Many seniors look forward to their golden years for retirement, freedom, independence, and endless amounts of vacations. Traveling and vacationing is a top retirement goal among many senior citizens. When seniors travel the world, many are unaware of what this means for their Medicare. Here are five things you need to know about Medicare on vacation.
1. Medicare has no networks
Original Medicare is America’s federal health insurance program available for seniors who are 65+ and people with specific disabilities. If you have Original Medicare, you can travel anywhere within the United States and access medical care from any doctor or hospital that accepts Medicare.
Medicare will also cover you inside the United States territories: Guam, the U.S. Virgin Islands, Puerto Rico, American Samoa, and the Northern Mariana Islands. With that said, if you plan to travel to any state in the United States or within its territories, make sure you bring your Medicare ID card to present to the doctor/hospital if needed.
Since Medigap plans work alongside Original Medicare, they also do not have any network restrictions. If a doctor or hospital accepts Medicare, they must take your Medigap plan regardless of plan or carrier.
With that said, Medigap plans are ideal for seniors who plan on vacationing inside the United States for an extended period.
2. Original Medicare does not travel internationally
Since Medicare is an American insurance program, most international states will not accept it as coverage. However, there are a few exceptions where you can use your Medicare for coverage in a different country (besides the U.S. territories).
For example, if you are traveling to Alaska and drive through Canada without any reasonable delay, and a medical emergency occurs, you can receive treatment at the Canadian hospital if it is closer than a U.S. hospital. Medicare will cover your injury or illness in this circumstance.
Also, if you live in the U.S. and a foreign hospital is closer to your home, such as a Mexico or Canadian hospital, and you have a medical emergency, you can go to the foreign hospital for treatment. Other than these types of circumstances, Medicare will not provide coverage in a foreign country. So do not plan a major surgery in France and expect Medicare to pay its part – you will pay 100% of the bill.
3. Medigap plans have foreign travel coverage
Medigap plans such as Plan C, D, F, G, M, and N, provide foreign emergency coverage for you when you travel internationally. After you meet the $250 deductible, your foreign coverage will pay 80% of your services, leaving you responsible for the bill’s remaining 20%.
Your foreign emergency coverage has a $50,000-lifetime benefit. With that said, $50,000 can go quickly if you have a medical emergency and must have surgery. Once you meet that $50,000 limit, you will no longer receive foreign travel coverage and will pay for services at 100%.
4. Medicare Advantage plans have networks
The two most popular Medicare Advantage plans are HMO and PPO plans. Depending on which plan you enrolled in will determine whether you can receive care outside its network in the United States.
If you have an HMO plan, your carrier will create a network of doctors and pharmacies for you in your area, where can receive coverage for healthcare services. However, if you go outside your network, and it’s not an emergency, you will have to pay 100% of the bill.
PPO plans are more flexible, as you can receive services in and out-of-network. Your carrier will still create a network of doctors and pharmacies for you. However, you can receive healthcare services outside your network if needed. If you receive services outside your network, though, your copay will likely be much higher than if you were to be in-network.
If you wish to travel out of the country, many Medicare Advantage plans have some type of foreign travel coverage. Since every plan is different, you will want to check your Summary of Benefits or contact your carrier to see if you have any international travel benefits.
Now, there is a chance you can lose your Medicare Advantage plan if you vacation for too long. If you travel outside your network for more than six months, your carrier will dis-enroll you from your Medicare Advantage plan. Once you are dis-enrolled, you will return to Original Medicare until you make it back to your service area.
5. Foreign hospitals/doctors are not required to bill Medicare
As mentioned briefly earlier, since Medicare is an American insurance program, international doctors and hospitals do not have to bill your Medicare plan. If that is the case, be prepared to pay 100% of the bill for your services and treatment.
Whether you have a Medigap or Medicare Advantage plan, if a foreign doctor or hospital will not accept your insurance, you will want to hold on to every receipt you receive after your services. Once you make it back to America, you can submit the itemized bills to your insurance agent for possible reimbursement.
As you are planning your vacation, keep your health and safety in mind. Emergencies and accidents are never planned, but you should contact your insurance carrier and verify your foreign travel benefits so you can be prepared. You can also visit Medicare.gov for more information.