Frequently Asked Questions
AccessHMO is a private company with an effective and efficient method of delivering the best quality healthcare and financial security to our clients.
Unlike many large insurers, AccessHMO is not at the mercy of the stock market, which can cause publicly traded companies to sometimes place their stockholders above their policyholders’ interests.
Most, if not all of our competitors, quote “international health insurance” plans on a global market level. AccessHMO has chosen to limit its reach exclusively to Central America and the Caribbean which are among the least expensive healthcare markets in the world.
By focusing on this region and excluding more costly regions, AccessHMO can offer health insurance better health insurance at a much lower cost.
We are a privately owned, U.S. based health insurance provider with experienced professionals are Medicare certified and licenses in both the United States and the European Union.
Our international roots go back to 2001, when our leadership was invited to Prague by the Czech Ministry of Health to find a solution to the needs of tens of thousands of foreigners or ‘Expats’, in need of access to hospitals and doctors, but were denied access to the national public health insurance system due to fears of adverse selection.
We successfully responded to the challenge by ultimately establishing the region’s first private, HMO based health insurance company dedicated solely to the healthcare needs of foreign residents, in cooperation with the Czech Republic Ministry of Health’s public health insurance company, VZP.
We are proud to have served tens of thousands ever since, via our popular VZPforForeigners and Find-a-Doctor platforms.
To best serve our diverse clientele, our professional staff is licensed in the United States, European Union and are certified Medicare advisers.
Our diverse background and extensive experience in navigating complex healthcare systems, including the ACA, Medicare and European public health insurance, allows us to offer unique insights and superior service to our clients.
We specialize in matching individual needs and desires with high quality, cost effective plans that fit.
In working closely with our network of participating physicians and health insurance partners, we are able to offer the best value for our clients’ health care and look forward to continue serving them and their families going forward.
Our home office is in North Miami, Florida, USA
We provide global medical concierge membership services to our clients and their family members, at no additional cost.
Find-a-Doctor is a unique and dedicated service, initiated to serve our rapidly growing clientele from North America and Europe, who made the bold and adventurous decision to relocate to Central America and the Caribbean and desire to maintain the quality level of healthcare they expect and are accustomed to.
Since our members are of all ages and nationalities, each with different individual needs, we provide 3 different health insurance plan designs or types, based on our 3 most successfully proven solutions:
For short term or seasonal foreign residents, with a trip durations abroad of less than 90 days, we recommend and provide a choice of U.S. or European based Travel Insurance plans, depending on nationality and destination to expedite healthcare needs that require follow-up treatment at a letter date, back in the home country when necessary.
For long term and permanent foreign residents, we analyze and compare local public healthcare and health insurance programs available in the chosen destination to determine if all individuals’ healthcare needs are covered and to what extent. In most cases, our clients decide on purchasing a private AccessHMO annually renewable, major medical, health insurance plan to supplement or replace lesser benefits and services offered locally. Optional medical evacuation protection, in the event that better medical treatment can be provided in North America or in Europe is also available.
For U.S. citizens over age 65, we offer a selection of cost effective Medicare Supplements and Medicare Advantage plans with Part D prescription drug coverage.
Medicare Parts A and B, Medicare Advantage Part C and Medicare Supplements, ALL have a maximum lifetime benefit of $50,000. and ONLY for emergency medical costs.
AccessHMO has been lobbying on behalf of American retirees abroad and have successfully advanced legislation to expand Medicare portability to cover medical costs abroad the same as in the U.S.
This pilot program has been announced and is set to begin in the region, starting with Dominican Republic, Panama and Mexico.
Germany, Israel, Philippines and South Korea are also included in this Medicare Portability pilot program.
Contact Us to learn more about your health insurance and Medicare options abroad to overcome the $50,000. lifetime limitation or click here
AccessHMO has been developing relationships with board certified doctors and specialists for over 35 years and have created an medical concierge service, available exclusively for our members who have purchased their travel health insurance plan or Medicare plan from AccessHMO.
To find a Doctor and schedule the next available appointment, simply enter your member number from your health insurance ID card onto our portal along with your location and symptoms, and our staff will locate your nearest available doctor, assist with scheduling your appointment and arrange direct payment to ensure prompt treatment.
In the event of an emergency, go directly to your nearest hospital and present your health insurance ID card. AccessHMO covers all members’ emergency treatment at any licensed facility in the region.
Most countries in the region require all visitors to have adequate travel medical insurance for the duration of the visit.
AccessHMO offers medical evacuation protection in addition to locally required coverage to enable our members to access healthcare at the nearest medical facility or in their home country. Please check your specific plan for details or contact us.
Your Medigap policy may cover services that Original Medicare doesn’t cover, like emergency medical care that you get outside the U.S.
Most Medigap plans (C, D, E, F, G, H, I, J, M, and N) provide foreign travel emergency health care with a lifetime limit of $50,000. These Medigap plans:
• Pay 80% of the billed charges for certain medically-necessary emergency care outside the U.S. after you meet a $250 deductible for the year.
• Cover foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care.
If you have plan E, H, I, or J, which are no longer sold, you may keep it if you bought one of these plans before June 1, 2010. They still cover foreign travel emergency care. Before you travel outside the U.S., ask your Medigap company or insurance agent for more information about your Medigap coverage while traveling. To learn more about Medigap policies, visit Medicare.gov/health-drug-plans/medigap or call 1-800-MEDICARE
Medicare Advantage Plans and other Medicare health plans must follow rules set by Medicare, including for coverage limitations outside the U.S.
However, your plan may cover additional health care services you get outside the U.S.
Check with your plan or contact us before traveling to find out what’s covered and what options are available to protect you beyond Medicare’s limitations abroad.
Yes. Because Medicare has limited coverage of health care services outside the U.S., you can choose to buy a travel insurance policy from AccessHMO to get more coverage.
Contact us or click here for more information about the different types of travel insurance available and based on your specific needs:
There are 3 situations when Medicare may pay for certain types of health care services you get in a foreign hospital (a hospital outside the U.S.):
• You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat you.
• You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat you. Medicare determines on a case-by-case basis what situation qualifies as “without unreasonable delay.”
• You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat you, regardless of whether you have a medical emergency.
Medicare drug coverage (Part D) covers all vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends, including certain vaccines you might need to get before you travel outside the U.S. (like yellow fever, chikungunya, and Japanese encephalitis). Your Part D plan won’t charge you a copayment or apply a deductible for vaccines ACIP recommends. Contact your Medicare drug plan for details and talk to your provider about which ones are right for you.
Medicare covers these services:
• Part A covers inpatient hospital care (care you get when you’ve been formally admitted with a doctor’s order to the foreign hospital as an inpatient).
• Part B covers emergency and non-emergency ambulance and doctor services you get immediately before and during your covered foreign inpatient hospital stay. However, if Medicare doesn’t cover your hospital stay and/or you get ambulance and doctor services outside the hospital after your covered hospital stay ends, Medicare generally won’t pay for these services. For example, Medicare won’t cover return ambulance trips home or doctor services you get in a foreign country after your covered foreign hospital stay ends.
Remember, Medicare only pays for its share of Medicare-covered services. If you only have Part A, Medicare only covers inpatient hospital care.
No. Unless you get dialysis during an inpatient hospital stay under one of the 3 situations described on page 1, Medicare doesn’t cover dialysis when you travel outside the U.S.
No. Medicare plans can’t cover drugs you buy outside the U.S. Contact your plan for more information. However, this limitation does not deter many seniors from moving abroad, because we have found in our many years abroad that in most countries, the cost of prescription drugs is actually cheaper than the Medicare Part D copayments and its ever increasing prescription drug deductible.
What do I pay if I get Medicare-covered services outside the U.S.?
Except in the limited situations described on page 1, Medicare doesn’t pay for health care services you get outside the U.S. If your circumstances don’t meet these limited situations, you pay the full cost to the health care provider.
If your situation matches one of the 3 situations on page 1 and Medicare covers the items or services you get, you would pay the related coinsurance or copayments and
deductibles.
Although U.S. hospitals must submit claims to Medicare for you, foreign hospitals aren’t required to file Medicare claims. If the foreign hospital doesn’t submit Medicare claims for you, then you’ll have to pay the full cost to the health care provider. You’ll need to submit a claim to Medicare to be reimbursed for your doctor, inpatient, and ambulance services described on page 1.
If you got Medicare-covered services on a cruise ship under a situation described on page 2, the doctor must submit the Medicare claim. You may also file a claim directly to Medicare.
Visit Medicare.gov/providers-services/claims-appeals-complaints/claims for information on where to send a foreign claim and get the “Patient’s Request for Medical Payment” form (CMS-1490S). Print out the form and instructions that apply to your situation (like for services you got on a cruise ship or during other foreign travel).
Or call 1-800-MEDICARE (1‑800-633-4227). TTY users can call 1-877-486-2048
Medicare doesn’t cover health care services you get when the ship is more than 6 hours away from a U.S. port.
Medicare may cover medically-necessary health care services you get on a cruise ship if:
• The doctor is allowed under certain laws to provide medical services on the cruise ship.
• The ship is in a U.S. port, or no more than 6 hours away from a U.S. port, when you get the services (regardless of whether it’s an emergency).