Medicare Coverage while Traveling: What to Know

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If you are a US citizen and traveling outside the country, it is important to know about some of the coverage options available to you through Medicare. There may be different coverages available depending on where you will be going and how long your trip will last. It’s also worth noting that if you retire from work while abroad, there may be ways for Medicare to help with costs associated with medical care in your new location. Many people are not aware of the rules for Medicare coverage while traveling. The following is a list of things to know about what is covered under Medicare while you are out-of-state or out-of-country.

Medical Cover Outside Country’s borders

You have no coverage for emergency care outside of your country’s borders, unless it is an emergency and you cannot get back to your own country in time. However, if you live in Puerto Rico or one of the U.S. Virgin Islands, then this rule does not apply to you. The main reason is that these locations have health plans that cover emergencies abroad.

Developing Medical Problem during a Travel

If a medical problem develops during travel and requires hospitalization, then Medicare will help pay after a deductible has been met (similar to a deductible for inpatient hospital care). The amount of the deductible varies, depending on whether or not you have already used Medicare benefits for this year, and the type of Medicare you have. This deductible is in addition to any other deductibles that may apply (such as hospital admissions, or an ER copay).

Medicare Cover while Travelling within the U.S.

If you are traveling within the U.S., then your Medicare coverage will depend on where exactly you go. If it is an area that has its own Medicare plan, then you should be covered under that (and not travel with original Medicare). The exception to this would include if part of your trip takes place outside of any areas served by a specific insurance company’s network. For example, flying from one coast to another and stopping at several points in between. You may need to coordinate trips or book through knowledgeable professionals like providers at CareMore Health System. They can help make sure all bases are covered throughout your care journey.

Medicare Cover while Travelling outside the U.S.

When traveling outside the U.S., one has no direct coverage for emergency or other medical services from medicare. One must have other types of coverage to be protected against catastrophic expenses. If not, then your only option would be to pay out-of-pocket for care that is needed while traveling outside of the country, until you can return to the U.S., at which point your Medicare coverage will resume again. You would need additional insurance coverage for both Emergency Medical Evacuation (which covers medically necessary transportation back to the U.S.) and an annual maximum of $50,000 in repatriation services (for funerals or other similar costs). These two types of protection also apply when traveling within Canada, but not Mexico.

Medigap Supplemental Insurance Policy

Purchasing a Medigap supplemental insurance policy could be an option for one planning to travel outside of the U.S. It will cover some or all costs for medical care while abroad (depending on which one you choose), through your current or former employer, or directly from an insurance company. These policies typically involve deductibles and copays (for hospital admissions/care) but will help pay for some of the expenses you might incur while traveling outside of the country. If you decide to take this route, then make sure that the policy covers both Emergency Medical Evacuation and repatriation.

Medicare Advantage Program Within the U.S.

The Medicare Advantage program is a private health care coverage plan for people who are eligible for both Medicare and Medicaid. The program is administered by the Centers for Medicare and Medicaid Services (CMS) within the United States Department of Health and Human Services. You can choose from four types of plans: HMO, PPO, point-of-service (POS), or Private Fee For Service (PFFS).

Health insurance companies offer these plans to individuals in an area where they do business; CMS oversees all plans offered nationwide. If you qualify for this type of coverage, your state pays part of your premiums if you enroll in a plan with low monthly costs like an HMO or PPO, or if you choose a plan with no monthly costs, such as an HMO or PPO. People who can’t afford their share of the premiums are automatically enrolled in the “basic” fee-for-service coverage option by default, but they can change to one of these other types of plans during open enrollment periods.

When you enroll in a Medicare Advantage plan, you will receive all your Part A and B benefits. Any additional coverage can come from either the public or private insurance company offering this kind of health care coverage plan. You will be responsible for any costs that are not covered by these plans such as hospital services, prescription drugs, skilled nursing facilities, home health agencies, ambulance fees and other medical supplies if they aren’t included with certain HMOs or PPOs. Some options include dental procedures at no charge to you through participating providers along with vision discounts available exclusively to seniors enrolled in their specific healthcare plans. In recent years many people have been turning towards managed Medicare advantage. The main reason is because it is often cheaper than traditional fee-for-service.

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