If you are a retiree and on Medicare, and feeling the travel bug, be sure to know whether your insurance plan will cover you.
Whether you are planning a trip within the United States, or plan to travel overseas, coverage at your destination hinges on your specific Medicare plan. The nature of your care, routine or emergency visit, may also play a roll.
According to a recent study from the personal finance website ValuePenguin, just over a quarter of Americans (28%) say that they have fallen ill or been hurt while vacationing.
Among the group, bacterial and food borne illness were most common at 33%, followed by respiratory illnesses at 28%, bodily injuries at 24% and 12% of them said they had contracted COVID while on vacation.
It is worth knowing what to expect from your Medicare coverage so there are no surprises if you need to visit a doctor or other health care provider when you are far from home.
Original Medicare and Travel in the US
If you have opted to have Medicare Part A (hospital coverage) and Part B (outpatient care) there is a good chance that you have paired it with a stand-alone prescription drug plan (Part D). If this is your situation, coverage while traveling within the United States is fairly straightforward: you can go to any doctor or hospital that accepts Medicare, and most do, whether it be for routine care or for an emergency.
Original Medicare DOES NOT cover travel outside of the United States except in very limited circumstances. Those exceptions include when you are being treated on a cruise chip within six hours of a U.S. port, or you are traveling from state to state, but the closest hospital that can treat you is in a foreign country. Example: You are in Canada while heading to Alaska from the 48 contiguous states.
Part D plans will not cover medications filled outside of the United States, so you will want to make sure that if you are planning to travel overseas, you bring enough medication with you.
Travel and Medicare Advantage Plans:
For Beneficiaries who get their Medicare benefits through a Medicare Advantage plan, you will need to check to see what your plan will cover, whether you plan to travel abroad or not. While Medicare Advantage plans are required to cover emergency care anywhere in the U.S., if it is routine care you are needing outside of the MA plan service area, you may be responsible for the payments.
Travel and Medicare Supplement Plans:
If you have a Medicare Supplement policy (Medigap) alongside original Medicare, it could give you some coverage abroad. Medigap policies are generally standardized across the states, offer some coverage for the cost sharing that goes with original Medicare, such as copays and co-insurance.
Some Medicare Supplement policies include some coverage outside of the United States. Plans C, D, F, G, M and N have up to a $50,000 lifetime maximum benefits, with the beneficiary paying 20% of costs after a $250 deductible, and you are covered for the first 60 days of your trip.
This coverage only applies to medically necessary emergency care and there could be other restrictions, according to the Centers for Medicare and Medicaid Services (CMS).
Some older Medicare Advantage policies that beneficiaries still have, plans E, H, I and J, also come with travel coverage abroad.
- Be Aware: Medicare Supplement plans come with their own rules for enrolling, and policies can be pricey depending on your age, where you live, or other factors.