Am I Covered by Medicare on vacation?

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According to Trips to Discover, Alaska, Arizona, the Caribbean, and Portugal are among the top travel destinations for seniors. In fact, many seniors plan to travel both domestically and internationally during retirement. 

So how does Medicare work when you set out to travel in retirement? 

That is a great question and the type of Medicare coverage you have and where you travel to considerably impacts how you are covered. The two main types of Medicare coverage you have available to you are Original Medicare with a Medigap plan or a Medicare Advantage plan. 

Domestic travel Medicare coverage

The good news about traveling in the United States is that Medicare is a federal program and any healthcare provider in the U.S. should know what Medicare is and can help you determine if you’re covered. That said, you will have different levels of coverage with Original Medicare versus Medicare Advantage (also known as Part C).

Original Medicare and domestic travel

Nearly one million providers across the country accept Original Medicare Part A and Part B. And because Original Medicare is federally regulated, you can see any of these providers who accept Medicare. Therefore, if you receive your coverage through Original Medicare, you are covered in any state while on vacation. 

Medigap plans supplement Original Medicare and cut your out-of-pocket spending. When you have a Medigap plan, your doctor’s office bills Original Medicare, and then Original Medicare bills your Medigap plan. If Original Medicare approves the bill, so will your Medigap plan. Therefore, your Medigap plan covers you in any state, at any office that accepts Medicare, while on vacation. 

Medicare Advantage plans are domestic travel

Medicare Advantage plans are regulated by the private insurance carriers that sell them. Most of them have set networks in which you can receive medical attention. The two most popular networks for Medicare Advantage plans are HMO and PPO networks. 

If you have an HMO Medicare Advantage plan, you usually only have in-network benefits, meaning traveling outside your network area would leave you without coverage, except in emergencies. With a PPO Medicare Advantage plan, you likely have both in and out-of-network benefits. However, out-of-network coverage tends to come with high cost-sharing expenses.

Medicare Advantage networks are generally only a few counties wide, so traveling out of your home state likely means you’re traveling out of your plan’s service area. 

International travel Medicare coverage

As an American health insurance program, Medicare generally only covers its beneficiaries within the United States’ borders and in U.S. territories. However, Medicare may cover you during international travel in the case of an emergency. 

Original Medicare and international travel

Original Medicare Parts A and B only cover emergency care in foreign countries under specific circumstances. For example, if you’re traveling through Canada to or from Alaska when an emergency happens, Medicare may cover your emergency care at a Canadian hospital. The same applies if you’re traveling within the United States when an emergency happens, and a Canadian or Mexican hospital is closer than an American one.

Original Medicare will not cover your emergency care if you’re on vacation in a foreign country overseas. According to Medicare’s international coverage rules, the only countries you have possible coverage in for emergency care are Canada and Mexico.

However, some Medigap plans have an additional benefit that offers you foreign travel emergency coverage elsewhere. When using the Medigap plan’s international travel emergency benefits, the Medigap plan is the sole payer, meaning Original Medicare pays nothing. If you travel to a foreign country, and within your first 60 days of traveling, you need emergency care, your Medigap plan may cover 80% of your care after a $250 deductible.

The Medigap plans that offer this benefit are Plan C, Plan D, Plan F, Plan G, Plan M, and Plan N. All of these plans provide a maximum benefit of $50,000 for foreign travel emergencies.

Medicare Advantage plans and international travel

Most Medicare Advantage plans include a worldwide emergency care benefit. However, the cost and coverage of this benefit varies by plan. You should also know that foreign hospitals aren’t required to bill your Medigap or Medicare Advantage plan. More often than not, the foreign hospital will require a cash payment instead.

Once you return to the United States, you can submit a request for reimbursement form through your Medicare plan’s carrier. Because you will most likely have to pay cash upfront for your emergency care outside of the country, you should prepare an emergency fund before traveling.

It would be best if you also investigated purchasing a short-term travel health insurance policy, so you aren’t relying on Medicare’s possible coverage. The good news is if you’re traveling within the states, with Original Medicare or a Medigap plan, you can rest assured that you’re covered.

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