Medicare provides health insurance for Americans when they turn 65. Because it’s a national health insurance program, Medicare provides coverage here in the United States, but what about when you are traveling.
Here’s an overview of what Medicare does and doesn’t cover related to travel, so you can learn what to expect if you have a medical need while traveling.
Travel Benefits Outside the U.S.
Traditional Medicare, in general, doesn’t cover routine medical care when you are outside the United States. So, for example, if you came down with a cold and visited a doctor in Mexico, you would pay for this expense out of pocket.
Medicare does, however, cover emergency medical services in certain situations when you travel to other countries.
If you are traveling to or from Alaska through Canada, Medicare may cover a medical emergency in which a Canadian hospital is closer to you than an American hospital.
Another circumstance where you may be covered is if you are a resident of the United States that is living close to the border and a foreign hospital is closer to you than any American hospital. Medicare may pay for your care in the foreign hospital in this situation.
Likewise, Medicare could also cover a medical emergency when you are traveling, and a foreign hospital is closer than an American hospital.
There may also be limited coverage when you are traveling on a cruise ship. The cruise ship’s doctor can provide medical care to you on the ship if you are within six hours of a U.S. port, and Medicare will cover this care. However, if you are further than six hours from a United States port, then medical services will be at your expense.
What Will You Pay?
Medicare has cost-sharing that beneficiaries pay whenever they use medical services. This works the same in the travel situations described above as it would in your hometown.
Your hospital coverage is provided by Part A and your outpatient care falls under Part B. For example, Part B might pay for ambulance rides or physician care during an emergency.
You, however, must pay a share of these expenses in the forms of deductibles or copays.
Because Medicare doesn’t cover everything, many people enroll in supplemental coverage to help pay the gaps.
Medicare supplement plans help to pay for your share of the costs. Popular comprehensive plans like Plan F and Plan G also offer an emergency travel benefit. Here’s how it works: you must satisfy a $250 deductible up front. Then the Medigap plan will pay 80% of your expenses related to the foreign travel emergency. The other 20% is your responsibility. There is a limit of $50,000 in lifetime benefits.
Medicare Advantage Plans
About one-third of all Medicare beneficiaries have chosen to get their Medicare Part A, B and sometimes D benefits from a Medicare Advantage plan instead of from Traditional Medicare.
When you join a Medicare Advantage plan, you will have a network of providers that you will get your medical care from in order to pay the lowest costs. These networks are generally in your local home area. The network might be across several counties or perhaps even statewide.
When you travel with a Medicare Advantage plan, you have emergency coverage worldwide. This means that even if you are outside the network, your plan will pay for your emergency care. You will be subject to the plan’s terms and conditions and you’ll pay the normal cost-sharing that you would pay if you were treating locally for the same emergency.
If you enrolled in a Medicare Plan with a PPO network, you generally will also have out of network services for non-emergencies. You just may pay more because you are outside the network. This can be a problem with these plans, just one of the ways Why Medicare Advantage Plans are Bad: 7 Top Complaints.
What about Travel Here in the States?
Medicare has excellent benefits for U.S. travel. Why? Because Medicare is a national network of providers that is over 800,000 providers strong. You can treat with a doctor in Kansas the same way you would in Texas or any other state.
Likewise, if you enrolled in a Medicare supplement plan, that plan will provide benefits to you anywhere in the United States.
Medicare Advantage plans provide benefits here in the U.S. depending on your network you’re your plan is an HMO plan, you have only emergency coverage outside the network in the U.S. If your plan is a PPO Plan, then you would have out-of-network benefits. You’ll pay more for out of network services though.
Improving your Coverage
Many people who are traveling outside the United State want the peace of mind that solid medical emergency coverage providers. If this is you, speak with a travel agent for guidance on short-term plans that you can purchase that pay benefits in the event of a medical emergency while traveling.
Danielle Kunkle is the co-founder of Boomer Benefits, where her team helps beneficiaries navigate their Medicare benefits.
We are happy to present this collaborative post to offer valuable information to our readers.