When it comes to Medicare and traveling, it is prudent to know which healthcare options you have, wherever you may be. Ultimately, the destination will determine which Medicare health plan will meet your needs, based on coverage and cost. Whether you are traveling domestically or abroad, there are several factors to consider.
Original Medicare (Part A & B) provides coverage in all 50 states, as well as the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, Northern Mariana Islands, and American Samoa. So long as your provider accepts Original Medicare, you will have coverage everywhere in the United States. Health care that you receive in foreign countries is not covered and Medicare does not cover medical services on a cruise ship if the ship is more than 6 hours away from a U.S. port.
- You are in the U.S. when a medical emergency occurs that requires immediate medical attention to prevent a disability or death, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
- You are 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 the emergency.
- 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 an emergency exists.
It is important to note that foreign hospitals are not required to file Medicare claims for you, so make sure to keep records of your medical expenses abroad. You will need to submit an itemized bill to Medicare for any services rendered if one of the above-mentioned situations applies to you and the foreign hospital does not file your claims for you.
Medicare Advantage plans (Part C) operate off a network like an HMO or PPO and typically restrict where you may receive coverage throughout the United States. Unless it is an emergency or urgent situation, a provider may deny care or charge a higher copay.
Urgent Care is defined as urgently needed care to treat a sudden illness or injury that is not a medical emergency requiring immediate medical attention to prevent a disability or death. Emergency Care is defined as needing treatment for an injury, a sudden illness, or an illness that quickly gets much worse. Copays may apply for emergency and urgent care if you have this type of plan.
Some Advantage plans offer travel coverage that allows you to see providers throughout the U.S. if they participate in the carrier’s network. In addition, you will have limited coverage near the U.S. border and out of the country.
Medicare Supplement plans (Medigap plans) can be used anywhere throughout the U.S. if the provider accepts Original Medicare, however they provide limited coverage abroad. The foreign travel emergency benefit of Medigap insurance applies only during the first 60 days of travel and will cover 80% of emergency health care outside the country, with a $250 deductible to be satisfied first. There is a lifetime limit of $50,000 for foreign travel emergencies also with a Medigap plan.
Prescription Drug plans (Part D) do not cover prescription drugs you buy outside the U.S. You may be able to fill your prescriptions while traveling inside the U.S. by contacting your plan and searching for an in-network pharmacy in the area which you are traveling.
If you plan on traveling, be sure to speak with your plan provider beforehand so you are fully aware of what is covered and how the insurance company will process your claims. Emergencies happen, but by being an informed consumer, you can avoid being caught off guard with surprise expenses.