Coverage during domestic travel may depend on whether you have an Advantage Plan or basic Medicare, and whether it’s an emergency or routine care.
Medicare generally does not cover any medical costs outside of the U.S. and its territories.
Some Medigap plans — which can only be paired with basic Medicare — offer limited coverage for travel beyond U.S. borders.
For Covid-vaccinated individuals in the 65-and-over crowd, hitting the road (or sky) may become more alluring than it’s been in nearly a year.
Be sure to consider whether your Medicare plan will travel with you.
While coverage when you’re away from home depends partly on your destination, it also hinges on the specifics of your Medicare plan. Whether the care you receive is routine or due to an emergency also can play a part.
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In other words, it’s worth knowing what to expect so there are no surprises.
Basic, or original, Medicare consists of Part A (hospital coverage) and Part B (outpatient care). Individuals who choose to stick with that coverage — instead of going with an Advantage Plan — typically pair it with a stand-alone prescription-drug plan (Part D).
If this is your situation, coverage while traveling in the U.S. and its territories is fairly straightforward: You can go to any doctor or hospital that accepts Medicare (most do), whether for routine care or an emergency. It’s when you venture beyond U.S. borders that things get trickier.
“If you travel outside the U.S., Medicare doesn’t cover you except in very limited or rare circumstances,” said Danielle Roberts, co-founder of insurance firm Boomer Benefits.
Those exceptions include when you’re on a ship within the territorial waters adjoining the country — within six hours of a U.S. port — or you’re traveling from state to state but the closest hospital to treat you is in a foreign country (i.e., you’re in Canada while heading to Alaska from the 48 contiguous states).
Be aware that amid the ongoing pandemic, the State Department has numerous advisories in effect for foreign travel. Additionally, the Centers for Disease Control and Prevention is requiring all air passengers — including citizens — heading for the U.S. (or returning to it) to show proof of a negative Covid test, or proof of recently recovering from the virus.
Nevertheless, if you are eyeing a different country for a vacation, pairing basic Medicare with a supplement policy — aka Medigap — may give you some coverage abroad.
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Those policies, which are generally standardized across states but vary in cost, offer some coverage for the cost-sharing that goes with basic Medicare, such as copays and co-insurance. Some of them also have limited coverage for foreign travel, said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and general agent for Medicare plans.
“A member pays a $250 deductible and 20% of the cost of the medical treatment received, up to a lifetime maximum of $50,000,” Gavino said.
Be aware that this coverage applies to medically necessary emergency care and there may be other restrictions, according to the Centers for Medicare & Medicaid Services.
Advantage Plans
For beneficiaries who get their Medicare benefits — Parts A, B and typically D — through an Advantage Plan, it’s worth checking to see if you get any coverage for emergencies while abroad. And even if you don’t leave U.S. soil, you should see what your plan would cover.
While Advantage Plans are required to cover your emergency care anywhere in the U.S., you may be on the hook for routine care outside of their service area.
“With a traditional HMO plan, when you travel outside the network, you have emergency coverage only,” Roberts said. “With a PPO, you have both coverage for emergencies and out-of-network coverage for non-emergencies [but] will pay more for these out of network services.”
