Am I covered by Medicare if I fall ill on vacation?
Everyone deserves a vacation, especially seniors in their golden years. Some of the top vacation destinations for seniors are Alaska, Hawaii, The Caribbean, and Thailand. There are many different moving parts that go into planning a successful vacation, such as your travel, hotel, transportation, and much more. However, what if you become ill or a medical emergency occurs while on vacation? Many seniors have a common question, “Am I covered by Medicare if I fall ill on vacation?” Let’s discuss Medicare’s coverage while on vacation.
Traveling in the United States
Medicare is America’s federal health program for citizens aged 65 and older and for others who qualify due to certain disabilities. When you enroll in Medicare, you will have inpatient coverage through Part A and outpatient coverage through Part B.
If you have Original Medicare, you can travel anywhere in the United States with your health insurance. Medicare does not have a provider network, so if you visit a doctor or hospital that accepts Medicare, then Medicare will cover your care if medically necessary. If you travel to one of the United States territories: Puerto Rico, Guam, American Samoa, the U.S. Virgin Islands, Northern Mariana Islands, Medicare will also cover you if the doctor/hospital accepts Medicare.
Medigap plans work alongside Original Medicare. This means if you travel somewhere in the United States and Medicare approves your healthcare service, Medicare will pay its share first, and your Medigap plan will pay second. If a doctor or hospital accepts Medicare, then they must accept your Medigap plan no matter the plan or carrier you have.
Medigap plans are ideal for seniors who are frequent travelers and go on vacations often, as the plan will travel with you.
Medicare Advantage plans are different than Original Medicare and Medigap plans. For example, instead of getting your Part A and Part B benefits through the government, you will get them from your Medicare Advantage carrier. Medicare Advantage carriers establish your cost-sharing amounts and your network of providers.
What this means is your Medicare Advantage plan may or may not cover you outside your service area; it will all depend on your plan. The two most common Medicare Advantage plans are HMO and PPO plans.
Medicare Advantage HMO plans have a network where you will receive your healthcare services from. If you were to receive health services outside your network and it’s not an emergency, you will pay your medical bill in full.
Medicare Advantage PPO plans are more ideal for senior travelers. With a PPO plan, you can visit doctors outside your network. However, you will pay more for your services than if you were in-network. Keep in mind that your doctor or hospital might not take your plan, so you will want to ensure you visit a doctor who accepts your specific Medicare Advantage plan.
Traveling outside the United States
Since Original Medicare is American health insurance, the coverage will vary when you travel internationally.
Typically, Medicare will not cover you when you go outside the United States to receive healthcare services. However, there are a few special circumstances where Medicare may cover your care when you are in another country, such as Mexico or Canada. These special circumstances are:
- You live in the United States and have a medical emergency, and an international hospital is closer to you than a United States hospital; you can go to the foreign hospital to treat your ilness or injury.
- You live in the United States, and a foreign hospital is closer to you than an American hospital, whether it’s an emergency or not, you can go there for your care.
- You are traveling to Alaska and driving through Canada without an unreasonable delay, and a medical emergency occurs; you can visit a Canadian hospital to treat your illness or injury if it’s closer than an American hospital.
Medicare will only pay for medically necessary services in these special circumstances when outside the United States. Remember, though, when you are outside the United States, a foreign country does not have to bill your plan since it’s American health coverage.
Medigap plans C, D, F, G, M, and N, offer a foreign coverage benefit. This foreign coverage benefit consists of a $250 deductible and a lifetime coverage benefit of $50,000. If you are outside the country and a medical emergency occurs, you will first pay the $250 deductible, and then your Medigap plan will pay 80% of your Medicare-approved costs. Therefore, you cannot go out of the country to receive cosmetic surgery and expect your Medigap plan to provide coverage.
Your Medigap plan will only provide you emergency coverage outside the United States within the first 60 days of your vacation. If you do not have one of the Medigap plans mentioned above, expect to pay 100% of your healthcare costs outside the country.
Depending on your Medicare Advantage plan, you may or may not have a worldwide emergency coverage benefit. As mentioned earlier, Medicare Advantage plan carriers create their own rules when it comes to their plans. So before traveling outside of the country, check your plan’s summary of benefits to see if you have a worldwide emergency benefit.
Since Medicare Advantage plans have service areas, you cannot be outside your network for more than six months. If you are outside your network for more than six months, you could potentially be disenrolled from your plan and return to Original Medicare. Keep this in mind if you plan on vacationing for a period of time.
Planning a vacation is always an exciting time but falling ill while away from home is not. If you ever have questions on if you will be covered while on vacation, you can always look back at your plan’s summary of benefits to read more in detail about your plan’s coverage. However, if you are traveling across the United States with Original Medicare, know you are covered if you fall ill while on vacation.