the St. Maarten Medical Center, which is NOT home. Or they could drop you in St. Thomas or San Juan, both US territories. That's not home either. Home is where you live....big difference.

Jeff


Jeff Berger
Visiting SXM Since 1978
Re: Medical Insurance coverage while in SXM [Re: bostonbob] #319722
05/17/2024 08:50 AM
05/17/2024 08:50 AM
Joined: Aug 2000
Posts: 82,887
Central Florida!
Carol_Hill Offline
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bob--I always book our insurance on Insure my Trip. Just go there and put in your information and what your needs are. It will bring up a huge list of policies. Then you can have them ranked cheapest to most expensive, if you like. For me, the nonrefundable part of the cost of the trip is usually very low, so, even though I get a comprehensive policy, I'm mostly getting it for the medical part of the policy. I would suspect most here are the same--if you literally couldn't go, probably you could get a full refund or transfer of your rooming cost (but maybe not, so check that out). Also, if you cancel a few days out, often you can get a refund of airfare to travel credit. Just look at your particular situation. But, Eric is the oldest and he is 70, so I wouldn't be surprised if the cost goes up pretty steeply, based on age. I haven't put in a fake age to check that out though. BUT! the older you are, the more you need it.

As far as medical evac, for us, a hospital in Miami is OK. If we had to be evacuated from anywhere, the closest suitable hospital to our house would probably be either Tampa or Orlando and either one of those is an hour and a half from home, so 3.5 hours to Miami isn't that different.


Carol Hill
Re: Medical Insurance coverage while in SXM [Re: jmbcomms] #319742
05/17/2024 11:03 AM
05/17/2024 11:03 AM
Joined: Aug 2000
Posts: 1,378
Hershey, Pennsylvania
Tom Offline OP
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Tom  Offline OP
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Jeff,
We thoroughly researched this subject. Our insurance folks were specific that if required and the emergency medical treatment was unavailable in SXM, (which would be a hospital and appropriate Doctor) the medical people in SXM would need to contact our insurance people and a preauthorization for medical evacuation would be issued by the insurance company. We confirmed that cost would be the responsibility of the insurance firm. I did not claim that evacuation would be to my home hospital but would be to a qualified medical facility. We are aware of your relationship with SkyMed but since we are 78/75, we are also aware of that cost. We simply just asked our personal insurance representitive and as stated, you must get the very best care during an emergency medical event. We know some folks want to go home, we would like to get to the nearest, in network, facility in the USA. Will we get additional coverage? We might. There are many websites that offer choices, length of coverage, and associated costs for folks like us.


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