With the rise in the number of vaccinations, more Americans are starting to get back to traveling. Recent data shows that over 175.5M Americans had been fully vaccinated since August 31, 2021, representing 53.2 percent of the total population.
Another recent survey showed that older adults (55 years and above) are more eager to resume traveling. As many as 89 percent reported they were ready to travel once they were fully vaccinated. And while the open road beckons, older adults on Medicare need more than just their vaccinations to be completely prepared for travel.
Are you looking to travel more this year? Check what your Medicare coverage looks like. Depending on your travel plans and destination, you may need additional coverage. The last thing you want is to find you have no health insurance in a foreign land.
Keep reading for everything you need to know about Medicare coverage during travel.
Medicare does not provide any health insurance for people who are traveling outside the USA. There are certain exceptions:
Traveling on a ship in the territorial waters surrounding the country (hello, cruises!), but you must be no more than six hours away from your closest port
Traveling state to state, but the nearest hospital to you is in another country (e.g., you’ll be in Canada at some point on your way to Alaska)
Apart from these exceptions, you will have some level of coverage depending on your Medicare plan as follows:
With the Original Medicare plan, you have coverage when traveling within the 50 states as well as Washington DC, the US Virgin Islands, American Samoa, Northern Mariana Islands, and Puerto Rico. In addition, you can be treated by any provider that accepts Medicare.
Outside these locations, you are only covered in the following circumstances:
You have a medical emergency in the US, but the closest hospital that can help is in a foreign country
You have a medical emergency while traveling to/from Alaska from/to another US state through Canada, and a Canadian hospital is closer than the nearest US hospital to you
You live in the US, but a foreign hospital is closer to you than the nearest US hospital, even without an emergency
You have received medically necessary medical attention on a ship within territorial waters near the US (must be less than 6 hours from the nearest US port)
Medicare drug plans do not cover prescription medication bought outside the US in any circumstance.
Note that you must pay your usual Part A and B deductibles and any coinsurance or copayment where you are covered. In addition, you must get an itemized bill and submit it to Medicare as foreign hospitals do not submit claims to Medicare directly.
Under the Medicare Advantage or Medicare Part C plans, you receive all the protections of the Original Medicare and coverage when you receive emergency medical care while traveling within the US. However, other than these scenarios, you must check your specific coverage according to your service and type of plan.
If your Medicare Advantage plan has a provider network, you may pay more if you get out-of-network care. PPO and PFS plans are more flexible than HMO plans. Regular travelers may get travel programs within their standard Advantage plans. However, this doesn’t apply if you’ll be abroad over a certain period, usually 6-9 months.
Check with your provider or plan to see the specific coverage of your Advantage plan when traveling.
Medicare covers many things, but it doesn’t cover everything.
Suppose you have the original Medicare plan, and you meet the criteria above. In that case, Medicare may pay for inpatient hospital fees, doctors’ fees, ambulance services, and kidney dialysis in a foreign country. Otherwise, you should check your specific plan for exact details related to the following:
Dental care and dental implants
At-home health care
COVID-19 testing and vaccination
Mental health services
There are two scenarios where you can benefit from both Medicare and another insurance plan (e.g., employer’s insurance):
If you are above 65 years of age
If the company you work for has less than 20 employees
In the above cases, you need to confirm whether your employer or other insurance provides coverage for the areas where Medicare does not offer coverage. Moreover, you should verify who pays first. If not, you should get additional coverage through Medigap, Medicare Advantage, or a travel insurance policy.
With Original Medicare, you can purchase a Medicare Supplement Plan (Medigap) to cover foreign travel healthcare. Plans C, D, F, G, M, & N offer emergency care during foreign travel. If you already have plans E, H, I, & J, you also have emergency foreign healthcare, but these plans are no longer on the market.
Medigap offers 80 percent of billed charges after your annual $250 deductible within the first 60 days of a trip abroad. After that, it has a lifetime coverage limit of $50,000.
As mentioned, you may be able to get foreign emergency healthcare with a Medicare Advantage plan, but the details would depend on your specific plan. Many of the benefits are opt-in benefits. They may cost more or less according to your destination and the duration of your trip.
If none of the above options work for you, get travel health insurance for non-routine medical care (get routine care at home) when you’re traveling. Travel insurance is relatively affordable, especially if you’re traveling for a short trip.
This policy can cover you for emergency medical attention, dentistry, or medical evacuation. Ensure your policy covers you in the countries you’ll be visiting for whatever duration you will be there.
There are many details to getting any type of insurance, and health insurance is no different. Things can get more complex when you are looking for healthcare coverage when traveling. While the pandemic is fairly under control in the US, the same may not apply to your travel destination, and you’ll need to be covered.
Are you looking for reliable insurance providers? PolicyScout can help. Find out more about how we can match you with high-value, low-cost providers near you.