After spending most of last year at home due to the COVID pandemic, you may be thinking about planning your next vacation once cities and countries open again. Whether a medical incident is an emergency or not, you will want to know how your Medicare insurance will cover you in all situations, in the United States or overseas.
Vacations in the U.S.
When you plan to travel outside of your zip code or state but inside the U.S., it is essential to understand your coverage. The planned vacation may only be a short weekend or an RV trip across the United States. However long the vacation might be, if a medical incident occurs, you want to be prepared.
Medicare Part A and Part B will travel with you as there is no network for Original Medicare. You can travel across the nation and see any doctor or physician that accepts Medicare. According to Kaiser Family Foundation (KFF), about 97% of physicians that bill Medicare are participating physicians.
A Medigap plan acts as secondary to Original Medicare and will pay the gaps that Medicare leaves you responsible for paying. Since a Medigap plan is secondary, you can continue to see any physician that accepts Original Medicare. This means you can travel throughout the nation with a Medigap plan as well.
Medicare Advantage plans
Medicare Advantage plans have a network of doctors and hospitals that you must use to get coverage from your plan. An HMO Advantage plan will only cover you if you see a physician that is considered in-network with your plan, limiting your coverage when you are outside of your zip code and state. A PPO Advantage plan allows physicians to bill out-of-network if they aren’t considered in-network. This can open your range of coverage when you travel. Some plans may offer a travel benefit that can make receiving coverage easier when you are not in your service area.
Part D prescription coverage
You can get prescription coverage through a Part D plan. There are two kinds of pharmacies with each Part D plan that you will want to use to fill your prescriptions. If you go to a preferred pharmacy for your drugs, you will have more cost-effective copays. If you go to a standard pharmacy for your drugs, you will likely pay more for your prescriptions. You can use any pharmacy throughout the country if they are considered preferred or standard with your Part D plan. Some pharmacies are not in-network, where you would pay the total drug cost for the prescription.
Vacations outside the U.S.
Planning a trip outside the country can be extensive. You need to figure out your stay, activities, currency, outlet adapters, and insurance. There is a lot that goes into planning a vacation outside the country.
Original Medicare has limited coverage outside of the United. States. There are only a few exceptions when Medicare may cover your medical services if in the case of an emergency.
Five Medigap plans will cover foreign travel emergencies. The incident must be within the first 60 days you are traveling for the plan to cover you. You are responsible for the $250 deductible. After the deductible is met, the Medigap plan will pay 80% of the costs up to a $50,000 lifetime limit. You pay 20% and all costs after you meet the lifetime limit.
Medicare Advantage coverage
Medicare Advantage plans offer worldwide emergency coverage. Each plan will have a set copay or coinsurance for this benefit that you must pay. The keyword to remember is emergency. If the incident is not an emergency, your plan may not cover you, and you will pay the full cost of the procedure.
Part D coverage
Outside of the U.S., you will not have prescription drug coverage. You will want to make sure you have enough medications to last you until you return from your vacation. You will pay out-of-pocket for any prescriptions you get at a foreign pharmacy.
Vacation travel exceptions
There are few exceptions when Medicare may cover you while outside of the U.S. If you are on a cruise ship traveling within U.S. territorial waters, then Medicare Part B may cover your services. Medicare may also cover you if you need emergency medical attention and a foreign hospital is closer to you than the nearest U.S. hospital. If you also live in the U.S, but a foreign hospital is closer to you than the nearest U.S. hospital, then Medicare may cover you even if it is not an emergency. Lastly, if you are traveling through Canada to or from Alaska and a medical emergency happens with a Canadian hospital being closest to you, Medicare may cover those services.
When you are vacationing with the U.S., your Medicare and Medigap plan will travel with you. A PPO Advantage plan can open your range for travel compared to an HMO Advantage plan. However, if you are outside of the U.S., you may have coverage from your Medigap or Advantage plan in the case of a medical emergency. You will want to keep all bills and receipts if you need to submit the bills to your plan because foreign physicians and hospitals are not required to bill your plan. If you are unsure how you may be covered when you are on vacation, you may want to contact your agent or insurance to verify your options.