This guest post comes from Danielle K Roberts. the co-owner of Boomer Benefits, a licensed insurance agency that helps Medicare beneficiaries find suitable Medicare supplement coverage.  

Here in the United States, Medicare covers healthcare services for people aged 65 and over and for some individuals with disabilities. This national health insurance program offers both inpatient and outpatient benefits as well as voluntary prescription drug coverage.   Still, since Medicare is a U.S. healthcare program, it has limited benefits for beneficiaries when they are traveling. Here’s a review of some common travel scenarios and what Medicare travel coverage be in each of them.

Medicare Travel Coverage
Foreign Travel Benefits

Original Medicare generally does not include any coverage for routine healthcare services outside the U.S. This means that if you get a flu bug or have a cold or virus while traveling, you will pay for your own visit to a foreign doctor.  However, Medicare does provide benefits for medical emergencies when you are traveling in certain circumstances.

• If you are a U.S. resident living near the border and a foreign hospital is actually closer to you than a U.S. hospital, Medicare may pay for the regular covered services that you receive in the foreign hospital.
• Another scenario is when you are on a trip to or from Alaska and another state. If a medical emergency happens and a Canadian hospital is closer than a U.S. hospital, Medicare may pay for your care in the Canadian hospital. These situations are reviewed on a case by cases basis.
• Medicare may also cover medical emergencies when a foreign hospital is closer than the nearest U.S. hospital while you are traveling (regardless of whether you live near that hospital).
• Medicare may cover medically necessary services that you undergo on a cruise ship. The ship doctor is allowed under certain laws to give you medical services on the ship. You can get coverage on the ship when it is in a U.S. port or within 6 hours of a U.S. port. The doctor will submit the claim to Medicare if his office is in the U.S. Otherwise, you will need to mail a claims form to Medicare yourself.  If you are more than 6 hours from the U.S. port, Medicare generally will not provide coverage.

 

Medicare Travel Coverage
Your Expenses under Original Medicare

When Medicare does provide services under these situations, your coverage works exactly the same as it does when you are home.

• Medicare Part A provides you with inpatient hospital coverage.
• Medicare Part B looks after outpatient medical services, which might include diagnostic scans or ambulance services as well as doctor visits while you are in the hospital.

As usual, you will be responsible for your own deductibles, coinsurance, and copays. However if you signed up for supplemental coverage, then that coverage may kick in to help you with some of that cost-sharing.

 

Medicare Travel Coverage
How Medigap Plans Cover the Gaps

Medicare supplements, (aka Medigap plans), pay after Medicare to help take care of your deductibles, copays, and coinsurance. In most states, there are ten standardized plans to choose from.  Medigap Plan F is the most comprehensive plan. This one leaves you with no out-of-pocket spending.

Plan F and several other Medigap plans also include a foreign travel emergency benefit. This benefit will pay 80% of your emergency medical costs up to a $50K max per lifetime. You will be responsible for a small deductible up front and then you also pay the other 20%.

 

Medicare Travel Coverage
How Medicare Advantage Plans Pay While You Travel

Some Medicare beneficiaries choose to get their Medicare benefits from a Part C Medicare Advantage plan instead of from Original Medicare. These plans generally have networks of doctors and hospitals where you will get your care.

All Medicare Advantage plans have worldwide emergency coverage. Some Medicare Advantage plans operate PPO networks. This means that you can get medical treatment outside the network, although you will pay more for out-of-network services.

What you pay as your share will be based on the plan’s Summary of Benefits. You should review this document or speak with your Medicare insurance agent before your trip to be sure you fully understand your benefits.

 

Medicare Travel Coverage
Coverage for U.S. Travel

Your benefits for travel inside right here in the U.S. are pretty good. Medicare and Medigap plans allow you to seek treatment with providers anywhere in the nation.

If you are enrolled in a Medicare Advantage HMO, be aware that most HMO plans usually have emergency coverage only when you are traveling outside the network area. If you are in another state and you need routine or minor care, you will pay those expenses out of pocket.

 

Medicare Travel Coverage
Short-Term Travel Coverage

If you have plans to travel and you’d like additional coverage beyond what we’ve described here in this article, you might check with your travel agent. Some travel agencies can help you purchase medical emergency coverage for your trip.

 

Danielle K Roberts is the co-owner of Boomer Benefits, a licensed insurance agency that helps Medicare beneficiaries find suitable Medicare supplement coverage in 47 states.