Using Medicare when you travel
One of the benefits of retirement is the ability to travel on a schedule based on your own preferences and not on the rules set by your employer.
Probably the last thing most of us think about when we travel is our Medicare coverage. But, unforeseen emergencies can arise while we are on vacation. What do we need to consider in terms of health care before we leave on that dream vacation or extended winter trip?
Will my Medicare work for me if I become ill out of New York state? If you have Original Medicare any provider in the 50 states, the District of Columbia, Puerto Rico, the territories of the U.S Virgin Islands Guam, American Samoa and the Northern Mariana Islands, should accept it.
What if I travel outside the U.S. and its territories? If you travel to a foreign country, including Canada and Mexico, Original Medicare will usually not cover your care with the exception of a few limited cases:
If are traveling through Canada on a direct route, and without unreasonable delay, between another state (including Alaska) and the closest hospital is in Canada, you should be covered. However, Canadian and other foreign hospitals are under no obligation to file a Medicare claim so you may be asked to pay for the care and file the claim yourself.
If you are in need of treatment in either Canada or Mexico and the foreign hospital is closer than the nearest U.S. hospital that is available and equipped to treat your medical condition, you should be covered.
If you are in the U.S. and a foreign hospital is closer than a U.S. hospital, you may be taken across the border for emergency care and be covered by Original Medicare.
What if I am on a cruise ship and need medical care? Original Medicare will cover you on a cruise ship if you are within U.S. territorial waters. “In U.S. territorial” waters means that the ship is in a U.S. port or within six hours of arrival or departure from such a port.
The ship’s doctor is allowed, under certain laws, to provide care while you are on board. Given the problems that have been reported in recent years on cruise ships, always check with the cruise line or your travel agent about purchasing travel insurance for the cruise.
What if I have a Medicare Advantage Plan? Because Medicare Advantage Plans are built on a network of providers your plan may not cover you while you travel outside of the network, even if you are still in the U.S.
Payment depends on the kind of plan you have, how long you travel, where you travel and the kind of care you will need. For example, while some plans will allow you to travel for up to 12 months without losing coverage, if you are outside the overage area for more than six months, you will be automatically dis-enrolled.
You will not lose coverage, but will be put back into Original Medicare if you do not choose another Advantage Plan.
If you regularly spend time outside of the network area, for example several months in Florida every winter, make sure the plan you choose will cover your needs. Be sure you understand the rules on out-of-network coverage.
Regardless of the type of plan you have, all Advantage Plans will cover emergency or urgent care. Your out-of-network change cannot exceed $65.
What if I have a supplemental insurance plan, such as a Medigap plan? Will it cover my foreign travel? Many Medigap plans will cover up to 80 percent of the cost of emergency care abroad during the first two months of a trip. Usually there will be $250 deductible and a lifetime limit of $50,000 for coverage. Again, check with your plan about their rules. If you regularly travel outside the U.S. you will want to factor this in when choosing supplemental coverage.
What if I need to get a prescription refilled? The rules that apply to Original Medicare and Medicare Advantage Plans also apply to Part D plans. When traveling be sure to take extra medications with you. If you need to obtain an early refill or additional medications before leaving, check with your pharmacist for help.
What steps should I take before I travel to make sure that I am covered?
If you have Original Medicare and you are traveling with the area limitations described above, you should be covered for emergency or urgent care.
If you have a Medicare Advantage Plan check with your plan before any travel outside the provider network to make sure you are covered.
If you are traveling outside the US you may choose to purchase travel insurance. But, not all travel insurance plans cover medical care so it is important that you purchase the proper coverage. Some credit cards also offer travel insurance. Consult your travel agent, insurance agent or credit card company about such coverage.
What if I need to purchase additional travel insurance? According to the International Federation of Health Plans there are four types of travel insurance plans:
Low Cost International Medical Insurance. These plans generally cover you both within and outside of the U.S. for single trips ranging from 5 days to12 months.
Flexible, Renewable Medical Insurance for Travel or Living Abroad. These plans are for trips lasting at least three months and are renewable for up to three years.
Travel Insurance for the Frequent Traveler. You sign up each year for coverage and choose your benefit package. This insurance covers any number of trips for up to 30 days each during the year. These plans are designed for those who travel frequently for either business or pleasure.
Flexible Trip Cancellation and Medical Expense Coverage. These policies can cover everything from airline cancellations and lost baggage to medical expenses including air evacuation. Air evacuation expenses can run as high as $20,000.
The Oneida County Office for the Aging/Continuing Care HIICAP program can offer you assistance in making sure you are covered on your next trip.
Dr. William Lane is the owner of William Lane Associates, a gerontological firm based in Delmar. He is writing a monthly column on issues related to health insurance for the Office for the Aging. He does not sell insurance, work for any insurance company or recommend any insurance products.