Especially to those who are new to Medicare, it is important to think about your travel patterns as you contemplate your reviewing your Medicare coverage.
Don’t forget your health insurance coverage in making your travel plans. Medicare coverage is probably the last thing we think about when we hop in the car to drive down to Boston to take in some historic sites or up to Canada for a quick weekend trip. But emergencies do arise.
So, before you embark on that dream vacation or a brief trip outside of New York, let’s take a look at some of the rules related to using Medicare outside of your home area.
Using Original Medicare outside of New York. Original Medicare works in every state and will be accepted by any provider who accepts Medicare. However, always be sure to ask if the practitioner accepts Medicare assignment. If they don’t accept Medicare assignment, you may be asked to pay for the service up front and collect from Medicare later.
If you are traveling to a foreign country, including Canada and Mexico, Original Medicare will usually not cover your care. There are, however, a few exceptions.
If you are traveling through Canada on a direct route, say from Winsor, Ontario (north of Detroit) to the 1000 Islands bridge, and without reasonable delay, the closest hospital in Canada should accept your Medicare coverage. However, the hospital is under no obligation to file the Medicare claim so you may need to file the claim yourself.
If you are traveling along either the Canadian or Mexican borders, you will be taken to the closest hospital for emergency care. If the foreign hospital is closer than the U.S. facility and is equipped to treat your condition, you should be covered. This means that you could be taken across the border for emergency care and still be covered.
Supplemental insurance coverage. If you currently do not have a Medicare supplemental insurance plan now is an excellent time to consider one. The term supplemental insurance refers to insurance that you purchase from a private company to pay costs, such as co-payments, deductibles, and even health care if you travel outside the U.S., that is not covered by Original Medicare.
However, these policies do not cover such things as long term care, dental and vision care and hearing aids that are not covered by Original Medicare. If you are enrolled in a Medicare Advantage Plan you generally do not need this additional coverage.
If you are traveling within the U.S., any type of supplemental insurance policy is generally valid across the country.
These plans must be accepted by any provider who accepts Medicare, even if the hospital or clinic tells you they have never heard of your plan. Many of these plans will cover up to 80 percent of the cost of emergency care during the first two months of a trip.
Premiums for adding coverage outside the U.S. to your supplemental plan can be quite costly. So, if you rarely travel overseas you may want to consider taking out travel insurance ■ CONTINUED FROM PAGE 12
right before your trip. Consumer Reports recommends the website https://www.insuremytrip.
com/ as a starting point for checking on travel insurance options.
Your options include low cost international medical insurance for single short trips, flexible/renewable medical insurance for longer trips and living abroad and travel insurance for the frequent traveler. Policies that combine medical insurance and trip cancellation protection are also available.
Medicare Advantage Plans. First, you need to be aware that Medicare Advantage Plans combine the benefits of Original Medicare, Medigap insurance along with other benefits, such as membership in a health club, and are built on obtaining your care from a network of providers.
All Advantage plans will cover you in case of a true emergency, for example, a broken leg while skiing in Vermont or a heart attack in Omaha. All you generally need to do is inform your plan of the emergency within 24-48 after arriving the emergency department (ED). Also, always show the ED your Advantage card and not your Original Medicare card. The hospital will bill the carrier based on the card you give them.
If you are traveling “out of network” your coverage will depend on the rules of the plan.
Where, how long and kind of care you need will all be specified in the rules.
You should know that if you travel outside of the network area for more than six months you will be automatically disenrolled and placed back into Original Medicare if you do not choose another Advantage Plan.
If you spend more than six months a year outside of New York (long stays in Florida for example) make sure that you have a plan that will cover your needs without the possibility of disenrollment.
If your Advantage plan says that it is a “national plan” are you still covered? You will certainly be covered for an emergency but not necessarily for the oversight of a chronic condition. Check to make sure that your plan has practitioners that are considered to be part of your network.
Coverage for travel on cruise ships. Your Original Medicare will cover you if you are within six hours of arrival or departure from a U.S. port (including U.S. Territories). A ship doctor, under certain conditions, may be allowed to care for you while you are on board. Given the recurring health problems reported on cruise ships it is always best to check with your cruise line and/or your travel agent about purchasing separate travel insurance to cover your trip.
Prescription drug refills for travel. The travel rules for Original Medicare and Advantage plans also apply to Part D drug plans. You should always take some additional medications with you when you travel. If you need to obtain an early refill, check with your pharmacist for help.
In summary, if you have Original Medicare and supplemental insurance and are traveling within the U.S., including Alaska and Hawaii, you will be covered by providers who accept Medicare. If you have an Advantage Plan you will need to check the rules of your plan. If you are traveling out of the country, you should consider purchasing travel insurance. If you need assistance with these and other health insurance questions, contact the Oneida County Office for the Aging/Continuing Care HIICAP program at 315-798-5456 to speak to a counselor.
Dr. William Lane is owner of William Lane Associates, a gerontological consulting firm located in Homer, NY. He does not sell insurance, work for any insurance company or recommend any specific insurance products.