What You Need to Know
- Original Medicare will cover routine, urgent and emergency care provided by any provider in the United States that accepts Medicare.
- Medicare Advantage plans will cover emergency care away from the market of the traveler.
- Medigap policies often provide emergency coverage outside the United States.
- Most travelers going outside the United States should at least consider buying separate travel medical insurance.
As the summer months and travel plans are in full swing, clients who are Medicare beneficiaries should check whether their health care plans are ready to embark on their trip with them – whether their journey is in the United States or abroad.
To avoid unexpected costs, clients who are Medicare beneficiaries should know where their coverage applies and how to fill in travel coverage gaps in case one needs to visit a doctor or provider away from home.
Does your client’s current Medicare plan have travel coverage?
A beneficiary with Original Medicare traveling in the United States can go to any doctor or hospital that accepts Medicare for routine care if needed.
Beneficiaries with a Medicare Advantage plan may have to foot the bill for routine services when traveling outside of their service area.
Under both plans, emergency care is generally covered nationwide.
Some Medicare Advantage plans may offer a supplemental benefit that covers emergency services when traveling outside of the United States.
Beneficiaries of both plan types who are embarking on international travel are not covered, unless under very rare and specific circumstances, such as when a beneficiary is on a ship fewer than 6 hours from a U.S. port and needs emergency health care services.
Original Medicare recipients can opt into a Medigap policy such as Plans C, D, F, G, M, and N to fill in some coverage gaps for international travel.
Medigap plans are available only to beneficiaries on Original Medicare.
Beneficiaries who have Medicare Advantage cannot purchase one of these plans.
Medigap plans that offer international emergency health coverage (listed above) have up to $50,000 lifetime maximum benefits, and the beneficiary pays 20% of costs after meeting the yearly $250 deductible.
However, beneficiaries are covered only during the first 60 days of a trip and only toward medically necessary emergency care; this does not include prescription drug coverage.