Real World Emergency Medicare Hospitalization in Panama
You can assume that if you only have Medicare A and B, you will not be covered outside the USA in a medical emergency.
If you have a Medicare Supplement you will only be covered for the first 60 days after you leave the US.
If you have a Medicare Advantage Plan with WORLD-WIDE EMERGENCY AND URGENT CARE COVERAGE, you possibly have the best Worldwide Emergency coverage available.
The Advantage Plan, which covers worldwide emergencies, allows you to go to any hospital anywhere in the world for treatment and have the costs reimbursed to you.
Some hospitals in Panama and even some in Costa Rica and Mexico, now allow you to receive treatment comparable to that in the USA, paying only a deductible up to $130. They then handle all the direct billing for you. It is similar to what you would expect in the USA.
Many Hospitals were initially enthusiastic about this Direct Billing service for Medicare Advantage patients only later to become inconsistent, arbitrary, or even withdraw from it completely.
Remember EVERY HOSPITAL IN THE WORLD WILL TAKE CARE OF YOU IN AN EMERGENCY WITH THE APPROPRIATE ADVANTAGE PLAN and you then later getting reimbursed. The service comes down to the hospital’s billing procedures. Either the hospital takes the risk and directly bills your insurance company or you pay at the time of service and then get reimbursed by your insurance company.
Latest On Hospitals by Region in Panama:
Chiriqui Area
Chiriqui Hospital
In my opinion, Chiriqui Hospital is number one in all of Panama for direct billing Medicare Plans. Chiriqui Hospital is by far the leader when it comes to this regard in our opinion. Never a change in policy. Over the past year, more than a dozen clients have used their services and have given glowing reviews.
- It accepts all insurances, including Humana and most others.
- It never asks for a deposit as a rule.
- A dozen clients used their services in the past year and I only heard raving (favorable) reviews.
- Most clients just paid a $115-$130 deductible depending on the plan and that was it!
Mae Lewis Hospital
Mae Lewis is a good hospital medically speaking. I, myself have used it several times in the past. It came late to offering Medicare Direct Billing (or close to it). I sat down with the insurance administrators recently and they told me about some limitations they have.
1. They recently told me during a discussion on the subject that they can demand $5,000 to $7,000 upfront, regardless of the case’s severity, before they admit you. This is decided on a case by case basis. Some patients may be zero, but there isn’t a guarantee. But every patient whether on Medicare Advantage or any other insurance plan they told me can be required to pay this deposit as well. Some patients may be reimbursed, while others may not, even with fully covering insurance. If not, the patient can then bill their insurance company. They use a third party to facilitate their billing.
2. I have had clients transferred to Chiriqui for an MRI or CT scan because the machine was either non-functional, unavailable, or out of service at Mae Lewis.
Objectively, I lean toward Chiriqui Hospital for dire emergencies, but Mae Lewis does a very decent job for regular medical appointments.
Panama City Area
Pacifica Salud (Punta Pacifica) hospital is one of the best if not the best hospital in Panama regarding credentials, reputation and history. It is associated with the renowned Johns Hopkins hospital in the US and has many top US and foreign educated physicians there.
With great fanfare and marketing, they announced last year that they would be doing direct billing for Medicare Advantage plans. Months later, I spoke to an administrator for the hospital and he was being somewhat vague about what the problem the hospital was having with Medicare Advantage Plan Direct Billing, but apparently there was an internal problem with someone working within the hospital for this program and that Direct Medicare Billing would be suspended until further notice. Apparently it never came back because as of yesterday they told me they are no longer offering Medicare Advantage Plan Direct Billing service.
Still a great hospital (but you must pay and get reimbursed, which is the normal route).
Santa Fe Hospital was the first hospital to do the Direct Billing for Medicare Advantage People in Panama. They lasted several months until they too had a problem with their third party facilitator as it was relayed to me by the administrator. As a result they cancelled their program.
Panama Clinic is to my knowledge the only real dedicated and established Hospital in Panama City that still purports to take Medicare Advantage Direct Billing. I have received reports that some people were required to pay for emergency services regardless. I had one medicare recipient who went there during an emergency who had an Aetna PPO Plan but was turned down because the bill turned out to be only $900. (It was too small a bill?) I don’t know the answer. I have heard from many others that things can be a bit arbitrary not just in this hospital but anywhere (Except Chiriqui Hospital). For an example: Some people were required to pay a surgeon up front because he did not want to wait for the hospital to pay him.
Minimed. Since it is a relatively new entity and primarily made up of 14 independent doctors’ offices, clinics, etc. and since when you ONLY USE MEDICARE IN PANAMA DURING AN EMERGENCY or Urgent Care (less likely because there isn’t much to gain financially), it makes sense to only go to a respected and well known hospital in my estimation in an emergency. (Suppose you need a special surgeon, machine, etc.?) If you are using it otherwise (outside of an emergency) you will automatically be declined by your insurer. Given the normal costs of a doctor’s visit, or even an urgent care visit like a fish hook in your thumb, I see no value added for someone. I keep an open mind and perhaps someone can persuade me differently. Although I know some may like it for the convenience.
Conclusions?
Well outside of Chiriqui Hospital (for the moment at least), I think it is always wise to keep a high-limit credit card on hand for emergencies to cover your stay. Perhaps a line of credit on the equity on your real estate in Panama could be created with your bank? Direct Billing just buys time. Direct billing is not offered in any Advantage Plan directly. However, since some hospitals are aggressively seeking your future business, we can only hope that it continues ( use Medicare Plans myself) or that the CMA in Washington changes the rules to make Emergency Direct Billing standard for hospitals worldwide. It would be good if Medicare could modernize its rules for everyone. If they did, insurance companies’ costs would lessen because costs here and in much of the world are much lower relative to the USA. As it stands now, many travelling Expats save Medicare and Medicare Plans a fortune because they seldom use the services offered except when in the US.
We live in changing times…stay tuned.
About the author:
Guy Craig, who is on Medicare himself, is a licensed Medicare Agent in Panama and specializes in assisting Expats and people who have a little “gypsy blood” when it comes to travelling.
He can be reached at:
US 941-3017806 (WhatsApp)
Panama: 507-6936-2314 (WhatsApp)
Nancy Galvez US 239-297-0764 (WhatsApp) (Bilingual)
