Memorial day is the official start of summer and many of us have been anticipating warm-weather fun for months. If that includes getting away from home, you’ll want to pay special attention to some vital pieces of information about Medicare.
Whether you’re planning a camping trip, a visit to a national park, a beach vacation in Mexico, a wine tour in France, or a family visit in another state, you’re going to want to pay attention to your Medicare coverage. Why? Because accidents and illness can happen anywhere and being prepared will help you avoid expensive surprises and give you peace of mind so you can concentrate on having fun.
Traveling within the United States
Traditional Medicare
If you have traditional Medicare (Parts A and B), you’ve made a wise choice. You can go anywhere in the United States and its territories (the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands) secure in the knowledge that you’ll be 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. Medicare’s online guide lists every Medicare provider in the country.
Medicare Advantage
If you have one of the commercial Medicare-Advantage policies, you already know that you’re restricted to its network of doctors and hospitals. But you may not be aware that the network has geographical limits too. To find out if there are in-network providers in the state/city you’re visiting check your provider directory and the section of your policy that describes where you have coverage.
The good news is that your Medicare Advantage insurance must cover you in the US for emergencies or urgent care even if you’re traveling outside your regular coverage area. Plus, you can’t be charged any more than you would ordinarily pay, and the insurance company can’t impose any rules that don’t already apply when you’re at home. However, if you’re outside your plan’s service area for more than six months at a time, the company can cancel your coverage.
Example: Let’s say you have Medicare-Advantage insurance and you live in a place where the winters are cold, but you like to spend them where it’s warm. If you spend more than six consecutive months there your Medicare Advantage insurance company can cancel your policy. If that happens and you want to get back into Medicare Advantage, 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 automatically.
Some Medicare Advantage policies do allow travel for long stretches in the US and its territories. 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. Neither traditional Medicare nor Medicare Advantage can be used except in some very specific circumstances.
Traditional Medicare
Traditional Medicare will cover you for emergencies in Mexico and Canada only if you’re in the US when you have a medical emergency, and the foreign hospital is closer than the nearest US hospital that can treat you
Example 1: “You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest US hospital that can treat you. Medicare determines on a case-by-case basis what qualifies as without unreasonable delay.”
Example 2: Do you live in the US near the Canadian or Mexican border? Traditional Medicare covers you if your closest hospital is in Canada or Mexico and not the US.
Example 3: Taking a cruise? You’ll be covered if you’re treated when the ship is in US waters — that means in a US port or within six hours of one.
Medigap/Medicare Supplement
Some Medigap (Medicare supplement) policies provide emergency coverage outside the US for a limited time, usually no more than 60 days. Again, read the fine print before you rely on it.
Medicare Advantage
Some Medicare Advantage insurance may cover emergencies outside the US for a limited period. It’s all in the fine print.
Medical insurance while traveling abroad
Now you know that Medicare can’t be used outside the US, so it’s a good idea to buy travel medical insurance for your trip.
Travel insurance is not medical travel insurance
Travel medical insurance isn’t the same thing as the travel insurance you get when you pay for your trip with some credit cards. While some may cover what they define as medical emergencies, that’s not the same as being covered for a local-doctor visit if you get sick while traveling.
You’ve probably heard that medical care outside the US is much cheaper so you don’t need insurance, but that doesn’t mean you won’t run into a situation that can end up costing you a lot of money.
Many commercial insurance companies sell policies that cover medical care outside the US; coverage varies as does price.
Caution
Many travel insurance plans don’t pay the doctor or hospital directly. It’s up to you to pay the bill and submit the claim.
The amount reimbursed may not be as much as what you’ve actually paid.
Pre-existing conditions generally aren’t covered, and if they are different insurance companies may have different definitions.
Make sure your policy includes medical evacuation and repatriation.
To get information, search for medical insurance for US travelers, read several of the insurance websites, many of which are brokers that sell products from a number of companies, and get some quotes to get a feel for how it works, what it includes, and what it costs.
You can also find sites that provide medical-coverage advice for US travelers. And if you know someone who’s had experience with travel medical insurance ask for their input.