If you are a Medicare retiree and want to travel, make sure you know if your insurance plan can help.
Whether you want to hit the road for a trip to the United States or go abroad, coverage at your destination depends on the specifics of your Medicare plan. The nature of your care (routine or emergency) can also play an important role.
Just over a quarter of Americans (28%) say they got sick or hurt during the holidays, according to a recent study from the personal finance website ValuePenguin. Among this group, bacterial or food-borne diseases were the most common (33%), followed by respiratory diseases (28%) and bodily injuries (24%). In addition, 12% of them said they contracted Covid while on vacation.
In other words, it’s worth knowing what to expect from your Medicare coverage, so there will be no surprises if you need to visit a doctor or other health care provider while you’re away from home.
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With basic Medicare, travel to the United States is easy
Basic Medicare is Part A (hospital coverage) and Part B (outpatient care). Beneficiaries who choose to maintain this coverage, instead of going with an Advantage Plan, usually combine it with an autonomous prescription drug plan (part D).
If this is your situation, coverage while traveling to the U.S. and its territories is fairly straightforward: you can go to any doctor or hospital that accepts Medicare (most do), either for routine care or an emergency. It’s when you venture beyond the borders of the United States that things get more complicated.
Basic Medicare does not cover travel outside the U.S. except in limited circumstances. These exceptions include when you are on a vessel in the contiguous territorial waters of the country, six hours from a U.S. port, or when traveling from one state to another, but the nearest hospital to treat you is to a foreign country (i.e., you are in Canada while going to Alaska from the 48 contiguous states).
Also note that Part D plans will not cover drugs filled out of the U.S., said Elizabeth Gavino, founder of Lewin & Gavino and independent agent and general agent of Medicare plans.
“Make sure you bring enough medication with you,” he said.
A Medigap policy can help overseas
If you have a supplement policy, also known as “Medigap,” along with basic Medicare, it could offer you some overseas coverage.
These policies, which are generally standardized across states, offer some coverage for cost-sharing that includes basic Medicare, such as copayments and coinsurance.
Some Medigap policies include some coverage outside of U.S. plans. Plans C, D, F, G, M, and N have maximum benefits of up to $ 50,000 for life, with the beneficiary paying 20% of the costs after a $ 250 deductible, and you are only covered during the first 60 days of your trip.
This coverage only applies to medically necessary emergency care and there may be other restrictions, according to the Medicare and Medicaid Service Centers.
Some of the older Medigap policies that beneficiaries still have (E, H, I, and J) also include overseas travel coverage, Gavino said.
Keep in mind that Medigap plans include their own rules for enrollment, and policies can be costly depending on where you live, your age, and other factors. For example, for a 65-year-old woman, the cheapest Plan G policy in Dallas is just under $ 100 a month compared to about $ 278 in New York, according to the American Association for Supplemental Insurance. Medicare.
Check coverage details in Advantage plans
For beneficiaries who receive their Medicare benefits (parts A, B, and usually D) through an Advantage plan, it’s worth checking to see if your plan is among those that include overseas emergency coverage.
And even if you don’t plan on leaving American soil, you should see what your plan would cover. While Advantage plans are needed to cover your emergency care anywhere in the U.S., you may be asked for routine care outside of your service area.
“With a traditional HMO plan, when you travel offline, you only have emergency coverage,” said Danielle Roberts, co-founder of insurance company Boomer Benefits.
“With a PPO, you have emergency coverage and off – network coverage for non – emergencies. [but] will pay more for these off-network services, ”Roberts said.
There are also hybrid plans that may allow limited off-grid treatment in certain circumstances, he said.
Your Advantage Plan may cancel your enrollment if you remain outside its service area for a specified period of time, typically six months. In this situation, you would be switched to basic Medicare.
Important tips for traveling abroad
If you have any overseas coverage, you may have to pay out of pocket and receive a refund, Gavino said.
“Foreign hospitals will not file a Medicare claim for you,” Gavino said. “Get a detailed invoice to send to your plan refund.”
Also, depending on your overseas coverage and your comfort level, you may want to purchase a travel medical plan.
Foreign hospitals will not file any Medicare claims for you.
The price of these options is based on factors such as your age and the length of coverage. You can get coverage for a single trip of a couple of weeks or several months, or get a multiple travel policy, which could cover a longer period.
Plans typically include a deductible, for example, of $ 250 or more, and coverage could range from about $ 50,000 in maximum benefits to $ 1 million or more. Policies average between $ 40 and $ 80, although higher coverage limits and longer coverage terms tend to increase the cost, according to the insurance company Travelers.
“Be sure to find out if the plan covers pre-existing conditions and Covid,” Gavino said.
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