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Whether planning a trip to another state or going overseas, knowing the extent of your Medicare benefits on vacation can help you avoid unexpected medical expenses and ensure you receive the care you need if needed.
Understanding Medicare & Travel
First, it’s important to understand how the Medicare program is structured to understand how Medicare works with vacation and travel. You can learn more about Medicare by visiting boomerbenefits.com/understanding-medicare.
Medicare has four different parts, including Part A, B, C, and D. Each part covers various areas of medical coverage. Part A and Part B help cover inpatient and outpatient services, such as surgeries, medical equipment, doctor’s visits, and more.
Part C is another way to receive your Part A and Part B benefits through a private insurance plan instead of the government. These plans, also known as Medicare Advantage plans, combine Part A, Part B, and often Part D benefits into one plan.
Part D is coverage for the prescription medications you receive from the pharmacy.
Medicare Coverage Within the United States
Whether or not you will have coverage across the United States depends on the type of Medicare plan you have. Coverage through Original Medicare (Part A and Part B through the government) will work differently than coverage through an Advantage plan.
Original Medicare on Vacation in the United States
Fortunately, if you receive your Medicare benefits through Original Medicare (Part A and Part B through the government), Medicare covers you anywhere in the United States as long as the provider you see accepts Medicare insurance.
If you see a provider that doesn’t accept Medicare insurance, your medical services will likely not be covered.
Medicare Advantage on Vacation in the United States
Advantage plans work differently from Original Medicare as they each have their own network of providers. Some Advantage plans can be more lenient with their networks, while others are more restrictive.
Also, depending on your plan’s policies, you may lose coverage if you are outside its network for too long.
You should check your exact plan to see what national coverage you have. To do this, you can refer to your plan’s Summary of Benefits or contact your plan’s insurance carrier directly.
Medicare Coverage Outside the United States
Original Medicare and Advantage plans work differently when you travel internationally, so it’s important to understand your options beforehand.
Original Medicare on Vacation Outside the United States
Unlike travel within the United States, Medicare does not provide coverage internationally. Original Medicare helps cover medical services only in very specific emergency situations.
However, if you are traveling within United States territories, you should be covered as you would if traveling among the states. For example, you should be covered as normal in Puerto Rico, Guam, the U.S. Virgin Islands, and others.
If you have Original Medicare and plan to travel outside the United States, you may want to consider purchasing standalone travel insurance.
Medicare Advantage on Vacation Outside the United States
Advantage plans are required to provide the same benefits as Medicare, so they also have specific emergency coverage. These plans may offer additional travel coverage, but it varies from plan to plan.
Like provider networks, you should check with your specific plan to see what your coverage is like outside the United States.
Medicare Part D on Vacation
Traveling with Part D requires some planning to ensure you have access to your necessary medications. Within the United States, Part D plans are typically network-based, meaning you have preferred pharmacies where you can fill your prescriptions at a lower cost.
Before traveling, check to see if there are network pharmacies at your destination or if your plan offers mail-order services that can deliver your medications.
Regarding international travel, Medicare Part D does not cover prescription drugs outside the U.S. To avoid running out of medication abroad, you’ll want to ensure you have enough supplies to last your entire trip before leaving. You can also research to see if there is travel insurance that includes prescription drug coverage.
Medicare Supplement Plans (Medigap) on Vacation
Supplement plans, or Medigap plans, pay secondary to Medicare and help cover your portion of cost-sharing, including deductibles, copayments, and coinsurance. Since Medigap plans are secondary to Medicare, they will only help pay for a service if Medicare pays first.
So, if you’re traveling within the United States, your Medigap plan will also provide coverage if Original Medicare does so first.
Some Medigap plans offer limited emergency health coverage for international travel. If you are in need of emergency services in the first 60 days of your trip abroad, your Medigap plan can help cover the expenses if Medicare does not pay. Typically, these plans cover 80% of emergency care costs outside the U.S. after you meet a $250 deductible, up to a lifetime limit of $50,000.
Be sure to review your specific Medigap policy details and understand what is covered abroad.
Travel Insurance and Medicare
While Medicare provides valuable health coverage, it often falls short when it comes to expenses incurred during travel, especially abroad. Travel insurance can cover medical emergencies, evacuations, and other unexpected costs that Medicare does not typically handle.
For instance, if you need urgent care in a foreign country, medical travel insurance can help ensure you’re not left with hefty medical bills. When selecting a travel insurance policy, it’s important to review what medical care it covers, any exclusions, and the process for making a claim.
Final Thoughts on using Medicare on Vacation
Traveling with Medicare needs some preparation and understanding of your coverage options. While Medicare provides comprehensive coverage within the United States, it has limited benefits abroad, making travel insurance a good consideration for international trips.
Medicare Advantage plans can offer broader coverage overseas, but it’s best to verify the specifics with your plan.
You can ensure a worry-free vacation by reviewing your plan, understanding emergency protocols, and preparing medications.