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Medicare’s coverage of care when you travel depends on where you travel and how you receive your Medicare benefits. While never intended, some will find themselves in need of health care services when they are traveling. To avoid any potential stress and confusion, here are some things you need to know before taking off on your summer vacation…
Traveling Within the United States
If you have Original Medicare, you can travel anywhere in the U.S. and its territories and still be covered, as long as you use doctors and hospitals that accept Medicare. This includes:
- All 50 states
- The District of Columbia
- Puerto Rico
- The Virgin Islands
- American Samoa
- The Northern Mariana Islands
Traveling Within the US with a Medicare Supplement
Because Medicare supplements cover their portion of Medicare-approved medical bills, you will receive the same coverage anywhere in the United States, and the territories listed above.
Traveling Within the US with a Medicare Advantage Plan
If you receive your Medicare coverage through a Medicare Advantage plan, instead of Original Medicare, the rules for out-of-state coverage are different and will depend on the type of Medicare Advantage plan you’re enrolled in.
If you have a Medicare Advantage Plan, your plan may not cover your care while you travel in the United States unless you need emergency or urgent care. Your plan may allow you to see providers that are outside of your network or area, but you may have to pay more for the care (except for emergency care). You may also need to follow other plan rules like obtaining prior authorization. If you have a Medicare Advantage plan, contact your plan to see what rules and costs apply when you travel within the United States.
If you will be traveling to a foreign country, Medicare will not usually cover your medical care.
However, Original Medicare must cover your medical care outside of the U.S. in the following limited cases:
- If you have a medical emergency and the nearest hospital is a foreign hospital, instead of a U.S. hospital, Medicare will cover their portion of approved expenses.
- If you are traveling through Canada or Alaska without unreasonable delay, have an illness or injury, and a Canadian hospital is closer than a U.S. hospital, Medicare will cover their portion of approved expenses. Medicare determines what an “unreasonable delay” is on a case-by-case basis.
- If you live in the United States, but a foreign hospital is closer to your residence, Medicare will cover your health care services – regardless of whether it is an emergency or not.
- Medicare will pay for medical care you get on a cruise ship if you get the care while the ship is in U.S. territorial waters. This means the ship is in a U.S. port or within six hours of arrival at or departure from a U.S. port.
Traveling Internationally with a Medicare Advantage Plan
If you are traveling overseas, Medicare Advantage plans must provide at least the same level of coverage as Original Medicare, so you’ll be covered in the same limited situations described above. However, some Medicare Advantage plans may provide additional coverage when you are traveling outside of the United States. Check with your Medicare Advantage plan for more information.
Traveling Internationally with a Medicare Supplement
If you are traveling internationally, Medicare supplement plans C, D, F, G, M and N all provide coverage (up to plan limits) in Medicare emergency situations. If you have one of these plans, your plan:
- Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care.
- Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year.
Medicare supplement foreign travel emergency coverage with Medicare supplement policies has a lifetime limit of $50,000.
Before you travel outside of the U.S., talk with your insurance agent to fully understand your Medigap coverage while traveling.