Cruise with Medicare as your insurance? Better read her painful warning first. Michelle Couch-Friedman, author.

Can you cruise with Medicare? She has a painful warning to share

When Maureen Niland and her husband booked their recent Holland America cruise, their thoughts were on new adventures — not medical insurance. But tragedy struck just hours after the ship left the port in Ft. Lauderdale. John Niland suffered a sudden cardiac arrest and died. And the new widow learned an important lesson: Never take a cruise with Medicare and rely on it as your primary insurance.

The Nilands’ story is a reminder that unexpected events can happen at any time — even on vacation. And while it’s impossible to predict these calamities, some pre-planning can reduce their financial impact. And having a good trip insurance policy in place can often be a welcome relief in these difficult situations.

Taking a Holland America cruise with Medicare as their primary insurance

In January 2018, the Nilands boarded Holland America’s Eurodam for a cruise through the Caribbean. That same evening, John Niland collapsed and was rushed to the ship’s medical center. Attempts to revive him were unsuccessful, and he passed away.

“As I was leaving the ship, a Holland America employee handed me an invoice for medical services,” Niland recalled. “Then Holland America charged $3,000 to my credit card.”

That’s not very nice, Holland America.

Niland had just lost her husband. Maybe a sympathy card would have been a better offering as she left this Holland America cruise. A bill for medical services could have come later.

The Nilands had no travel insurance. And the couple had taken the cruise with Medicare as their primary medical insurance coverage. Assuming that Medicare would cover all the bills, she submitted a claim for reimbursement. That’s where Niland hit a giant roadblock.

Here’s why taking a cruise with a basic Medicare policy is a bad idea

Unfortunately, the Nilands did not check whether their Medicare policy would provide medical coverage during their trip. If they had, they would have discovered that Medicare would not cover any medical treatment during most of this cruise.

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There are limited circumstances that will allow for Medicare coverage on a cruise.

Medicare may cover medically necessary health care services you get on a cruise ship in these situations:
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.

Medicare doesn’t cover health care services you get when the ship is more than 6 hours away from a U.S. port.

Taking a Holland America cruise? Don't count on Medicare to cover your during your trip.
Areas within red are U.S. waters. In most cases, Medicare will only cover treatment within those borders.

The high costs of medical treatment on a cruise

So, if you choose to cruise with Medicare as your primary insurance, beware. If you fall ill — or worse — during your cruise, in most cases you are on the financial hook for all medical treatment.

And make no mistake, medical treatment onboard a cruise is quite expensive. Take, for example, the recent article that our publisher Christopher Elliott wrote about Murray Cohen. He spent just two days in sickbay during his cruise and it cost him almost $6,000.

We receive many requests for help to erase or negotiate lower cruise ship medical fees after the fact.  It’s important to be aware that no cruise line appears willing to bargain its services once rendered. We have no successes to report in that arena.

So, unless you don’t mind the possibility of a sky-high medical bill onboard your next cruise, it’s critical to have a valid medical insurance policy in place. And it’s not just Medicare that freezes coverage during your journey outside the United States. Most US-based insurance policies provide limited to no coverage for medical treatment outside of our borders.

Where exactly was this Holland America cruise during this event?

After reviewing all of the Medicare information, I thought there was still hope for Niland’s claim.

“The scheduled departure time was 4. My husband was at the infirmary by 9:30,” Niland told me. “…cutting it close aren’t we!”

Yes. That certainly is cutting it close, but still within the six hours from departure time allowed for Medicare coverage(E-Healthcare video) on this cruise.

Niland’s claim had been turned down because there is an alternative procedure to file a cruise-related Medicare claim. These claims must go through the passenger’s home state’s office of the Centers for Medicare and Medicaid Services.

Once Niland filed the claim through the correct office, it still wasn’t smooth sailing. Medicare requested medical procedure codes from Holland America. The cruise line responded by explaining that they do not use procedure codes and aren’t required to do so. And round and round the claim continued.

A sad lesson learned and a warning for Medicare subscribers

Suddenly, though, Niland’s Medicare struggle came to a pleasant end.

She had also filed a claim with her secondary insurance company. And, although that company initially told her it would not cover her husband’s treatment, it did. By surprise, a check for the entire requested reimbursement arrived five months after this terrible situation began.

Niland was more than happy to abandon her fight with Medicare and close this sad chapter of her life.

She ended our time together by sending this warning to our readers:

The lesson learned for me was how difficult and nearly impossible Medicare can make things!
From no coverage on foreign soil to no coverage if “procedure codes” are not used.
These are some things that travelers need to know….

Our files are filled with pleas for help from travelers who found out too late that their insurance would not cover illnesses and accidents abroad. Don’t let this happen to you. Before you head off on your next adventure, make sure that you’re covered for the unexpected.

Update: After this story first ran, I received several emails pointing out that there are Medicare supplements that can provide international coverage. It’s important to note that these are at an additional cost and must be selected before travel. A standard Medicare policy will not cover travelers outside the boundaries of the United States.

All Medicare subscribers should check their individual policies before traveling outside the United States by air, land or sea. For more information about Medicare coverage visit


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