Summertime means the beach, BBQ and travel. Will your Medicare coverage travel with you? Should you buy a travel insurance policy before going overseas? What if you have a Medicare Advantage plan?
If you’re on original Medicare (not a Medicare Advantage plan), travel throughout the 50 states and US territories (District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa) means your health care is covered just like it is at home, no problems. If you have a Medicare Advantage plan, traveling overseas, and even traveling away from home within our 50 states gets trickier. More on that below.
The Medicare website on travel offers an easy explanation that isn’t 100% complete, nor does it do a very good job of highlighting when you’re not covered while traveling. I’ve pasted and excerpt from the webpage below for your convenience.
Medicare may pay for inpatient hospital, doctor, ambulance services, or dialysis you get in a foreign country in these rare cases:
You’re in the US when a medical emergency occurs, and the foreign hospital is closer than the nearest US hospital that can treat your medical condition.
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 the emergency.
You live in the US and the foreign hospital is closer to your home than the nearest US hospital that can treat your medical condition, regardless of whether an emergency exists.
In some cases, Medicare Part B (Medical Insurance) may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the US Medicare won’t pay for health care services you get when a ship is more than 6 hours away from a US port.
Medicare drug plans don’t cover prescription drugs you buy outside the US
Ooh, there’s a zinger right there at the end! Did you miss it? Here it is again: Medicare drug plans don’t cover prescription drugs you buy outside the US.
Prescription drugs purchased overseas are never covered by Medicare Part D. Huh. That means your PDP plan is worthless overseas. Better stock up before you go. I must say, it’s also interesting to see if you go on a cruise, you better only get sick if you’re close to the US or one of its territories. It also makes no mention of what happens if you have a Medicare Advantage plan. Here’s one more item of note from the site.
Foreign hospitals aren’t required to file Medicare claims. If you’re admitted to a foreign hospital under one of the situations above, and if that hospital doesn’t submit Medicare claims for you, you need to submit an itemized bill to Medicare for your doctor, inpatient, and ambulance services.
This is a nice way of saying if you get sick overseas, you’ll very likely have to pay, either with cash or credit card for your health care at the time of service. You’ll then have to take all of the paperwork home with you, and fill out gobs of Medicare paperwork. Look, they make it easy for you on their website! (Heavy sarcasm here, folks) There are only potentially NINE forms you need to fill out. If you want your son or daughter to help out, they need to fill out a form, too. You better do it right as you get home; if you wait 12 months you’re out of luck.
So, I’ve teased it twice already; what do you do if you have a Medicare Advantage plan? First of all, if you’re on an HMO, you may be out of luck if you get sick even in the next county over from you. An MAPD HMO plan has a defined service area (usually by county) and there are ZERO out of network benefits. If you have an HMO and live in Sarasota, forget getting routine care while on your visit the kids in Denver. Oh sure, there’s emergency care… if you’re admitted, if you’re in an ambulance, etc. In all seriousness, aside from what the government mandates HMO plans include in their coverage, most do NOT have travel coverage. To get the skinny, you need to pull out your Summary of Benefits booklet that came with your policy, or call the company and ask.
If you have a Medicare Advantage PPO plan, those by nature DO have out of network coverage if you’re travelling out of your service area in the US. Often it’s way, way less than you enjoy in the network, but at least it’s there. They also must have out of pocket limits so you won’t go broke if you get really sick on vacation and need to be in the hospital for a long time. However, that does NOT mean you have overseas coverage. To find out, you need to look at your Summary of Benefits or call the company.
Some Medicare Advantage companies tack on an additional feature to their plans to include some sort of travel insurance. Most do not.
We know by now there are restrictions on getting medical care overseas if you’re on Medicare, and can be even more if you’re on a Medicare Advantage plan. Your Medicare Part D plan will not work overseas. What are your options? Buy overseas travel medical insurance if you have an MAPD plan that does not cover it, or are on Original Medicare only.
If you have a Medicare Supplement plan you are in luck, my friend. Medicare Supplement (Medigap) Plans C, D, F, G, M, and N provide foreign travel emergency health care coverage when you travel outside the US and Plans C, D, E, F, G, H, I, J, M, and N pay 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year. These Medigap policies cover foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care.
Be safe out there!
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Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.