& Vacations with a
Major Illness or Disability:
Are You Covered?
by Thomas P. McCormack © 2000
We hear a lot about planning for vacations and travel while ill: how to stock, pack and carry medications; what immunizations to get; how to stay in touch with your doctor; etc., etc. But what we never hear is what happens to benefits—including health coverage—for those traveling out-of-state or out-of-the-country. Here’s a brief overview.
Neither Medicare nor Medicaid ever pays for care outside the United States. State Medicaid programs generally refuse to pay for anything other than life-or-death emergency room and emergency hospitalizations in other states in the union. And then, since Medicaid is a welfare program, eligibility workers may well demand to know how and why a supposedly poor person on Medicaid can afford the “luxury” of travel.
Federal law does require state Medicaid programs to allow their patients to see medical providers anywhere in the country (but not overseas) in the case of life-and-death emergency or for ongoing, regular care in state border areas [e.g., the Washington, DC area, where patients could get care in DC or in nearby Maryland or Virginia, no matter which state’s program they’re enrolled in; or greater New York City, together with its nearby New Jersey and Connecticut suburbs]. But this is generally an empty right because only hospitals---because of the very large bills at stake for cases of emergency hospitalizations of visitors—are willing to bother to enroll as providers in another state’s Medicaid program. Doctors and other providers only enroll in their own state’s Medicaid program with great reluctance; few, if any, bother with other states. And, of course, if one is treated by a medical provider who is ineligible or unwilling to enroll in one’s home state Medicaid program the bills must then be paid with one’s own funds. )
State AIDS Drug Assistance Programs (ADAPs)---like all state programs for the needy—require one to be a resident and assume that long absence means a loss of residency. They don’t offer out-of-state and out-of country coverage. Hence, ADAP purchase of prescriptions in other states or overseas is generally forbidden. (To take one example, California ADAP discovered a recipient who’d left the state [to give long term care to an ailing old friend] by monitoring claims for prescriptions by drugstores which shipped to the customer at an out-of-state address and by checking on mail forward orders.. They terminated his coverage, of course. He then found that he was over-income for ADAP in his new state.)
Some Medicare supplement insurance (Medigap), in the few states which even offer it on an equal access basis to the disabled, don’t cover care outside the country—while some do. Check plan brochures to be sure. Some Medicare HMOs often don’t either---while some do. Few, if any, Medicaid HMOs cover care while overseas ---and few even cover non-emergency care in other states of the union.. To be sure, read plan brochures carefully and question the staff closely. (If you plan a long trip and carefully stock up on and pack all the drugs you’d possibly need during travel---and if Medicare and/or Medicaid is your primary health insurance—it might be possible to enroll in a foreign care-covering Medigap plan, Medicare HMO or Medicaid HMO just before leaving in order to secure its out-of-country coverage. And if HMO care really isn’t your cup of tea, you could then disenroll upon returning. )
Most—but far from all! —private health insurance plans and private HMOs offer at least some foreign care: again, one must read the policy carefully and question staff about details.
VA health care is not available outside the United States and the Philippines except for emergency care at European and Far East U.S. military bases for “service-connected” compensationers. (Compensationers are those veterans who get VA checks for illnesses or injuries, which began while on active duty.) Compensationers can have medical care from approved foreign sources covered by seeking advance permission for such coverage from the VA. Contact the Foreign and Insular Affairs Unit, Medical Administration, Veterans’ Affairs Medical Center, 50 Irving Street, NW, Washington, DC 20422 (202) 745-8242; numerous forms must be completed. Even so, because the clerical staff at overseas U. S. military medical facilities don’t know the complex VA rules well, other, non-compensationer veterans who present VA patient identity cards at emergency rooms of overseas U/S/ military medical facilities have been known to mistakenly receive free care
Income and Related Programs
Supplemental Security Income (SSI), Temporary Assistance to Needy Families (TANF), VA disability pensions, general assistance, home relief, home energy assistance, food stamps, school lunch program enrollment, Women’s, Infants’ and Children’s (WIC) benefits, HOPWA and other housing subsidies are canceled for anyone out of the country (or, usually, even the state) over 30 days. And, again, when officials discover the travel, or when those dropped from benefits reapply upon their return, difficult questions about how the “luxury” of travel could have been affordable (for someone supposedly poor enough for welfare) must be answered satisfactorily. (While it’s possible to simply not tell public agencies about the travel to avoid this problem, the difficulty is that one is on written notice---under penalty of fraud---to alert agencies to just these changes of circumstances. And agencies’ telephone calls and letters—if not promptly and properly answered---can and do quickly alert them that a disqualifying loss of residency has occurred. Agencies swiftly cancel benefits when they get “not at this address,” “moved,” “addressee unknown” or change-of address responses through the post office and they respond similarly when they encounter telephone recordings announcing a disconnected number or referring callers to new numbers out-of-state.)
Social Security Disability Insurance (SSDI) and VA disability compensation are payable to Americans citizens outside the country over 30 days. However, SSDI is not payable overseas to any alien—even aliens who are qualified U.S. “permanent residents” This is so even though many aliens fairly acquired those benefits through taxes paid while working. (One way of avoiding this prohibition---if you are a legal resident alien who won’t become a citizen, but who wishes to retire eventually to your home country and still enjoy benefits based on your U.S. earnings--- is to arrange to have your American Social Security earnings record transferred and credited to your home country’s Social Security system. U.S. earnings, together with what you earned while home, can generate and increase one’s benefit through the home country’s own Social Security system. Credits can be so transferred ---and then paid to you through your home country’s system---under treaties most countries have with the U.S. Contact your home country’s consulate for details.)
Of course, Social Security and other benefits are not payable at all---even for work on which taxes were paid---to illegal aliens, whether they are in the U.S. or outside it. Provisions of private, employer and union disability pension and income-insurance programs vary: check the plan materials and ask detailed questions before leaving.
Congress and the Social Security Administration recently became alarmed when it was discovered that untold thousands of SSI checks were going to post office boxes in U.S. towns near the Mexican border, causing crowding in post offices and nearby check-cashing facilities and banks on the first of the month, with recipients quickly then dispersing back across the border for the rest of the month. Many citizens, in effect, had “retired” to Mexico while on SSI---illegally! As a result, severe new restrictions on and monitoring of post office box usage are going into effect in some of these areas
Readers should beware: Many policies are sold as “travel health insurance” when all they offer is trip interruption and cancellation, medical transport/evacuation benefits and telephone advice lines—but not actual travel health insurance. There are unconfirmed reports that Mutual of Omaha, International Trip Assist and Carefree policies include genuine health insurance coverage that can be used by traveling patients with pre-existing conditions. If interested, make careful inquiries---being sure to ask about the all-important pre-existing condition clauses.
Travel Guard (800) 826-1300 and CSA Travel Protection (800) 873-9855 however, do offer the only genuinely confirmed policies that do this. These policies even cover pre-existing medical conditions for those who purchase the insurance within seven or fourteen days of making an advance trip down payment through a travel agent. Besides paying health costs up to $10,000, the policies also cover trip cancellation, delay and interruption; medical evacuation; a medical advice line; luggage and document loss; assistance in expediting cash advances from one’s credit card or bank; auto rental insurance; and accidental death benefits. Typical premiums would be $235 for a $3,000 trip purchase (Travel Guard, which ties premium prices to length and price of trip) or $87 for up to a 31 day trip for someone under age 55 (CSA Travel Protection, which ties premium prices to age and length and price of trip).
“Hospital indemnity” insurance (“$100 a day direct to you while you’re in the hospital!”) will often pay for days in foreign hospitals. For about $35 monthly, and with a 12 month preexisting condition waiting period, Mutual of Omaha and Physicians’ Mutual offer benefits of about $100 per day . Those over age 50 can get similar coverage—with only a 3 month preexisting condition waiting period—through the AARP.(Check with their 800 numbers and make detailed inquiries about foreign hospital coverage)
Some credit cards offer limited benefits. The American Express platinum card, which costs $300 yearly, pays for emergency medical evacuations and some treatment . But read the fine print to be sure. Visa offers ”optional enhancements” for those banks issuing its credit cards to cover, at extra cost, emergency evacuation and some actual medical insurance coverage. Cards issued by credit unions often carry this coverage as a marketing tool . Again, read plan materials with care to make sure that you’re buying actual insurance and not just medical evacuation and medical advice line services.
You can get the best, most up-to-date advice about travel health insurance from those travel agents who have long catered to a gay clientele. They more than anyone are likely to have acquired insurance details because of their long experience serving their HIV-positive customers.
As the American Express advertisement tells us, “Don’t leave home without it!”: Check in advance about your health coverage and other benefits before you leave!
primer at www.outandabout.com
CDC’s HIV Traveler Precautions at www.cdc.gov/travel/hivtrav.htm.
Travel (Oct. ’99) newsletter of Consumer Reports (800-234-1645; $5 to POB 53016, Boulder, CO 80322)
Society for the Advancement of Travel for the Handicapped (212) 447-1928 or 447-0027
International Association for Medical Assistance for Travelers (716) 754-4883
American Society of Travel Agents (703) 739-2782
Get Challenged, Ojai, CA (800) 328-4102, Salmon River rafting for HIV+ kids ages 13-16
Camp Heartland, Milwaukee, WI (414) 744-1118, programs for HIV-affected youth ages 7-16
Sunburst Projects, Petaluma, CA (707) 588-9477, HIV+ kids’ camp & training for junior camp counselors
Splore, Salt Lake City, UT (801) 484-4128, adventure trips for PWAs and other disabled persons
Find travel agents catering to gays by scanning for their advertisements in any gay newspaper or magazine.
Thomas McCormack wrote the "AIDS Benefits Handbook" and did benefits policy work with the federal Department of Health and Human Services and several AIDS and disability advocacy groups. He now consults with the Title II Community AIDS National Network. E-mail him at firstname.lastname@example.org
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