Many seniors look forward to traveling in retirement. However, traveling with Medicare may come with restrictions depending on your Medicare plan and where you travel. If you’re a Medicare beneficiary planning a vacation, there are a few points to remember before you go.
Medicare covers you all around the United States – and its territories.
A provider network is a group of providers that have agreed to accept a specific type of insurance. Some networks are small and some are big. Medicare’s network spans all across the country and even to U.S. territories, such as Puerto Rico, Guam, and the U.S. Virgin Islands.
Any doctor in the United States can choose to accept Original Medicare or not. As of 2020, nearly one million doctors across the country accept Original Medicare. If you access your Medicare coverage through Original Medicare Parts A and B, you are covered at any doctor’s office in the country that accepts Medicare.
Medigap plans have the same network as Original Medicare.
A Medigap plan, also called a Medicare Supplement plan, pays after Original Medicare to help cover costs such as the Part A deductible and Part B coinsurance. Medigap plans have the same network as Original Medicare. Therefore, if you travel across the country on vacation and see a doctor who accepts Medicare, Medicare will pay first, and your Medigap plan will pay second.
Medicare only covers you outside of the United States in specific scenarios.
Medicare is an American government-run insurance program; itis not required to cover you outside of the country. However, in some emergency scenarios, Medicare may cover your Part A and Part B services at a foreign hospital.
For instance, if you were to travel along the U.S. border, and during your trip you had a medical emergency, Medicare may cover your hospital care at a foreign hospital if it was closer to you at the time of the emergency than an American hospital. The same rules apply if you were to travel through Canada without delay to get to or from Alaska.
The other scenario where Medicare might cover your emergency care at a foreign hospital is if you’re at home and an emergency occurs, and a foreign hospital is closer than an American hospital. If you’re traveling outside the U.S., you generally don’t have health coverage with Original Medicare.
Most Medigap plans have foreign travel emergency coverage.
Six out of the 10 standardized Medigap plans include foreign travel emergency coverage. Medigap plans C, D, F, G, M, and N, will cover 80% of your emergency care outside of the country. However, there are a few stipulations. You must pay a $250 deductible when accessing this benefit, and you are only covered if the emergency happens within your first 60 days of travel. Also, there is a $50,000 lifetime limit to this benefit.
Most Medicare Advantage plans have smaller networks than Original Medicare.
Medicare Advantage plans are the alternative to Original Medicare and a Medigap plan. With a Medicare Advantage plan, you get your coverage from your insurer rather than the government. There are a few types of Medicare Advantage plans; HMO and PPO networks are the most common.
HMO networks are generally a few counties wide and only have in-network benefits. With an HMO Medicare Advantage plan, traveling outside of your plan’s network means you’d be responsible for 100% of your medical expenses, except in the case of an emergency. For example, if you lived in Los Angeles and traveled to New York, your HMO Medicare Advantage plan wouldn’t cover you unless it was an emergency.
PPO plans can have smaller networks like HMO plans and larger statewide networks – it just depends on the plan. However, the main difference between a PPO and HMO plan is that with a PPO plan, you can get care both in and out of the network. . For example, if you traveled from Austin to Miami, your plan may cover you, although with higher cost-sharing requirements. However, the out-of-network doctor must be willing to bill your plan for out-of-network care, , which they aren’t required to do.
Most Medicare Advantage plans include worldwide emergency travel coverage.
Medicare Advantage plans must cover you in the same three foreign travel emergency scenarios mentioned above. They are not required to cover you in other international travel situations. However, most Medicare Advantage plans include worldwide emergency travel coverage.
When accessing foreign travel emergency benefits, whether from a Medicare Advantage plan or Medigap plan, the foreign hospital isn’t required to bill your American insurance plan; you may have to pay out of pocket and request reimbursement later from your Medicare plan.
Consider purchasing a short-term travel health insurance policy.
Depending on your destination and your Medicare coverage, you may want to consider purchasing a short-term travel health insurance policy to fill the coverage gaps. If you’re worried about needing healthcare during your trip, a travel health insurance policy could be what you need to ensure you have a relaxing vacation.