Medicare goes on the road, or not
What you need to know about Medicare while travelling or living abroad
It’s spring. Some of the world is opening up and we’re looking forward to traveling again. But whether you’re planning a hike in the Rockies, a beach vacation in Cancun, or a wine tour in Bordeaux, you’re going to have to think about your Medicare. Because at our age (or any) accidents and illness happen wherever we are.
Thinking about becoming an expat? That takes planning.
Traveling within the United States
Do you have traditional Medicare (Parts A and B)? You made a wise choice. You can go wherever you want in the US secure in the knowledge that you’re covered just as you are at home. You can see any doctor who accepts Medicare, go to any hospital, or rush to any emergency room and you’ll be covered. Period. End of story.
Traditional Medicare has your back; those private insurance plans, aka Medicare Advantage, not so much. Medicare Advantage is more complicated, and that shouldn’t surprise you.
If you’re covered by a Medicare Advantage plan it must cover you in the United States for emergencies or urgent care even if you’re traveling outside your home area or their network. And they can’t charge you extra for it or impose any rules other than those that already apply when you’re at home. But, if you’re outside your plan’s service area for more than six months at a time, they can cancel your coverage.
Here’s an example.
Let’s say you have a Medicare Advantage plan and you live in New York, Boston, or some other place where the winters are cold. Now let’s say you like to spend the winter months or longer in some place that’s warm, say Florida, Arizona, or SoCal. If you’re there for more than six months your Medicare Advantage insurance company can cancel your policy. After that, if you want back in to a Medicare Advantage policy, you’ll have to wait for a special enrollment period and choose a different plan. If you don’t, you’ll be enrolled in traditional Medicare.
Some Medicare Advantage policies allow travel for long stretches in the US and its territories, but if you think yours is one of them, read the fine print first (always a good idea anyway). It may include only certain parts of the country, some services may not be covered at all, and unless it’s an emergency it could cost you more than it would at home.
Medicare outside the United States
If you’re crossing a border or an ocean, you’re out luck. Both Traditional Medicare and Medicare Advantage are useless except in some very narrow instances.
Here they are.
Traditional Medicare
You’ll be covered for emergencies in Canada, but only if you’re traveling between Alaska and another US state via a direct route and the closest hospital is in Canada. So if you fly from New York to Anchorage and get sick while making a scheduled connection in Vancouver, you’re covered. But if you leave the airport in Vancouver to tour the city and surrounding area, before catching your flight to Anchorage, you’re not.
Do you live near the US/Canadian or US/Mexican border? Traditional Medicare may cover in-patient hospital care if your closest hospital is in Canada or Mexico and not the US.
On a cruise? You’ll be covered if you’re treated when the ship is in US waters. That means the ship must be either in a US port or within six hours of one.
Medigap/Medicare Supplement
Do you have Medigap (Medicare supplement) insurance? Some policies provide emergency coverage outside the US, but make sure you read the fine print before you count on it.
Medicare Advantage
Some Medicare Advantage policies may cover emergencies outside the US, but again, read the fine print and get the details in writing from your insurer or insurance agent.
Medical insurance while traveling abroad
Medicare should be portable, but it’s not. So, until it is, you’ll need medical insurance while you’re away.
Medical insurance isn’t the same as the travel insurance you get when you pay for your trip with a credit card. Some of those credit card insurance policies may cover certain medical emergencies, but that’s not the same as being able to go to the doctor while you’re on a trip.
Many private insurance companies sell policies that cover medical care outside the US. Of course, prices and coverage vary. To get information, search for medical care for US travelers or medical care for US expats, read several of the insurance websites, and get some quotes to get a feel for how it works and what it costs.
There are also health-coverage advice sites for US travelers. And if you know someone who’s had experience with travel medical insurance ask for a referral.
Becoming an expat and living in a foreign country
It’s not only for young digital nomads
Tens of thousands of older Americans live outside the US, and every year thousands more join them. If you think you’d like to try it there are additional things you need to know.
Medicare, whether traditional or Medicare Advantage is useless for this.
You’ll probably need a visa and the visa may require you to have medical insurance as part of the application.
In some countries you can get covered by the national health-insurance system if you become a resident – requirements vary from country to country. Search for things like France visa requirements or European Union visa requirements, or how can an American live in Thailand, etc. You’ll find basic information plus sources of official information and applications.
Medical care in many places outside the US is excellent and the equal of care in the US. Plus, out-of-pocket expenses are shockingly low compared to the United States because of government regulations.
But…
There’s always a but. If you move out of the US you can stop paying your monthly Medicare Part B premium. But if you do and then you want to come back to the US and resume Medicare, there’s a 10% per year penalty added to the monthly premium for every year you’re out of the system. Yes, even though you paid into it all your working life. That’s a lot of money, and for that reason many expats continue to pay the Part B premium.
There’s an exception to the penalty
If you live outside the US when you first become eligible for Medicare, and you’re covered by that country’s national or other health insurance, and will continue to be covered after you turn 65, you won’t be subject to the penalty if you return to the US.
Thank you for your support. See you soon.