The day you’ll finally retire is a day most of us dream about all our lives. Entering these golden years means that you now have plenty of time to focus on your own interests, hobbies, friends, and family.
Hundreds of thousands of people also plan to do extensive travel throughout their retirements. If world travel is one of your retirement goals, then of course you’ll want to be informed on how Medicare covers you when you are on the go.
Let’s look at Medicare’s coverage for both U.S. travel and international travel so you can be adequately prepared.
Travel Outside America
During our working years, travel outside the United States can be hard to do because most of us are only allotted so much vacation time by our employers. For this reason, many retirees have saved their international travel for the years when vacation time limitations are no longer a hindrance.
If you’ve been dreaming of that trip to Italy or Greece -- or anywhere else outside the U.S. -- you’ll want to look into some short-term medical insurance for your travels. Medicare doesn’t provide any routine medical coverage while you are outside of the United States. There are, however, a few limited scenarios in which Original Medicare may provide some coverage in the case of an emergency.
Let’s say a medical emergency happens and you have no choice but to go to a foreign inpatient hospital for your care. Your Medicare Part A and B benefits will help to cover your emergency services in these scenarios:
- Your medical emergency occurs within our nation’s borders, but a foreign hospital is actually closer to you than the nearest American hospital.
- You take a journey through Canada on your way to or from the great state of Alaska and experience a medical emergency, requiring you to visit a Canadian hospital because it is closer to you than the nearest American hospital.
There is also one other similar scenario where you might qualify for coverage even for a non-emergency. This is if you seek treatment for a medical condition at a foreign hospital because it is closer to your home than an American facility.
You probably know by now that Medicare Part B only covers about 80 percent of your healthcare costs. For this reason, many Medicare beneficiaries enroll in Medicare supplement programs to help them pay for the things that Medicare doesn’t.
If you enrolled in a Medicare supplement plan that includes standard foreign travel emergency benefits, then you will have coverage for emergencies that occur within 60 days of leaving the United States. This means you’ll have a foreign travel emergency benefit and will still be covered even if you’re not near the United States.
For example, if you are in Mexico and you experience a heart attack or break your arm, your Medicare supplement may help pay for your emergency care at a foreign hospital. Be aware that there are six different standard Medicare supplements that include this emergency benefit, and the benefit will pay 80 percent of your costs after a $250 deductible -- up to a total of $50,000 in lifetime coverage.
We cannot stress enough that this benefit is intended for true medical emergencies. Your Medicare supplement won’t pay for a simple doctor’s visit in another country.
Part C Medicare Advantage Plans
Some people opt for private insurance instead of Original Medicare. These are called Part C Medicare Advantage plans and these plans typically cover networks of local doctors in your residential area. While all Medicare Advantage plans must cover at least as much as what Original Medicare covers, they can also involve benefits beyond what Medicare covers.
One such benefit is worldwide emergency coverage, which is standard for all Medicare Advantage plans. However, your care will be subject to the terms of the plan. So, for example, if your plan is a PPO with an out-of-network benefit, you may find that you owe a deductible up front for any out-of-network care. Consult your plan’s Evidence of Coverage to determine what kinds of cost-sharing you will be responsible for under your plan.
Travel Within America
When it comes to travel within U.S. borders, Medicare coverage gets much easier to understand. Since Medicare involves a national network, your Original Medicare coverage will provide care for you anywhere in the nation as well as within American territories like Samoa and Puerto Rico. Of course, Medicare coverage when traveling from state to state is less confusing.
So, if you’ve been thinking about some road trips right here in the U.S., understanding your coverage options is much simpler.
Your Original Medicare Part A and Part B benefits go with you wherever you travel in the U.S. You can see doctors in Kansas, Florida, Washington, and every state in between. This is not just emergency coverage. You can seek ordinary medical treatment from any doctor or provider who accepts Medicare, regardless of what state you’re in.
Since Medicare Supplements pay after Medicare pays its share, they have no networks. That means your Medicare Supplement will pay its share of any medical bills that you incur from treatment in other states while traveling. This makes these kinds of plans the preferred choice for people who travel frequently within the U.S.
Your coverage for treatment in other states will be exactly the same as coverage in your state of residence.
Part C Medicare Advantage Plans
As we mentioned earlier, Medicare Advantage plans typically involve networks that are based on your place of residence. So, if you are traveling out of state, you will usually be out of network on your plan as well.
Medicare HMO plans may not cover you outside your network except in emergencies. These plans also tend to require that you get approval from your primary care doctor before you can consult a specialist.
Medicare PPO plans will be more flexible, and you can use them to receive treatment from providers outside the network who are willing to bill the plan. However, your share of the costs will nearly always be higher when you are out-of-network and may include a deductible you must satisfy up front. For example, if your plan has a $1,000 deductible for out-of-network care, then you will be responsible to pay the first $1,000 in out-of-network bills that come in from your care.
Another thing about Medicare Advantage plans is that each plan can set its own premiums, co-pays, coinsurance, drug formularies, and networks, so it’s important to review your plan documents and gain a good understanding of how the plan will cover you in any circumstance you may encounter, whether during travels or at home.
Final Thoughts For Travelers In Retirement
Be aware that foreign emergency care providers may not always agree to submit bills to Medicare for you. When you receive bills, always hang on to them in case you need to submit them to Medicare yourself.
If you feel like your plan won’t provide enough foreign travel coverage for your own peace of mind, check with a travel agent or insurance specialist who can help you explore short-term medical emergency policies that are designed specifically for travelers.