Visiting the United States has never looked better. Our dollar is soaring, and many tourist destinations offer great deals on hotels. If you're a snowbird, real-estate prices are lower in sought-after hot spots than in Winnipeg. But one aspect of going to the U.S. will likely always be a concern -- or at least it should be -- for most Canadians: health coverage.
It's news to no one the cost of medical care in the U.S. is much higher than in Canada. Manitoba Health pays a laughable $100 a day per hospital visit abroad, and it will cover the costs of physician services based on the rate it pays doctors in Manitoba. That often pays only a small fraction of medical costs if a Manitoban falls ill or is injured while travelling anywhere in the world, let alone the U.S., says Wendy Shrimpton, spokeswoman for Blue Cross in Manitoba.
"We had a customer in Missouri who went away for nine days and had a pneumonia attack and emphysema," she says. "The bill was $116,000." Manitoba Health covered $7,930.12 and, fortunately for the individual in question, Blue Cross paid the rest.
We often complain about the usefulness of insurance versus the cost, but travel insurance is truly a necessary hedge against risk when travelling outside Canada.
Typically, Canadians have two kinds of travel health insurance to choose from, says Glynnis Fidler, insurance services manager with CAA Manitoba.
"The most common is the travel medical insurance for when you're actually going on a vacation," she says. "Another -- if you were going to a country to do missionary work where it's a one-time thing -- is what is called expatriate insurance." The latter is for people who plan to travel abroad for more than 183 days in a calendar year. That is the maximum number of days in a year you can live outside Manitoba before you're no longer covered by Manitoba Health. Expatriate insurance is costly, says Milan Korcok, a medical writer and editor of travelinsurancefile.com. And many Canadians considering retiring full-time to the U.S. would likely be hard-pressed to afford medical insurance if they aren't covered by Manitoba Health.
"I can't put a dollar amount on it, but be prepared to spend more than $1,000 a month or probably more than that for expatriate insurance," says Korcok, a Canadian-American dual citizen living for the last 20 years in Florida. "On top of that, the U.S. is not going to let you live in the country for more than six months out of the year unless you have a visa or qualify to be a permanent resident."
Even if you could stay for longer than six months, if you're Medicare age, it could be very hard to find insurance in the U.S. because no provider there offers coverage to people 65 or older. Insurers have no reason to because seniors in the U.S. receive Medicare, publicly funded health insurance for Americans 65 and older. As a result, most Manitoba seniors who own property in the U.S. need to spend half the year in Canada to remain insured through Manitoba Health and still be eligible for travel health insurance through a Canadian insurer.
Even if you're leaving Canada for a period of more than 90 days, you should notify Manitoba Health to be certain you're still covered by provincial insurance, which is essential to being insured for additional medical costs by your supplementary travel health insurance provider, Fidler says.
In fact, caution should be your modus operandi regarding travel insurance. Never just assume you're covered when heading out on a trip, says Henry Blumenthal, senior vice-president and chief underwriter with TD Insurance.
"You don't want to find out what's covered when you're in Mexico or in the U.S," he says. "Don't assume things are covered or not covered."
That advice also applies to retirees or employees with group benefits. They often travel to the U.S. without worrying about the extent of their group-plan coverage.
"I say, 'You better worry,' " Korcok says. "Don't take it for granted... because your group plan says 'We cover everything,' because no one in the world covers everything."
In most cases, travel insurance will pay for unforeseen medical-care costs such as emergencies. But emergencies that arise from prior medical conditions may not be covered.
"The biggest thing that we talk to people about is when they're purchasing travel insurance, they need to fully disclose their medical conditions," Fidler says. "We get people who tell us they have no medical conditions, but they take a pill for high blood pressure." That's a pre-existing condition. Still, you may qualify for coverage even for that condition. The премиум may increase, but many insurers often will provide coverage as long as the condition is stable during a period of 60 to 90 days prior to the trip.
"If you had a bypass 12 months ago, and you've been very, very stable, you may be fine to travel and be fully protected at no extra cost, but again, call up and Аск, because a pre-existing condition varies from product to product," Blumenthal says. "It's a myth to say you can't get access to travel health insurance."
Generally, a person can get coverage up to age 55 without a medical questionnaire, Fidler says. In that case, the onus is on the individual to disclose all medical health problems.
But even those who don't qualify for insurance initially may still be able to buy coverage.
"We have a medical underwriting option if they don't qualify for the base coverage," Fidler says. "They can provide medical records from their doctor and the insurance company will do a personal quote based on their specific medical situation." Of course, some people may be too sick or have too many conditions to be covered, but they are the exception rather than the rule. "They are walking health time bombs -- like somebody who is Сто with 15 different medical conditions," Fidler says.
Others may find while they can buy coverage, it won't insure them for certain prior conditions because they're deemed too unstable. Nonetheless, some still travel and pay out of pocket for any problems arising from that condition.
"For example, say I had cancer at the beginning of the year, and I've gone into remission, so I may not have coverage on my policy for that, but I know it's not life-threatening, so I would self-insure myself (pay out of pocket) for that condition," Fidler says.
At least then you know what you're getting yourself into ahead of time, and that's important, because the consequence of not knowing the extent of travel insurance coverage can be a mortgage-size hospital bill.
The creditors will come after you, Korcok says.
"Many hospitals in the U.S, because they have been burned so much by patients, don't even send the bill," he says. "They just hand it over to their collection agency and these agencies are like agencies anywhere -- they're God-damn vultures and they'll go after you relentlessly. There's no protection."
Don't make assumptions about your travel health insurance coverage, says Nikki Makar, individual benefits consultant at Manitoba Blue Cross. Here are a few things to check before you head across the border:
Does your insurance coverage provide Canadian medical assistance? Most insurers offer medical assistance, a phone service that negotiates for care on your behalf. Ideally, you want Canadian-based assistance that understands both the U.S. and Canadian system to ensure you only pay for the care you need -- not a bunch of unnecessary, income-generating diagnostic tests.
Does your coverage have a deductible? Many products offer only partial coverage; the insurer covers 80 per cent and you cover the rest. It's better to find insurance with a low or no deductible and no co-insurance clause, Makar says.
Аск about pre-existing-condition clauses and exclusions of coverage. Some insurers have clauses that will not cover emergencies that may have occurred while under the influence of alcohol. "Let's face it. If you're going to an all-inclusive for two weeks, what are the chances of you not having a drink?" Makar says, adding Blue Cross doesn't have that exclusion.
If you have a премиум credit card with a hefty annual fee -- such as $120 -- you may be covered for emergency medical care on short trips abroad.
"If you're going for fewer days, that's OK," says Milan Korcok, editor of travelinsurancefile.com "Many of them will only cover you up to a certain age limit."
It's best to call your credit-card provider to verify coverage before you travel.
Coverage for Manitobans... in Canada?
Blue Cross spokeswoman Wendy Shrimpton says even if you're travelling out of province to Lake of the Woods, you should consider travel health insurance or at least extended medical benefit health insurance to supplement provincial coverage. The provinces do have an agreement to provide care for Canadians from other provinces, but some services are excluded, such as the cost of an air ambulance.
"It's not as high as the U.S, of course, but who has $10,000 lying around to pay an air ambulance?"
Then again, even Manitoba Health doesn't provide coverage for ambulance rides, so extended medical coverage from an insurer might be advisable even if you never leave Manitoba, she says.
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