Does Medicare Cover You on Vacation?
When you think of retirement, you might be thinking of all the different vacations you will be taking. With all the freedom you will now be enduring, there isn’t a more perfect time than now to begin taking on the world. Now, an important part of being able to travel is to remain healthy. But what if you become sick or a medical emergency occurs when you are traveling? Does Medicare cover you on vacation?
You have the flexibility to travel anywhere in the United States with Original Medicare.When traveling within the United States, youcan visit any doctor or hospital on your vacation if they accept Medicare. If they do accept Medicare, you can present your Medicare ID card and Medicare will pay its cost-sharing portion.
Since Medicare is an American health insurance program, international doctors will likely not accept your insurance as coverage. However, you can receive coverage from Medicare in certain emergency situations. For example, suppose you are traveling through Canada to get to Alaska, and a medical emergency occurs. In that case, you can go to the nearest Canadian hospital, and Medicare will cover you (if the hospital accepts Medicare).
With that said, Guam, the U.S. Virgin Islands, Puerto Rico, American Samoa, and the Northern Mariana Islands are considered part of the U.S. Therefore, Medicare will cover your services if the doctor or hospital accepts Medicare in these territories.
Medicare Supplements, also known as Medigap plans, work alongside Original Medicare. With that said, Medigap plans do not have a network as well. Therefore, you can visit any hospital or doctor in the United States and receive health care services if they accept Medicare. Regardless of the Medigap plan or carrier you have, if a doctor accepts Medicare, they must accept your Medigap plan.
Now, almost all Medigap plans have an emergency foreign travel coverage benefit. However, your Medigap policy will only cover you within the first 60 days of your vacation. If your vacation surpasses 60 days, then you will be fully responsible for any medical bills.
The foreign travel coverage consists of a $250 deductible and will cover your services at 80% after meeting the deductible. However, these Medigap plans only have a $50,000-lifetime benefit. So, if an emergency occurs and you must have surgery, that $50,000 can go quickly.
Medicare Advantage plans have more travel restrictions than Original Medicare and Medigap plans. If you have a Medicare Advantage plan, you likely chose either an HMO or PPO plan, as these two plans are the most popular.
HMO plans have the most restrictions, as your carrier will create a network of doctors and pharmacies you can obtain medical care from and receive coverage. If you visit a doctor out-of-network and it is not an emergency, you will be responsible for the whole medical bill.
You have more flexibility with a PPO plan. With a PPO plan, you can receive healthcare services in and out-of-network. Your carrier will still create a network of doctors and pharmacies. However, if you want to go to a doctor out-of-network, you can do so.
With that said, your copayment or coinsurance will likely be much higher when you see a doctor out-of-network, compared to an in-network doctor visit. However, a PPO Medicare Advantage plan is ideal for travelers who vacation often.
Now, many Medicare Advantage plans offer emergency foreign travel coverage, but it will all depend on the type of plan you enrolled in. You can find these benefits listed in your Summary of Benefits, or your insurance agent should have this information on hand.
Keep in mind, though, since Medicare Advantage plans have networks, you cannot travel outside your network for more than six months. If you are on vacation for more than six months outside your service area, your Medicare Advantage plan will dis-enroll you, and you will return to Original Medicare.
It is always best to check your Summary of Benefits before you leave for vacation – that way, you can be more familiar with your coverage before you depart. In hopes a medical emergency does not occur, it is better to be safe than sorry when it comes to your health care coverage on vacation.