My husband and I are traveling now that the world has opened up. Can you tell me if Medicare will cover our medical expenses if we need to use a hospital or doctor outside of our state?
If you’re on a Medicare Supplement plan, you’re in luck! Medicare Supplement plans don’t come with network restrictions. That means you can essentially go to any doctor anywhere you’d like across the country. If you’re on a Medicare Advantage HMO (Health Maintenance Organization) plan, you may be out of luck if you get sick, even in the next ZIP code.
Medicare Advantage HMO Plans and Travel
An MAPD HMO plan has a defined service area (usually by county), and there are next to zero out-of-network benefits. For example, if you have a small, strict gatekeeper HMO model Medicare Advantage plan with a limited service area around where you live in Sarasota, Florida, forget getting routine care while on your visit with the kids in Denver, Colorado. That is, of course, unless there’s an emergency. There’s always ER coverage for emergencies wherever you are.
Aside from what the government mandates that HMO plans must include in their coverage (covering care for emergencies out of your area), most do not have what you’d normally consider “travel” coverage. To get the skinny, you need to pull out your Summary of Benefits booklet for your policy or call the company and ask. You can find more detailed information in the Evidence of Coverage.
Medicare Advantage PPO Plans and Travel
If you have a Medicare Advantage PPO (Preferred Provider Organization) plan, those by design have out-of-network coverage if you’re traveling out of your service area in the U.S. Often, it’s covered, but at the out-of-network rate and will cost you more than if you would have stayed in their network.
This is one of the nice features of Medicare Advantage PPO plans. The out-of- network MOOP will be higher than your in-network MOOP, so be aware of that. Many Medicare Advantage PPO plans have national networks—which means you can potentially stay in network outside of your state. This can be a big deal if you’re a snowbird or visit family outside of your home state or area for extended periods. Not all Medicare Advantage PPOs have this feature. So, again, ask your Medicare insurance agent or a phone representative about it if it’s important to you.
Many Medicare Advantage companies tack on additional travel features to their plans to include some sort of U.S. travel coverage to address this. They vary from company to company. Alternatively, some Medicare Advantage plans allow you to use in-network providers in other states. But you might have to call the insurance company and tell them you’re traveling, so they can make a note in your account. It all depends on the insurance company’s policies and procedures; there’s no one solution across the board. The details exist; you’ll just have to dig through the Summary of Benefits and the Evidence of Coverage to find them. You can also call the company or ask your Medicare insurance agent to explain it as it applies to your particular question or situation.
I hope this helps!
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Author Bio Matt Feret is the author of the Prepare for Social Security -The Insider’s Guide and the Prepare for Medicare – The Insider’s Guide book series and launched PrepareforSocialSecurity.com to help people get objective answers to questions about Social Security and Medicare. Matt is also the host of The Matt Feret Show. He has held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development, and strategy for over two decades.