Traveling and vacationing are top retirement goals among the baby boomer generation. According to The Wandering RV, boomers take four to five leisure trips a year. There is a lot that goes into planning a vacation, such as making reservations and scheduling transportation. But do you have a plan for a medical emergency? Visiting the doctor or hospital on your vacation might not be listed on the itinerary, but it is important to know how Medicare works when you travel.
Traveling with Medicare
Original Medicare is America’s healthcare program that is available to seniors aged 65 and older and people who qualify due to certain disabilities. Original Medicare consists of Part A for inpatient coverage and Part B for outpatient coverage.
Travel in the United States
With Original Medicare, you can travel and visit any doctor in the United States that accepts Medicare, as there are no network restrictions. You can also see doctors that accept Medicare in America’s territories, such as Puerto Rico, Guam, the Virgin Islands, American Samoa, and the Northern Mariana Islands. However, if you visit a doctor in the states or one in a U.S. territory, and they do not accept Medicare, prepare to pay the whole bill.
International travel
Since Medicare is an American health insurance program, Medicare generally does not provide cost-sharing outside the country. There are a few limited exceptions to how Medicare will cover you outside the states. For example, if you live near an international border and a medical emergency occurs, if the international hospital is closer than the nearest American hospital, you can go to the international hospital.
With that said, if you receive care outside the United States, the doctor or hospital does not have to accept Medicare as a form of payment, so you may be responsible for the bill.
Traveling with Medigap
A Medigap plan, also known as a Medicare Supplement, is an optional form of coverage sold by private insurance companies. Medigap plans work alongside Original Medicare; Medicare is primary and Medigap is secondary coverage.
Travel in the United States
Similar to Original Medicare, Medigap plans do not have network restrictions. Therefore, if you visit any doctor or hospital in the United States that accepts Medicare, they must accept your Medigap plan.
Medigap plans are generally a good option for seniors who travel often or for an extended period within the United States. However, your Medigap coverage changes once you leave America.
International travel
Most Medigap plans have a $50,000 lifetime foreign travel benefit. If you are traveling outside the U.S. and need emergency care, Medigap foreign travel benefits cover 80% of your healthcare costs up to the plan limit.
Medigap plans only provide you with coverage within the first 60 days of your travel outside the country, however. If you plan to be away for a long period of time, you’ll need other health coverage.
Traveling with Medicare Advantage
Private insurance companies sell Medicare Advantage (Part C) plans, and like Medigap plans, Medicare Advantage plans are optional. Medicare Advantage plans are structured differently than Original Medicare and Medigap plans. Medicare Advantage plan may or may not cover your healthcare services outside of its service area.
Travel in the United States
There are a few different Medicare Advantage plans, but HMOs and PPOs are the two most common types. With an HMO plan, you must stay within your network for most healthcare services. You can only go out-of-network with an HMO plan in the case of an emergency. Typically, if you go out-of-network with an HMO plan, you will pay 100% of your medical bill.
Medicare Advantage PPO plans can be more flexible, as you can visit out-of-network doctors. However, you will have a higher copayment when you go out-of-network versus you staying within your network. With that said, Medicare Advantage PPO plans do provide coverage when you travel.
International travel
Many Medicare Advantage plans have worldwide emergency benefits. However, your copayments and deductible will vary by plan, so you will need to check your plan’s Summary of Benefits for cost-sharing details.
Note that foreign providers dos does not have to accept your Medicare Advantage plan. If this is the case, you’ll need to submit your bills to your insurance company once you return home to be reimbursed for covered expenses.
If you travel outside your network for six consecutive months, there is a possibility that your carrier will drop you from your plan. If that happens, you’re automatically enrolled in Original Medicare. You’ll be able to return to your Medicare Advantage plan during the next Annual Election Period.
Conclusion
Medical emergencies are always a surprise which is why it is crucial to know how Medicare works when you travel. For more information over traveling with Medicare, refer back to your plan’s Summary of Benefits or contact your carrier. Safe travels, boomers!
