Today’s guest post examines an important topic: For those U.S. baby boomer travelers on Medicare, just exactly what kind of coverage can you expect when you’re on a trip, whether it’s in the U.S. or abroad?
Medicare expert Danielle Roberts says that all depends on where you’re going and what you’ve signed up for. Here’s her analysis:
By Danielle K Roberts
Whether you travel within the United States or to other countries, it’s important to know when Medicare travels with you and when it doesn’t.
Here are the key questions to ask yourself before setting off:
Are you going to another country?
How far outside the United States are you traveling?
Are you traveling from state to state?
Do you only have Original Medicare?
If not, what kind of Medicare plan do you have?
If you know the answers to these questions, you’ll be ready if and when you need to seek medical care during your trip.
Travel Outside of the United States
It’s safe to say that if you travel outside of the United States and you only have Original Medicare, your routine health care isn’t covered. (Note that the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa are all considered part of the U.S.)
However, Original Medicare may cover medical emergencies abroad in these three cases, which Medicare calls “rare.”
- You’re in the U.S., but a medical emergency occurs and a foreign hospital is closer to you than the nearest United States hospital that can treat your condition. (An example might be if you’re in the U.S. Virgin Islands but need to be treated in the British Virgins.)
- While traveling a direct route between Alaska and another state, you have a medical emergency and an appropriate Canadian hospital is closer than a United States hospital.
- Even if you don’t have a medical emergency and you live in the U.S., you can get treatment at a foreign hospital if it’s closer to your home than a United States hospital and can treat your medical condition.
If you fall under one of these cases, Original Medicare may cover your inpatient hospital stay, your doctor, ambulance services, or dialysis.
What You Pay with Original Medicare
Unless you have a special circumstance from the list above, you will pay 100% of the bill. If you have one of the circumstances, you will pay just like you would when receiving health care within the United States.
Here’s what’s covered: When you first apply for Medicare through the Social Security office, you enroll in Part A and Part B.
Part A will be in charge of your inpatient hospital stay while Part B takes care of outpatient services such as doctor services, lab testing, diagnostics and ambulance rides.
You will have your normal cost-sharing such as copayments, coinsurance, and deductibles. The coverage is exactly the same as if you were in the U.S.
What You Pay with Medigap Plans
When you first become eligible for Medicare, you may sign up for additional coverage to help pay for things that Medicare doesn’t. Medigap plans cover the gaps within Medicare, helping to pay the copays and deductibles mentioned above.
Medigap plans C, D, F, G, and N all have a foreign travel emergency benefit. After you meet a $250 deductible, your plan will pay 80% of your costs from the medical emergency in another country.
But this extra benefit comes with restrictions. You can only use this benefit within your first 60 days outside of the United States. Also, you have a lifetime limit of $50,000 that your Medigap plan will spend on foreign travel emergencies.
What You Pay with Medicare Advantage Plans
Medicare Advantage plans are private health insurance policies that pay instead of Medicare. You get your benefits from their network of providers and pay copays and deductibles as you go along.
All Medicare Advantage plans have a worldwide emergency coverage benefit that kicks in when you travel outside the network so that you will have help with any emergency medical expenses.
These plans set their own-cost sharing for members. You may be responsible for the copays and coinsurance outlined in your plan’s Summary of Benefits as well as any out-of-network deductibles.
Travel Within the United States
If you plan to travel within the states, Medicare coverage is a lot less complicated. If you have Original Medicare, your coverage will be normal, just as it would be in your home state.
Medigap plans also travel with you, so you don’t have to worry about paying extra. You will have the same coverage as you would in your home state.
The only time when coverage gets tricky when traveling within the United States is if you have a Medicare Advantage plan.
Most Medicare Advantage plans have networks that require you to stay within their own networks to receive your medical care at normal costs.
If your plan is an HMO (Health Maintenance Oranziation), your coverage outside the network is usually only emergency care. If your plan is a PPO (Preferred Provider Organization), you will have some coverage but will have to pay more than you would if you stayed within the network.
Before setting off on your trip, check with the insurance agent who helped you enroll in your Medicare coverage. This agent can help explain how your coverage will work depending on where you travel and what type of plan you have.
If you didn’t use an agent, you can call the customer service number for the insurance company itself and ask to be connected to a representative who can explain your benefits.
If you are still concerned about the costs you might incur, check with your travel agent or online travel insurance sites for a short-term solution. Many travel insurance plans have medical options in which you can obtain emergency coverage during your travels.
Author Bio: Danielle K Roberts is a Medicare insurance expert at Boomer Benefits, where her team helps baby boomers with their Medicare insurance options. For Danielle’s free course offering a step by step guide to all things Medicare, go here.