When you’re planning a trip, your main concerns are likely finding the best hotel, planning fun times, and figuring out the airline’s packing restrictions. If you’re leaving the country, you probably want to check your passport and whether there are any visa requirements. Questions about health insurance, though, may not occur to you until it’s too late. What happens if you get sick on the trip, or have a medical emergency? Does your Medicare coverage extend to your vacation getaway? This post explains your Medicare coverage while traveling in the U.S. and abroad, as well as how to get coverage when you aren’t in the United States.
Medicare Coverage and Interstate Travel
If you’re traveling within the United States and have Original Medicare, you don’t have to worry. You’re covered throughout the country and most providers accept Medicare insurance. In addition to all 50 states and Washington, D.C., Original Medicare beneficiaries are covered in:
- American Samoa
- Northern Mariana Islands
- Puerto Rico
- The U.S. Virgin Islands
If you have Medicare Advantage (MA), though, your plan may not cover treatment received outside of your service area. Or, your plan may cover treatment but at a higher cost to you, since you’re out-of-network.
However, even if you have a Medicare Advantage plan, it must cover emergency treatment received anywhere in the United States without levying additional charges against you.
Before traveling, contact your plan provider and ask about coverage and any restrictions, such as prior authorization requirements. In addition, most MA plans disenroll you if you travel outside of your service area for six months or more. If that happens, you qualify for a Special Enrollment Period. Failure to enroll in another MA plan during this period results in automatic enrollment in Original Medicare.
If you travel a lot and want to keep Medicare Advantage, look for a plan that allows continuous travel throughout the United States and its territories. But, carefully consider the restrictions (if any) that plan imposes. For example, it may only cover certain areas, specific types of care, or charge more for treatment outside the network.
Medicare and International Travel
Medicare rarely covers care received while traveling in another country. Exceptions include:
- Emergency care in Canada for an injury or illness sustained while traveling between one of the “lower 48” states and Alaska, assuming the closest hospital is in Canada.
- Medical care received on a cruise ship while in U.S. territorial waters, i.e. within six hours of a U.S. port.
- Non-emergency inpatient care in a foreign hospital if that hospital is closer to your residence than the closest U.S. hospital is. This mainly applies to beneficiaries who live near the border of Canada or Mexico. (Technically, this is not Medicare coverage while traveling.)
Some Medicare Advantage plans cover emergency care abroad. Check with your plan provider to determine international coverage.
If you have a Medigap policy, it may cover medical treatment during foreign travel. See the section titled Medigap and International Travel.
What Is Your Cost?
The vast majority of the time, Medicare does not cover medical costs incurred during foreign travels, so your cost is 100 percent. However, if your situation matches one of the above scenarios, and the service received is covered by Original Medicare, your costs are the same as if you had received treatment here. Typically, this means 20 percent of the approved amount and whatever remains of your Part B deductible.
Medigap and International Travel
Many Medigap plans offer healthcare coverage while traveling outside of the United States, including Plans C, D, F, G, M, and N. In addition, if you purchased Plan E, H, I, or J before June 1, 2010 and you have had it continuously since then, you have emergency healthcare coverage when traveling outside the United States.
There are, of course, restrictions. If you have a qualifying Medigap plan, it covers emergency care only if it begins during the first 60 days you spend traveling outside of the U.S. Once you’ve met your yearly $250 deductible, your Medigap plan covers 80 percent of billed charges for emergency care deemed medically necessary. There is a $50,000 lifetime limit on foreign medical emergency coverage through your Medigap plan.
Before leaving for your trip, talk to your Medigap plan agent to determine coverage while traveling outside of the United States and its territories. If you do not have a Medigap plan and would like to buy one, call us toll-free at 855-350-8101 (TTY 711) to speak to a licensed sales agent.
Final Thoughts on Medicare and Travel
Although Medicare does not cover most medical treatment required during foreign travel, many Medigap plans do. In addition, you can add health coverage to your travel insurance.
You may also wish to visit the Centers for Disease Control (CDC), which offers numerous resources for Americans traveling to foreign countries (or even within the United States). The site provides information on vaccinations and potential health issues, as well as details and updates on medical alerts and safe travel practices.