Getting sick or injured when you are on vacation is upsetting in the moment and could leave you with an unwanted souvenir — a big medical bill. Whether it’s a tumble over some cobblestones or a serious medical event, such as a heart attack, sometimes you need emergency healthcare abroad.
When an emergency happens, you can’t put off medical care until you get home. You have to be treated where you are and sort out the expenses after the emergency subsides. But that doesn’t mean you can’t plan. Understanding what your Medicare insurance does and doesn’t cover when you are away from home is the first step.
Whether or not you can expect assistance from Medicare when you travel boils down to what type of Medicare policy you have and whether you are traveling domestically or internationally.
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Beneficiaries with Original Medicare have access to more care when in the U.S. and can shop around for limited international coverage that is included in some Medigap plans. Those enrolled in Medicare Advantage plans (MA) are at a significant disadvantage because their care is tied to a defined network of doctors and hospitals. If you have an MA plan, you will likely pay more domestically for care and may be able to find a plan that provides travel insurance as one of the perks.
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What’s covered by Medicare when you are traveling in the U.S.
The type of Medicare policy you have will impact your ability to use your Medicare benefits when traveling in the US.
Original Medicare. If you are enrolled in Original Medicare, you’re in luck. You can use your coverage anywhere in the 50 U.S. states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Your Medicare coverage doesn’t change when you cross state lines; there are no price increases, out-of-state restrictions or additional approvals when you need care.
Medicare Advantage. An essential cost management feature of the MA plans is the network of physicians, hospitals, and providers with whom they have contracted to provide care to their members. The size and scope of these networks can vary significantly between plans — they don’t usually reach across state lines. When you leave a network, you run the risk of paying more for your care.
Take some relief and comfort knowing that MA plans are required to cover emergency and urgent care anywhere in the U.S. without imposing additional costs or coverage rules. If you have an MA plan and seek non-emergency/urgent care, your plan may or may not cover that care outside of its service area.
Some plans may cover providers that are out-of-network or out of your service area, but with higher cost-sharing and coinsurance. Your plan may also impose other rules or restrictions for non-emergency care, such as prior authorization. You should contact your plan to see what the rules are and what costs apply when you travel within the U.S.
If possible, use telehealth to see your regular doctor or provider for prescription refills or to attend to an issue that doesn’t require a physical examination.
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Limits of international Medicare coverage
When it comes to international travel, Original Medicare and Medicare Advantage plans provide minimal assistance and shouldn’t be relied upon to cover a medical event, minor or major, when you are outside of the country. There are exceptions to the rule, however. There are three circumstances where Medicare will provide some coverage at a foreign hospital, but they primarily benefit beneficiaries living in or traveling near Canada or Mexico. In practical terms, the exceptions only apply if you are in the U.S. or traveling to Alaska.
These are the three situations when Medicare may pay for certain types of healthcare services you get in a foreign hospital (a hospital outside the Medicare definition of the U.S.):
- A foreign hospital is closer while traveling in the U.S. You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat you
- Traveling to Alaska. You’re traveling through Canada without “unreasonable delay” by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat you (Medicare determines on a case-by-case basis what situation qualifies as “without unreasonable delay”)
- A foreign hospital is closer to your home. You live in the U.S., and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat you, regardless of whether you have a medical emergency
Be prepared to pay all of your costs outside the U.S. out-of-pocket. Foreign hospitals have no obligation to file claims for payment. As you may expect, you also pay any coinsurance, copayments, and deductibles you’d normally pay if you received these same services or supplies inside the U.S.
In the same way that Medicare only covers foreign medical expenses in limited circumstances, it also limits the types of services it will cover.
Medicare Part A, Part B, and MA plans may approve payment for the following services:
- Medicare Part A hospital insurance will cover your hospital care when you’ve been formally admitted with a doctor’s order to a foreign hospital as an inpatient
- Medicare Part B will cover your emergency and non-emergency ambulance and doctor services you get immediately before and during your covered foreign inpatient hospital stay.
- Medicare will not pay your ambulance or doctors’ expenses if it doesn’t approve payment for your hospital stay. It will also deny reimbursement if you received the ambulance and/or doctor services outside the hospital after your covered hospital stay has ended
Medicare Advantage plans are required to provide all of the services that Original Medicare does, but not more. Although many MA plans have lots of perks that cover things Medicare doesn’t, such as hearing aids, they don’t automatically offer international travel benefits beyond what was already discussed.
However, there are Medicare Advantage plans that offer forms of coverage for emergency care and urgent care services during international travel. As you may imagine, the coverage and rules vary, so it is important to check with your plan to determine the details of your foreign coverage before you enroll in a plan and again before you travel.
Warning for snowbirds and globetrotters
Many MA plans limit the amount of time you can spend outside your service area and still be covered. Typically, the limit for coverage is six months. For example, if you’re a snowbird who spends winters in Florida, you can remain there for six consecutive months and maintain your MA coverage.
If you stay longer than your allotted time, you may be disenrolled from the plan, and a Special Enrollment Period (SEP) would be triggered. If you fail to make a new selection of coverage, you will be automatically enrolled in Original Medicare. While the six-month limit is common, a small number of MA plans allow you to travel continuously within the U.S. for up to one year and still keep your benefits. However, that’s a condition you need to seek out when you choose your plan.
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Prescription drug coverage
Whether you have a standalone Part D prescription drug plan or get coverage through your Medicare Advantage plan, Part D won’t cover prescriptions you get outside the U.S. If you have to buy medication from an international pharmacy, you should expect to pay the entire cost out of pocket.
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Vaccination coverage
Your Medicare Part D drug coverage covers all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including certain vaccines you might need to get before you travel outside the U.S. Those vaccinations include: yellow fever, chikungunya and Japanese encephalitis.
Your Part D plan won’t charge you a copayment or apply a deductible for vaccines ACIP recommends. Before traveling, talk to your medical provider about which ones are right for you.
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Select Medicare Advantage plans and Medigap are your best bets for international coverage
Some Medicare Advantage plans include travel benefits for when you need care away from home. These travel benefits usually cover more than just emergency and urgent care and help ensure you have coverage no matter where you are. However, not all plans have the same rules and limitations. As such, it’s important to ask questions when shopping for the right Medicare Advantage plan.
Several Medigap plans offer some coverage for foreign travel emergencies. There is a deductible, a lifetime limit, and a limited window of time during which your coverage is active while traveling.
Medigap plans C, D, F, G, M, and N provide foreign travel emergency health coverage. Here are the features and limitations of this coverage:
- Initial deductible: You pay a $250 annual deductible for foreign travel emergency services
- Coverage limit: Plans cover 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet the $250 deductible
- Lifetime limit: There is a lifetime limit of $50,000 for foreign travel emergency coverage
- Time limit: The emergency care must begin during the first 60 days of your trip outside the U.S. If your trip lasts longer, the coverage will not apply after the first 60 days
And take note of these examples of what these Medigap plans will not cover:
- Routine Care: Regular check-ups, non-emergency treatments, or elective procedures are not covered. If you plan to see a doctor abroad for a routine check-up, your Medigap will not pay for it.
- Trips Longer Than 60 Days: If you are traveling abroad for an extended period, more than 60 days, any medical emergencies occurring after the initial 60 days are not covered
- Exceeding Lifetime Limit: If you have already reached the $50,000 lifetime limit for foreign travel emergency coverage, any further claims will not be covered
Medigap plans E, H, I, or J, which are no longer sold, may be kept it if you bought one of these plans before June 1, 2010. They still cover foreign travel emergency care.
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Be safe at home and away
Original Medicare and Medicare Advantage plans provide limited travel medical coverage outside the U.S.; you should consider buying a travel insurance policy to get more coverage. Check with an insurance agent or travel agent to get more information about the cost of travel medical insurance. Be careful to read the terms of the coverage. Travel insurance doesn’t necessarily include health insurance, so it’s important to read the conditions or restrictions carefully.
And those with Medicare Advantage need to also consider getting travel health insurance for their domestic sojourns. Unless you enrolled in an MA policy that includes travel coverage, don’t assume you’ll be covered by your policy.