The last way you want to spend your vacation is in the doctor’s office. However, something might come up, leaving you with no other option. Vacationing while on Medicare may leave you wondering if you’ll be covered or not. It depends on your type of Medicare coverage, the doctor you see, and where you vacation.
Depending on those factors, you may be covered just like you are at home. On the other hand, you may be in for some surprises. Learning how Medicare will cover you on vacation should be at the top of your to-do list when planning your trip.
Will Medicare cover me on vacation in the United States?
When you vacation in the United States, some Medicare plans follow you, while others do not. Whether you’re vacationing inanother city in your home state or across the country, here’s how each Medicare plan coversyou.
Original Medicare and Medicare Supplement plans
If you’re enrolled in Original Medicare, you’ll find that you have extensive coverage. Original Medicare is your Part A and Part B. Part A and Part B cover you in all parts of the country. However, you must see doctors who accept Original Medicare. If you see a doctor who doesn’t accept Original Medicare, regardless if you’re on vacation or not, Medicare won’t cover you.
If you live in Texas and vacation in Florida, verify that any doctor you see accepts Medicarebefore your appointment. With that said, there are nearly one million providers in the country who accept Medicare, so you should have a few options.
Medicare Supplement plans, also called Medigap plans, pay after Original Medicare pays. If Original Medicare approves a claim, so will your Medicare Supplement plan. You can use your Medigap plan with any doctor who accepts Medicare.
Medicare Advantage plans
If you choose a Medicare Advantage plan, you agree to receive your coverage from the plan carrier rather than Original Medicare. Plans are free to set their own benefits and coverage rules as long as they cover at least everything Original Medicare covers.
Medicare Advantage HMO plans use provider networks; you have to get all non-emergency care from network providers. Medicare Advantage PPO plans also have provider networks, but you can see out-of-network providers, too. You just pay more out-of-pocket for your care. With a PPO, you can see any provider that accepts your plan even outside your local service area.
For example, if you live in Ohio and have a Medicare Advantage HMO plan and you travel to California on vacation, any doctor you see there would be out of network, and you’d be responsible for 100% of the bill unless it wasan emergency. On the other hand, if you have aMedicare Advantage PPO plan, you may be able to get partial coverage for an out-of-network doctor if they are willing to accept your insurance.
Will Medicare cover me on vacation outside of the United States?
Medicare coverage outside of the United States is rare. However, if your circumstances qualify for coverage while vacationing in another country, it will only be in the case of an emergency. Essentially, you have no Medicare coverage when you travel to a foreign country.
Original Medicare and Medicare Supplement plans
There are a few circumstances in which Original Medicare will cover your emergency care in a foreign hospital:
- You’re traveling through Canada to or from Alaska from or to the lower states, and a Canadian hospital is closer than an American hospital.
- You’re traveling along the U.S. border, and a Canadian or Mexican hospital is closer than an American hospital.
- You are home when the emergency occurs, and your home is closer to a Canadian or Mexican hospital than an American hospital.
Most Medicare Supplement plans have an extra foreign travel emergency benefit .. If you travel to any foreign country and you need emergency care within the first 60 days of your vacation, then the Medicare Supplement plan will cover your medical care at 80% after a $250 deductible. This benefit has a lifetime limit of $50,000.
Medicare Advantage plans
While your vacation coverage in the U.S.variesdepending on the type of network your Medicare Advantage plan has, nearly all Medicare Advantage plans cover emergency care in foreign countries. However, the coinsurance when accessing this benefit can vary by plan.
It’s important to remember that foreign hospitals aren’t required to bill your American Medicare insurance. If the hospital doesn’t bill Medicare for you, you will have to pay out-of-pocket first and request reimbursement from Medicare or your plan later. To avoid hiccups like these, consider purchasing a travel health insurance policy, especially if you’re traveling outside of the United States.
