Medicare coverage depends on where you travel. It also depends on the type of coverage you have through Medicare.
If you have Original Medicare, you can go anywhere in the United States and its territories and not worry about medical care. This is the plan that most people start with when they begin receiving Medicare. You can seek medical attention from any doctor or hospital you choose. With Original Medicare, you are not covered if you are outside of the United States. This can be a problem if you regularly travel to other countries and something happens to your health.
The Medicare Advantage Plan is different in that you will not be covered for routine medical care. You will only receive medical expense assistance when you have an emergency or need urgent care. Some plans will allow you to see a doctor, but they must be in your network of providers. If you see a doctor outside of the network of providers, you will need to pay for the expenses out of pocket. For some situations, you will need an authorization from a hospital or urgent care facility to see a doctor without having to pay for it out of pocket.
It’s important to know that if you have Medicare Advantage Plan, and you travel outside of the United States for more than six months, you will be disenrolled from the plan. If you become disenrolled from the plan, you will not lose coverage. When you’re disenrolled from Medicare Advantage Plan, you will automatically be covered by the Original Medicare plan. This plan does not cover medical expenses outside of the United States.
To re-enroll, you will need to choose a Medicare Advantage Plan during the Special Enrollment Period. It might be good to seek a plan that doesn’t automatically disenroll you if you leave the service area for more than half a year. Many plans exist in which you can travel outside of the United States for more than six months and still have coverage.
All Medicare Advantage Plans will cover emergency care expenses, but keeping that plan is what you’ll need to look out for with traveling abroad for several months at a time. You must also consider your PPO (Preferred Provider Organization). This means you should seek medical care from a network of providers and no one else or you will have to pay for the cost. There are also Health Maintenance Organizations (HMOs) which have specific rules for who you can see for healthcare and how much you need to pay.
Traveling Outside of the United States
People traveling outside of the United States are usually not covered by their Medicare plan. There are some exceptions to this rule, however. The following are cases in which medical care is covered when having either Original Medicare or Medicare Advantage Plans.
- If you’re traveling in Canada, Medicare may pay for your care if it’s an emergency.
- Cruise ships have medical professionals available, and Medicare will pay for it if you are in U.S. territorial waters. The ship must be in a U.S. port or at least six hours away from a port.
- Those who are close to the border of Mexico or Canada may be covered by their Medicare plan. This is only when it’s a non-emergency, in-patient medical service in a foreign hospital.
Covering the Cost Outside of Medicare
Since Medicare doesn’t cover most medical expenses outside of the United States, it’s wise to seek supplemental insurance. Medigap plans can help with this because they include foreign travel protection. Medigap has plans such as C through G and M and N that covers 80 percent of emergency cost. This only covers the first two months of a trip, and there is a deductible of about $250 to $50,000 depending on the plan you choose.
Call your plan for more information on the specific rules your current Medicare plan has before you plan to travel outside of the United States. It’s better to be prepared for the event of a medical situation than simply go to any medical facility or doctor and then end up with an overwhelming bill that could hurt you financially for many years to come.