When you’re traveling, what does your Medicare Plan cover? How does it work? What happens if you’re traveling outside of the country? We’ve got all the details here for you about traveling with Medicare.
Your Medicare insurance coverage while traveling depends on your travel destination and how you are receiving your Medicare benefits. So if you have plans to travel during your retirement, Medicare certainly should not stop you! However, it is important to do research before you travel so you know where to go for care and you can anticipate any costs associated should an illness or injury arise.
Typically, you have two options for Medicare coverage: Original Medicare with a supplement and Medicare Advantage. There are notable differences with how travel is covered between Original Medicare (with a supplement) and Medicare Advantage.
Medicare and Traveling Within the United States: Original Medicare v. Medicare Advantage Coverage
When on Original Medicare, you have insurance coverage anywhere in the U.S. and its territories. That includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Most (over 93% nationwide) doctors and hospitals accept Original Medicare insurance. This means, if Original Medicare is your primary insurance, you have an enormous pool of providers to choose from if you are traveling in the U.S.
When you have a Medicare Advantage plan, Original Medicare is no longer your primary insurance. The Medicare Advantage plan is your primary insurance. Medicare Advantage Plans are typically HMO or PPO plans, and may include drug coverage rolled into the plan. These plans utilize a provider network, which is usually specific to a certain region or county. A Medicare Advantage plan may or may not cover care outside of that service area. If they do, there may be higher out-of-network or costs like copayments, coinsurances. A Medicare Advantage plan may enforce other rules or restrictions like prior authorizations. If you are on a Medicare Advantage plan, contact your plan to check benefits prior to traveling.
Important Note: Medicare Advantage Plans are required to cover emergency and urgent care anywhere in the U.S. without imposing additional costs or coverage rules.
Medicare Supplements and Domestic Travel
Original Medicare alone has gaps in coverage, so supplement plans were created to bridge those gaps. The supplement plans are standardized, meaning the same policy, regardless of state or insurance carrier, covers the exact same benefits. The supplement plans share the equivalent program rules as original Medicare in terms of provider access; you can visit any provider nationwide that accepts Medicare.
Medicare Coverage and Traveling Outside the United States
Original Medicare and Medicare Advantage Plans do not cover medical costs incurred when traveling outside the US and its territories. However, there are certain situations when Original Medicare may pay for specific services you receive when traveling outside of the country. Keep in mind this is Original Medicare coverage, not Medicare Advantage coverage.
There are three situations when Original Medicare may pay for certain types of health care services you obtain 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 your illness or injury.
- 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 your illness or injury. Medicare determines what qualifies as “without unreasonable delay” on a case-by-case basis.
- You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it’s an emergency. Remember, in these situations, Medicare will pay only for the Medicare-covered services you obtain in a foreign hospital.
Medicare Supplement Plans and Foreign Travel
If you have a Medicare supplement plan, some plans will cover foreign travel emergency healthcare services when traveling out of the U.S.
With supplement plan C, D, E, F, G, H, I, J, M or N, you have these added benefits:
- Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare does not otherwise cover the care.
- Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year.
Supplement policies have an overall lifetime maximum of $50,000 for eligible healthcare costs abroad. This means $50,000 is the maximum dollar amount your Medigap policy will pay toward your covered expenses during your lifetime.
Important note: Foreign hospitals are not required to file Medicare claims for your medical costs. You may need to submit an itemized bill to Medicare for your doctor, inpatient, and/or ambulance services for reimbursement.
Medicare Advantage Plans and Foreign Travel
Medicare Advantage Plans may also cover emergency care abroad. Contact your plan for more information about its costs and coverage rules.
Medicare Part D Prescription Drugs Plans and Traveling
It is also important to understand that Medicare Part D plans can require members to use in-network pharmacies, and some have localized networks rather than nationwide networks. Check with your Part D plan before traveling and see if you will need to make arrangements to purchase medication in advance or use a mail-order pharmacy. Typically, Medicare drug plans do not cover prescription drugs you buy outside the U.S.
Medicare Coverage on a Cruise
Medicare may cover medically necessary health care services you need 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 obtain the services, regardless of whether it’s an emergency.
Medicare does not cover health care services when the ship is more than 6 hours away from a U.S. port.
Travel Insurance for Foreign Travel
Many people consider buying travel insurance to help pay for the cost of health care services, which is allowable. Because Medicare has limited coverage for health care services outside the U.S., you can choose to buy a travel insurance policy to gain more coverage. However, travel insurance does not necessarily include health coverage, so it’s important to read the conditions or restrictions carefully.
To help you obtain the best Medicare Plan and answer all your Medicare questions, contact Medicare Dana: 512-666-7785, fill our a contact form, or leave a comment below. Looking forward to hearing from you!