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Traveling with Medicare – Things to Know

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Retirement is an exciting time for senior citizens and is something to celebrate. Many seniors like to celebrate by traveling. According to NCBI, 75% of adults age 65 to 74 years old are daily travelers. There are things to know about traveling with Medicare, whether you are traveling in or outside the country. 

Whether you have Original Medicare, Medigap, or an Advantage plan, there may be some travel restrictions on coverage. Here are things to know when traveling with Medicare.

Original Medicare

In the United States

Original Medicare is healthcare coverage provided by the federal government when you turn 65. With Original Medicare, there are no network restrictions. f a doctor accepts Medicare, your Medicare-approved service is covered

Original Medicare can travel with you anywhere in the United States, including its territories (the U.S. Virgin Islands, Puerto Rico, Guam, Northern Mariana Islands, and American Samoa). However, Original Medicare doesn’t cover you when you’re traveling internationally.

Outside the United States

There are only a few emergency exceptions when Medicare covers you outside the U.S. For example, if you are in North Dakota and have a medical emergency and the closest hospital to you is in Canada, you can go to the Canadian hospital for treatment and Medicare will pay.

Remember, Medicare only pays for medically necessary services. You can’t see a Canadian doctor for a checkup or minor illness and expect Medicare to pay. Also, foreign hospitals do not have to accept Medicare coverage. You may have to pay for your care upfront and request reimbursement from Medicare when you return home.

Medigap

In the United States

Medigap plans work with your Medicare coverage to help pay your out-of-pocket costs. If providers accept Medicare, then they must also accept your Medigap plan, regardless of the insurance company., 

Outside the United States

Many Medigap plans have emergency foreign travel coverage with a lifetime benefit of $50,000. Medigap will help cover costs for emergency care within the first 60 days of foreign travel. 

Most Medigap plans will pay 80% of your medically necessary service in another country, with a $250 deductible. Keep in mind the doctor at the foreign hospital does not have to accept your Medigap plan. You may have to pay your bill in full and get reimbursed by your plan later.

Medicare Advantage

In the United States

Most people choose either an HMO or a PPO Medicare Advantage plan. The type of plan you choose determines your coverage when you travel. 

HMOs use a provider network; you must get all your non-emergency care from providers in your plan’s network and service area. If you see a doctor outside your network, you typically have to pay 100% of the charges, unless it’s a medical emergency. 

With a PPO plan, you can get care outside your network, but you will likely pay more out-of-pocket than you would for network providers. In other words, your PPO plan would likely cover your care when you travel, but at a lower level.

Outside the United States

Most Medicare Advantage plans provide members with worldwide emergency coverage. Check with your plan’s member services department to verify coverage before you leave home. 

Remember, however, that foreign providers may not accept your Medicare Advantage plan, so be sure to save your itemized bill and submit the documents to your plan when you return home. 

Since many Medicare Advantage plans have a service area and provider network, you may lose your Medicare Advantage plan if you travel outside your service area for more than six months. If this happens, you will be disenrolled from your plan and automatically enrolled in Original Medicare.

Most people don’t go on vacation intending to have a medical emergency, but it’s important to know if you’re covered in case something happens. It’s almost always a good idea to buy short-term travel insurance to supplement your Medicare coverage if you’re going overseas. That way, you know you are covered. 

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