Medicare Coverage While Traveling
Medicare while Traveling – What You Need To Know Before You Go
The high travel season is fast approaching. And with so many retirees utilizing their retirement as an opportunity to travel, there is one thing to remember when planning your adventures…your health care coverage. Wherever your travels take you, if you have Medicare it’s important to understand what’s covered, and what’s not, before you hit the road.
Original Medicare vs. Medicare Advantage
The first step in understanding what’s covered when you travel is to understand which type of Medicare plan you have. A Medicare Advantage plan, sometimes known as Part C, is Medicare coverage that’s provided by private health insurance companies. Because it’s a private health plan, the rules for what’s covered and what’s not may be a little different than with original Medicare.
With original Medicare, whatever is covered when you’re at home is, for the most part, covered when you’re traveling within the United States. A few important points to remember:
- Emergency care will be covered wherever you are in the U.S.
- When seeing a doctor for non-emergency care, make sure he/she accepts Medicare insurance.
- U.S. travel means all 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa and the Northern Mariana Islands.
- Different rules apply for coverage on cruise ships.
A Note About Durable Medical Equipment
If you have original Medicare and need to obtain durable medical equipment or supplies while traveling, you must use a Medicare-approved supplier. For a list of approved suppliers, visit www.Medicare.gov/supplier.
Private health insurance companies provide Medicare Advantage plans. If you get your Medicare coverage through a Medicare Advantage plan, you’ll want to check with your plan before you travel so you know exactly what’s covered, and what’s not. In many cases:
- Emergency services may be covered by your plan, wherever you are.
- If you see a doctor for non-emergency services and he/she is not in your plan’s network, you may have to pay more than usual.
- You’ll need to check your plan’s Summary of Benefits or Evidence of Coverage documents or call your plan directly to know what’s covered and what isn’t.
Medicare Coverage Outside the U.S.
When traveling outside the U.S., your Medicare coverage is very limited. In specific situations, however, Medicare will cover some or all of your medical costs. For instance, you may be covered if:
There are 3 situations when Medicare may pay for certain types of health care services you get in a foreign hospital (a hospital outside the U.S.):
1. You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat your illness or injury.
2. You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury. Medicare determines what qualifies as “without unreasonable delay” on a case-by-case basis.
3. You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it’s an emergency.
Remember, in these situations, Medicare will pay only for the Medicare covered service. You should keep in mind while traveling outside the U.S. that:
- Medicare drug plans can’t cover prescription drugs you purchased outside the U.S.
- Medicare will only cover dialysis as part of an emergency situation while you are in a hospital, but will not cover your dialysis otherwise.
- If you only have Original Medicare Part A then Medicare only pays for its share of the cost for inpatient hospital care.
- U.S. hospitals must submit claims to Medicare for you, foreign hospitals however are not required to do the same. So if you are admitted to a foreign hospital that does not submit Medicare claims, then you must submit an itemized bill to Medicare personally.
If you are a foreign traveler then you should consider having a Medicare Advantage or Medigap plan. Some Medicare Advantage or Medigap plans provide worldwide or emergency coverage when you travel outside the United States. Specifically the Medigap plans C,D,F,G, M and N provide coverage for foreign travel emergencies. You should always check with your plan before traveling outside of the country.
For complete details on what Medicare covers outside the U.S., download Medicare Coverage Outside the United States from the Center for Medicare and Medicaid Services (CMS), or call 1-800-MEDICARE. If you have a Medicare Advantage plan, consult your plan’s Summary of Benefits or Evidence of Coverage documents, or call the plan directly. If you’re curious about your coverage at a second home, view our Medicare ABC’s page to learn more.
To find a Medigap plan in your area that covers health services while you’re abroad, call us at 1-877-614-2333 to speak with a licensed sales agent.