People travel every day in the United States, whether it’s for work, to see family, or to get away on vacation. A senior’s opportunity to travel will increase when they enter retirement. Many seniors take advantage of this opportunity to travel and take vacations in and out of the United. One thing many people do not plan for is medical emergencies. If one happens when you are away from home, are you covered? Here are the five things to know about Medicare when you travel.
1. You can use Medicare anywhere in the U.S.
Medicare is American health insurance for seniors aged 65 and older and others who qualify for specific disabilities. Since Medicare is American healthcare coverage, you can use it anywhere in the United States that accepts Medicare. For example, if you live in Texas and visit a doctor in New York, and the doctor accepts Original Medicare, you can visit that doctor for your healthcare service.
You can also use Medicare coverage when traveling in the United States territories. The United States territories are Guam, the Northern Mariana Islands, Puerto Rico, the U.S. Virgin Islands, and American Samoa. If you visit a doctor or hospital in one of these territories and the they take Medicare, then you can go there for your care.
2. Medicare may cover you outside the country
Since Medicare is American insurance, Medicare will likely not cover you outside the country. However, there are a few special circumstances where you can use your Medicare coverage in another country.
- You live closer to a foreign hospital than a U.S. hospital, and a medical emergency occurs; you can visit the foreign hospital to treat your injury or illness.
- You live closer to a foreign hospital than a U.S. hospital; you can visit a foreign hospital to treat your medical condition, whether it’s an emergency or not.
- You are traveling through Canada on the most direct route to Alaska without unreasonable delay. A medical emergency occurs; you can go to the Canadian hospital to treat your injury or illness.
Remember, Medicare only covers medically necessary services, and it will leave cost-sharing expenses for you. So, if you visit a foreign hospital for a medical emergency, expect to have out-of-pocket costs.
3. Medicare Advantage plans have networks
Private health insurance companies sell Medicare Advantage plans. When you purchase a Medicare Advantage plan, you will receive your Part A, Part B, and Part D benefits through that carrier. The carrier will set your cost-sharing amounts and your network of providers, where you can receive your care.
Depending on the Medicare Advantage plan, the plan might not be easy to travel with. Two of the most common purchased Medicare Advantage plans are HMO and PPO. HMO plans are the strictest plan, as you can only use the doctors within your plan’s network. When you go out-of-network for your care, you will pay the whole medical bill unless you have an emergency.
Medicare Advantage PPO plans are favored by travelers, as PPO plans allow you to go out of the network in the U.S. However, your medical costs out-of-network will likely be more expensive than if you were to visit a doctor in the network.
4. A Medigap plan can cover you outside the U.S.
Private health insurance carriers also sell Medigap plans. Medigap plans work alongside Original Medicare. If a doctor accepts Medicare, then they have to take your Medigap plan. However, unlike Original Medicare, you may be able to use your Medigap plan outside the United States.
If you have either Medigap Plan C, D, F, G, M, or N, you have a foreign travel emergency benefit. If you must seek medical treatment outside the United States, you will pay a $250 deductible and then a 20% coinsurance, as Medicare will pay 80% of your Medicare-approved costs.
Your foreign travel benefit has a $50,000-lifetime coverage benefit. This means that if your plan spends $50,000, you will no longer have a foreign travel coverage benefit through your Medigap plan.
Your Medigap plan will only cover your care if you use your plan within the first 60 days of your travel. Therefore, if you have a medical emergency outside the country on day 80, expect to pay for your service in full.
5. Part D plans travel with you
It is important to know if you have access to pick up your prescription medications while traveling. Medicare Part D plans have a network of pharmacies, and within that network, you have standard and preferred pharmacies, such as Walmart.
If you were to travel to another state, you can still order and pick up your medications if that state has your standard or preferred pharmacy. You can do this at no extra cost. However, you may not be able to go to a mom-and-pop pharmacy and have your Part D plan cover your medications. In this case, you will likely pay your prescriptions full cost.
Do not let your health insurance stop you from having a good time while traveling the world. Before you venture off, look over your Medicare plan’s Summary of Benefits or reach out to your Medicare agent to discuss your plan’s coverage when traveling.