Traveling is a goal for many retired senior citizens for various of reasons. When you travel, you get to experience new surroundings, different cultures, and unique people. There are a lot of boxes you must check off when you plan your travel. For example, you need to know how you are getting to your destination, where you’re staying, what to pack, and so much more. One thing you might forget to check off doing is figuring out how Medicare will cover you when you travel. If this is something you aren’t familiar with, then keep reading to see how Medicare will cover you.
Medicare coverage when traveling
With Medicare being American healthcare insurance, you can access medical care across the United States. There are no specific doctors or hospitals you must visit when you have Medicare. If a doctor or specialist accepts Medicare, then you can see that doctor for your healthcare needs. You can also travel to the U.S. territories and receive coverage if that doctor takes Medicare for insurance.
However, Medicare typically will not pay out for your medical services if you are outside of the United States and its territories. There are a few limited scenarios where Medicare will cover you in a different country:
- You’re traveling in the U.S. when a medical emergency occurs, and a foreign hospital is closer to you than a U.S. hospital. In this case, you can visit that hospital to treat your injury and illness.
- Suppose you’re traveling through Canada using the most direct route between Alaska, and a medical emergency occurs. In that case, if a Canadian hospital is closer to you than a U.S. hospital, Medicare will likely cover you.
- You live in the U.S., and a foreign hospital is closer to you than a U.S. hospital; you can visit that hospital if the doctor can treat your medical condition, whether it’s an emergency or not.
In only in these above scenarios is when Medicare will likely cover your services outside of America. Remember, Medicare only covers medically necessary services. So, if you receive a healthcare service that does not diagnose, or treat an injury, illness, or disease, then Medicare will likely deny coverage.
Traveling with a Medigap plan
Medigap plans, also known as a Medicare Supplement, go hand in hand with Original Medicare. What this means is that if a doctor accepts Medicare, they must also accept a Medigap plan. No matter the type of Medigap plan or carrier you enrolled in, your plan will pay out if Medicare pays out first. So, if you plan on traveling often, a Medigap plan could be ideal secondary coverage for you.
Although Original Medicare does not cover you outside of the country, if you have either Medigap Plan C, D, F, G, M, or N, you will have emergency travel coverage for when you travel abroad. This emergency benefit has a $50,000-lifetime limit, which means once you reach $50,000, your Medigap plan will no longer provide emergency coverage.
How it works is that you will first need to meet a $250 deductible, and after you pay the deductible, your Medigap plan will cover 80% of your Medicare-approved services. Therefore, you are responsible for paying a 20% coinsurance for your emergency visit. This benefit is only effective within the first 60 days of your international travel.
Again, this additional benefit is for medical emergencies only. So, don’t plan a cosmetic surgery outside of the country and expect your Medigap plan to pick up the bill because it won’t.
How traveling with a Medicare Advantage plan works
Medicare Advantage plans are separate from Medicare and Medigap plans. If you purchase a Medicare Advantage plan, you will get your benefits solely through the private insurance carrier and no longer the government. Due to this, the carrier can create a network of doctors and your cost-sharing amounts.
Depending on the type of Medicare Advantage plan you enroll in, it might be difficult to get covered if you are outside of your service area. For example, if you enroll in an HMO Medicare Advantage plan, you can only visit the doctors inside your plan’s network. If you go outside the network, you will pay the total price of your medical bill unless it is an emergency.
PPO Medicare Advantage plans are more flexible, as you do have the options to travel outside of the plan’s network for healthcare services. However, you would pay more for your care than if you were visiting in-network doctors.
Since Medicare Advantage plans have service areas and every plan is different, you need to look over your plan’s Summary of Benefits to know if your plan will cover you outside of the country. Your plan may or may not have an emergency travel benefit, and this benefit may also vary. So, read over your plan’s benefits before you travel so you can know your options if a medical emergency occurs while you are traveling.
A medical emergency can happen while traveling, so it’s beneficial to know how Medicare will cover you just in case. If you aren’t sure which type of plan you have and what benefits are available to you, resort back to your plan’s Summary of benefits or reach out to your carrier directly for more information.