With so many of us going on vacation this summer, knowing if your coverage travels with you is important. If you’re relaxing at a resort in Mexico and need to go to the doctor, will you be stuck with the bill? How about if you’re visiting family out of state and need emergency care? The distinction between different kinds of plans and destinations can change your coverage options.
Medicare Coverage While Out of State
If you’re traveling within the United States with Original Medicare, you’re in luck. Medicare Parts A and B coverage has no regional restrictions in any of the 50 states, as well as any territory (lookin’ at you, Puerto Rico!) or the District of Columbia.
Though Original Medicare doesn’t have a regional restriction, not all physicians accept Medicare patients, choosing to opt out of the system.
That said, not all physicians accept Medicare patients. Some doctors, especially specialists, opt out of the Medicare system. You can find participating doctors and hospitals using the tools on the Medicare.gov homepage.
If a doctor accepts Medicare assignment, they’ll also accept your Medigap plan if you have one.
The alternative to Original Medicare, Medicare Advantage plans can be more expensive when receiving health services on the road. While Medicare Advantage plans cover many of the services included in Parts A and B, they often limit coverage for out-of-network health care.
Medicare Advantage (MA) plans traditionally come in three forms: HMO, PPO, and Special Needs Plans (SNPs).
HMOs restrict coverage for health services to a network except in the case of emergency care or out-of-area urgent care. HMO point-of-service plans (HMO-POS) may enable you to receive out-of-network care, though it comes at a higher cost.
PPO plans give members the flexibility to receive care out of the network, though it comes at a higher cost than in-network care.
SNPs generally require you to receive care only from in-network doctors or hospitals, except in the case of emergencies or urgent care. Out-of-area dialysis for End-Stage Renal Disease is also exempt from network restrictions.
Network area and the out-of-network costs are defined within your individual MA plan.
It’s always a good idea to talk to your doctor before traveling to have a health emergency plan in place.
Medicare Coverage While Out of Country
Original Medicare may assist you throughout the United States, but very rarely covers international costs. There are only a few instances where Original Medicare will pay for inpatient hospital, doctor, ambulance services, or dialysis in a foreign country. These instances are:
If you have a health emergency in the U.S., but the nearest hospital that can assist you is in another country.
If you’re in Canada while traveling the most direct route between Alaska and the continental U.S. when the emergency occurs. In this case, a Canadian hospital must be the closest hospital and your trip must not be taking any “unreasonable delay[s].”
If you live in the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition. In this instance, a medical emergency is not required for coverage.
In each of these cases, you are responsible for 20% of the approved medical costs. If you’re on a cruise outside of the U.S., Medicare may cover your needs if your ship’s doctor can provide medical services and the ship is within 6 hours of a U.S. port.
If you fall into any of the approved circumstances, your Medicare plan will cover most, if not all, of the services that Medicare Parts A and B usually cover. Medicare deductibles, coinsurances, and copayments still apply.
Since Original Medicare has limited coverage internationally, there are a few important factors to consider. You can purchase a travel insurance policy from a travel agent, though they don’t always include health coverage, so read through the plan thoroughly to ensure coverage.
If you use your insurance outside of the U.S., save your itemized medical bill. You’ll need it later.
If you do need to use your health insurance while outside the U.S., save your itemized medical bill for all services you received. You will need to submit this to Medicare, since foreign hospitals are not required to file a claim.
If you have Original Medicare and are traveling abroad, you can still gain coverage for health emergencies in foreign countries with specific Medigap plans. Some Medicare Advantage plans also cover health care costs outside of the U.S. In both cases, you’ll want to explore your plan to see the exact specifications.
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Vacation season will find millions of Americans traveling away from home. Before traveling this year, make sure your Medicare plan will cover you, wherever you roam. To explore Medicare plans with coverage options that interest you or speak with a licensed sales agent, check out the Medicareful Plan Finder.