The Healthcare System in the U.S. Virgin Islands: Medicare, Medicaid, Private Insurance, Hospitals and Emergencies

The U.S. Virgin Islands have no universal health insurance fund comparable to French Sécurité sociale. Protection rests on three tiers: the federal Medicare programme for people aged 65 and over, the territory’s Medicaid, called the Medical Assistance Program, for low-income households, and employer or individual insurance. The MACPAC commission lists the Virgin Islands among the five US territories where Medicaid operates, with a federal contribution permanently set at 83% and an annual funding cap instead of the open-ended funding enjoyed by the states.

France Diplomatie describes for the United States an excellent medical infrastructure but at a very high cost, with no social security agreement covering health insurance between France and the United States. The carte Vitale therefore has no effect in the Virgin Islands, and the French embassy covers no costs. Each situation (employee, retiree, student) has its own path: the page healthcare reimbursement in the U.S. Virgin Islands details them one by one.

Medicare is for US citizens and qualified immigrants lawfully resident aged 65 and over. According to the Centers for Medicare & Medicaid Services (CMS), those with at least 40 quarters of contributions (10 years for most people) receive Part A, hospital cover, without a premium; about 99% of beneficiaries pay no premium for this part. Without enough quarters, it is possible to take out Part A for a premium, after enrolling in Part B, which imposes a five-year residence condition on permanent residents.

Every year, CMS publishes the amounts of the standard Part B premium (doctors, outpatient care), of the annual deductible, of the Part A hospital deductible per benefit period, and of the Part A premium, reduced for 30 to 39 quarters of contributions and higher below 30 quarters. Extra Help for Part D medicines is not available in the U.S. Virgin Islands, according to Medicare.gov, which refers people to local assistance programmes for people with limited resources and advises contacting the Medicaid office.

The Medical Assistance Program is administered by the Department of Human Services (DHS). According to the DHS, it covers pregnant women, children under 21, CHIP children under 19, children and adults receiving family assistance (TANF), as well as people who are blind, disabled or elderly, provided they meet criteria on income, assets, residence in the territory and citizenship. Beneficiaries pay no financial contribution, and CHIP services are free for eligible applicants. Enrolled people do not have a free choice of providers.

Processing of an application generally does not exceed 45 days, or 60 days for a disability application. A territory hospital can grant presumptive eligibility to an uninsured person who needs care: it runs until the end of the following month and can only be granted once in any 12-month period, a complete application then having to be filed at the DHS office. People approved are then approved for 12 months, with an annual review. For a foreigner, immigration status matters: CMS reminds us that many qualified immigrants must wait five years before claiming Medicaid, and indicates that the territory has chosen to cover lawfully present children and pregnant women, including those who would otherwise be subject to this waiting period. A French national holding a temporary visa or a recent resident card therefore arranges other cover during that period.

CMS indicates that residents of the Virgin Islands cannot use the federal Marketplace to enrol in health cover. For insurance taken out individually, or through an employer whose activity is limited to the territory, the contact is the territory’s Division of Banking and Insurance (website ltg.gov.vi). Medicaid and the CHIP programme fall under the DHS.

The cover of a locally recruited employee generally goes through their employer’s insurance, which is part of the hiring offer (see working in the U.S. Virgin Islands). Self-employed workers, students and retirees compare an individual contract, the CFE and worldwide international health insurance whose coverage zone includes the United States.

The emergency number is 911 throughout US territory (France Diplomatie, Department of Tourism). The territory has three reference facilities:

• Saint Thomas: Roy Lester Schneider Hospital, 9048 Alton Adams Sr Dr, tel. 340-776-8311.
• Saint Croix: Governor Juan F. Luis Hospital and Medical Center, 4007 Estate Diamond Ruby, Christiansted, tel. 340-778-6311.
• Saint John: Myrah Keating Smith Community Health Center, tel. 340-693-8900 according to the Department of Tourism, whose call link displays a different number: to confirm before dialling.

The Department of Tourism specifies that Saint John patients needing extensive care are transferred by boat to Saint Thomas, and that medical evacuation services exist. The Department of Health offices can be reached on 340-718-1311 on Saint Croix, 340-774-9000 on Saint Thomas and 340-776-6400 on Saint John. In an emergency, France Diplomatie specifies that the ambulance has priority on arrival at the hospital, but that admission is subject to a financial guarantee: insurance with direct payment avoids advancing funds. For routine care, the choice of primary care doctor and their network depends on the contract (employer, Medicaid, individual insurance); the list of approved practitioners should be requested from the insurer before the first consultation.

Medicines fall under Part D for a Medicare beneficiary, or under the contract of the chosen insurance. As Extra Help does not exist in the territory, people with limited resources turn to local programmes, including Medicaid for eligible beneficiaries. The Department of Tourism advises bringing the necessary medicines with you. For ongoing treatment, it is prudent to arrange with your family doctor the prescription and supply for the first months, then to check with the local insurer the list of reimbursed medicines and the co-payment requested.

Dental and optical care follow their own rules depending on the contract: the page healthcare reimbursement covers them item by item. The reimbursement guide explains the notions of reimbursement basis and out-of-pocket cost.

Dengue. The territory’s Department of Health indicates that the Virgin Islands are endemic for dengue, with cases or an outbreak possible at any time. The disease is transmitted by the bite of an infected female Aedes mosquito; its signs are high fever, joint and muscle pain and pain around the eyes, sometimes with a severe rash after the fever, and the outcome can be fatal. There is no curative treatment; France Diplomatie recommends seeing a doctor without delay and strictly avoiding anti-inflammatory drugs. No case count was read for the territory: the Department of Health refers to its online epidemiological dashboard.

Zika and chikungunya. The same department describes Zika, also transmitted sexually and liable to cause serious malformations during pregnancy, and chikungunya, whose joint pain can last six months or more. France Diplomatie asks pregnant women or those planning a pregnancy to consult a doctor before any travel to an infected area.

Vaccinations. France Diplomatie asks for an up-to-date French vaccination schedule, in particular diphtheria, tetanus, poliomyelitis, whooping cough and measles. Additional vaccinations may be indicated: tuberculosis for children under 15 in case of frequent or prolonged stays, chikungunya in case of an epidemic or prolonged stay, dengue in certain cases. The Department of Tourism reminds travellers that the CDC recommends vaccines for travellers. The family doctor adjusts this list before departure. Natural risks (hurricanes from June to November) appear in the page living in the U.S. Virgin Islands.

France Diplomatie deems it essential to have, before any stay, an assistance contract or insurance that covers all medical costs, including surgery and hospitalisation, as well as medical repatriation. For a move, cover is chosen according to status: employer insurance, individual contract, CFE or international insurance, then Medicare or Medicaid when the conditions are met. The notions of first euro, coverage ceiling and coverage zone help compare contracts; Expavy lets you weigh these benefits against your situation.