Traveling the world is part of the retirement plan for many people and while you are making all of those plans, don’t forget to think about your Medicare coverage. Make sure you take your travel plans into consideration when you enroll in Medicare and select your supplemental coverage products.
Original Medicare generally doesn’t cover treatment outside the United States and its territories and Medicare prescription drug plans do not cover outpatient medications purchased outside the United States.
Medicare might pick up the tab (with the patient paying 20 percent of the approved amount, plus the Part B deductible if outpatient care is covered) with very limited exceptions. But foreign hospitals do not have to submit claims to Medicare; if you qualify for coverage, you might have to submit your own itemized bill for reimbursement.
Original Medicare will only provide coverage the following situations outside the United States and U.S. territories:
- You’re in the U.S. when you have a medical emergency but you’re close enough to its border that the nearest hospital is outside the United States, or you live near the border and the closest hospital that can treat you (regardless of whether it’s an emergency) is outside the United States.
- You’re traveling between Alaska and another U.S. state via a direct route through Canada “without unreasonable delay” and a medical emergency occurs while you’re in Canada (note that Medicare makes case-by-case determinations on what counts as an “unreasonable delay.” So if you’re taking an extended road trip through Canada en route to Alaska, you’re probably not going to be covered if something happens while you’re in Canada).
- You’re on a cruise ship within six hours of a U.S. port.
Other than those situations, Medicare does not reimburse for care provided outside the United States. So if you’re approaching Medicare enrollment and you’ve got plans to travel, you want to make sure that you look for supplemental coverage that will protect you in case of a medical emergency outside the United States.
Are there other options?
If you’re adding a Medigap supplement plan to your Original Medicare, six of the current Medigap plan options provide coverage for medical emergencies outside the United States. Plans C, D, F, G, M, and N cover medical emergencies while traveling, as long as medical care starts within 60 days of leaving the United States.
Medigap plans are only available with no medical underwriting during your initial enrollment period (and very limited special enrollment periods), so it’s wise to plan ahead and choose Medigap coverage with international emergency benefits if you think you might travel during retirement.
(If you have one of four older Medigap plans — E, H, I, and J — they also provide coverage for emergencies outside the United States. They are no longer options for new enrollees, but if you already have one of them you will be covered. And plans F and C will no longer be available to for new Medicare enrollees after the end of 2019).
With a Medigap plan that covers foreign travel emergencies, the patient pays a $250 deductible plus 20 percent coinsurance, and there’s a lifetime maximum benefit of $50,000.
If you are considering a Medicare Advantage plan instead of Medigap supplement plan, and are planning to travel outside the United States, check with the carrier to see if they cover emergency care outside the United States.
Also, if your Medicare coverage is supplemented by retiree health benefits from your employer, check with your plan to see if you have coverage for emergencies during foreign travel.
More than Medicare coverage
For added peace of mind, many seniors choose to purchase travel medical insurance prior to a trip. Travel medical plans are widely available, but be sure to confirm the specifics of the plan including the amount of coverage available to seniors and if it includes medevac coverage.
Traveling only in the United States
More than 90% of all U.S. doctors who provide Medicare-covered services are participating providers with Original Medicare. Original Medicare along with a Medigap supplement plan and a Medicare Part D prescription plan will provide coverage across all fifty states and includes the U.S. territories.
Make sure you check with your Part D plan before traveling, you’ll want to know if you need to make arrangements to purchase medication in advance or use a mail-order pharmacy. Medicare Part D plans can require members to use in-network pharmacies, and some may not have a nationwide network.
Now, if you have a Medicare Advantage plan, these plans cover emergency care anywhere in the United States or its territories, but for routine care, plans typically require enrollees to use your local provider network.
If you have a Medicare Advantage PPO plan and travel in the U.S. for less than six months, you’ll have access to out-of-network providers for routine care, but you may have to pay higher out-of-pocket costs. If you’ve got an HMO, you may not have coverage at all for non-emergency care when you’re outside your normal service area.
Make sure while you are planning for your travel that you are also planning ahead for your medical coverage. No one wants to have a medical emergency during a trip, but careful planning – both when you first enroll in Medicare, and prior to your trip – can save you a lot of headaches down the road – wherever that road may take you. Call us at 919-303-9690 and we can help you choose the right Medigap supplement plan for your circumstances!