aldomurillo | E + | Getty Images
Retired, Vaccinated, and Ready to Hit the Street? Don’t forget to check if your Medicare plan will travel with you.
While coverage when away from home will depend in part on where you are going, it will also depend on the specifics of your coverage. Whether the care you receive is routine or emergency can also play a role.
Around 70% of people 65 and over have now received their first Covid shot, and 43% are fully vaccinated, according to the Centers for Disease Control and Prevention. If a larger part of the population is vaccinated against the virus, Travel is back in people’s minds who have huddled together for the past year.
Here’s what you should know about the differences in Medicare coverage outside of your home.
Basic or original Medicare consists of Part A (health insurance) and Part B (outpatient care). Individuals who choose to keep this coverage rather than opting for a benefit plan usually combine it with a standalone prescription drug plan (Part D).
If this is your situation, coverage when traveling in the U.S. and its territories is fairly straightforward: you can turn to any doctor or hospital that accepts Medicare (most do), be it for routine care or for you Emergency. When you venture beyond US borders, it gets tougher.
“When you travel outside of the US, Medicare only covers you in very limited or infrequent circumstances,” said Danielle Roberts, co-founder of insurance company Boomer Benefits.
These exceptions include when you are on a ship in bordering territorial waters – within six hours of a U.S. port – or traveling from state to state, but the nearest hospital for treatment is in a foreign country (i.e. you are in Canada while traveling to Alaska from the 48 contiguous states.
Be aware that the State Department has amid the ongoing pandemic Numerous tips for trips abroad. In addition, the Centers for Disease Control and Prevention requires all passengers – including citizens – on their way to the United States (or the United States) to provide evidence of a negative Covid test or evidence of recent recovery from the virus.
However, if you are considering another country for a vacation, you can get some overseas coverage by combining basic Medicare with supplemental insurance – also known as Medigap.
These policies, which are generally standardized across states but vary in cost, provide some coverage for the cost sharing associated with basic Medicare such as medical insurance. B. Copays and Co-Insurances. Some of them also have limited overseas travel coverage, said Elizabeth Gavino, founder of Lewin & Gavino and independent broker and general agent for Medicare plans.
“A member pays a deductible of $ 250 and 20% of the cost of medical treatment received, up to a lifetime maximum of $ 50,000,” said Gavino.
Note that This coverage applies to medically necessary emergency care There may be other restrictions, according to the Centers for Medicare & Medicaid Services.
For beneficiaries who receive their Medicare benefits – Parts A, B, and usually D – through a benefit plan, it’s worth checking to see if you can get emergency coverage abroad. And even if you didn’t leave U.S. soil, see what your plan would cover.
While benefit plans are required to cover your emergency care anywhere in the United States, you may be hooked for routine out-of-service care.
“With a traditional HMO plan, you only have emergency coverage when you travel outside of the network,” said Roberts. “With a PPO, you have both emergency coverage and off-network coverage for non-emergencies [but] will pay more for these out network services. “
There are also hybrid plans that could allow limited off-network treatment in certain circumstances, Roberts said.
It is possible for your benefit plan to deregister you if you are outside of the service area for a period of time – usually six months. In this situation, you would switch to Medicare.
Some beneficiaries, regardless of their specific coverage, take out travel health insurance for trips overseas, Gavino said.