Travel is a common bucket list entry among baby boomers. Seeing as Medicare is the leading insurance provider among baby boomers, it’s important to know how Medicare covers its beneficiaries as they travel. If you’re starting Medicare soon and have a vacation planned, be sure to research how each Medicare plan covers you in your designation. You may find some don’t cover you at all.
Original Medicare
Original Medicare includes Medicare Part A and Medicare Part B. Both of these parts are provided by the federal government, so they are consistent throughout the country. With Original Medicare, you can have it by itself, add on a Medigap plan, or replace it with a Medicare Advantage plan.
Domestic travel with Original Medicare
Domestic travel means you are traveling within the United States. Original Medicare covers you exactly the same in every state. Therefore, if you live in California and travel to Washington, your Original Medicare will cover you just like it would at home.
Original Medicare has no network, meaning any doctor in the country can choose to accept it. In fact, about 93% of doctors in the country accept Original Medicare. As long as you see doctors who accept Medicare, you can travel to any state or U.S. territory and receive regular coverage.
International travel with Original Medicare
While you can travel anywhere within the U.S. border with Original Medicare and receive the same coverage as you would in your home state, the opposite is true when traveling outside the country. Original Medicare doesn’t cover you when you vacation outside the country and its territories. However, in special circumstances, Original Medicare may cover you in the case of an emergency.
For example, if you were making your way through Canada to get back to the states after vacationing in Alaska, and an emergency occurred, Original Medicare would cover your emergency care at a Canadian hospital. Also, if you were driving through the states, near one of the borders, and an emergency occurred, Original Medicare would cover your care at a foreign hospital if it were closer than any American hospital.
Medigap and Medicare Advantage plans
Medigap plans supplement your Original Medicare, whereas Medicare Advantage plans sort of replace your Original Medicare. However, you must have Original Medicare in order to have a Medigap plan or Medicare Advantage plan.
Domestic travel with Medigap and Medicare Advantage plans
Medigap plans pay after Original Medicare. Therefore, doctors who accept Original Medicare also accept all Medigap plans. This means you can travel anywhere in the country and throughout the U.S. territories, and your Medigap plan will cover you.
Medicare Advantage plans, on the other hand, have networks, so traveling outside of your home state may mean leaving your plan’s service area. There are two main types of Medicare Advantage plan networks: HMO and PPO. HMO plans have a stricter network than PPO plans. With an HMO plan, traveling to another state could mean you’re traveling without coverage, whereas with a PPO plan, it may just mean you’ll pay higher cost-sharing.
When traveling with a PPO plan, be sure to ask the out-of-network doctors if they are willing to bill your plan. Since they are out-of-network, they aren’t required to bill your plan. The good news is, both HMO and PPO plans will cover you out of network in the case of an emergency.
International travel with Medigap and Medicare Advantage plans
Usually, Medigap plans will only pay after Original Medicare first approves the claim. However, when it comes to international emergencies, Medigap plans play by their own rules. Six Medigap plans include a foreign travel emergency benefit of 80%.
You can access this benefit anywhere around the world as long as it’s within your first 60 days of travel. Emergencies that happen outside of your first 60 days are not covered. This benefit has a $50,000-lifetime limit and a $250 deductible.
Most Medicare Advantage plans also include a foreign travel emergency benefit. However, the coverage can vary from plan to plan. Remember, foreign doctors and hospitals are not required to bill your Medigap or Medicare Advantage plan for you. You may have to pay out of pocket and request reimbursement from your plan later.
Medicare is a tricky program, even more so when you start traveling with it. As long as you learn how your specific plan covers you in your destination, you will avoid any potential surprises.