Before selecting a Medicare plan, you should be aware of all the coverage options available to you, including the coverage you may or may not receive when traveling.
Here is a breakdown of when and where you could receive coverage from Medicare when traveling.
Medicare will cover you in the United States anywhere that a provider accepts your Medicare coverage. You can go to any hospital that accepts your coverage, and the full benefits of Part A and Part B will apply. If you have a Medigap policy, you have the same assurance. This coverage extends to the U.S. territories of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
Healthcare providers may vary in their participation with Medicare and their agreement to bill only what Medicare approves for a given service. Participating providers will accept the Medicare-approved amount as full payment for a service or treatment. Non-participating providers will charge more for Medicare-covered treatments, billing in excess up to 15 percent. These added charges are called Part B excess charges. Some Medigap plans assist in paying a portion of these overages.
Opt-out providers decline the Medicare-approved amount and will bill you in full for the treatment. If possible, it is best to avoid these providers unless you can afford the out-of-pocket costs for your procedures.
Medicare Advantage plans often operate with networks of preferred providers, which affects the cost you are expected to pay. If you have a plan from a Health Maintenance Organization (HMO), you should go to providers that are in the plan’s network. Preferred Provider Organizations (PPO) have a stronger preference for providers in the plan’s network, so you end up paying more if you visit a provider that is not in the network. You can check with your provider or benefits manager before traveling to see if you have coverage in another state.
Pharmacies are networked in Part D prescription drug plans such that a plan will have a preference for specific dispensaries at the local, regional, or national level. You may be covered while traveling in other states, but checking with your provider will provide clarity.
Medicare does not cover you outside of the U.S., its territories, and its territorial waters. There are only a few specific instances where you will be covered. If you travel from Alaska to another state through Canada when you encounter a medical emergency, and the nearest hospital is Canadian, Medicare will apply as normal. If you have a medical emergency in the U.S., but the nearest hospital is a foreign hospital, you will be covered. If you live in the U.S. and the hospital closest to your home is in a foreign country, you are covered there. If you are on a ship within six hours of the U.S. shoreline and receive medically necessary treatment, you are covered.
Travel with Medigap
Six of the ten available Medicare Supplement plans offer foreign travel emergency health care coverage. These are plans C, D, F, G, M, and N. Within the first 60 days of your trip abroad, your Medigap plan will cover emergency medical expenses. After you reach the deductible in out-of-pocket expenses, your plan will cover 80 percent. These plans have a lifetime cap of $50,000 in foreign travel emergency health care coverage.