COLUMN: Resuming travel after the pandemic
Medicare coverage is probably the last thing you think about when you hop in the car to drive down to Pennsylvania for a festival or up to Canada for a quick weekend trip.
But emergencies do arise. So, before you embark on that dream vacation or just to take a brief trip outside of New York, you need to understand the travel benefits provided under Medicare.
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 make sure that the practitioner providing the service accepts Medicare assignment. If they do not 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, exceptions.
If you are traveling through Canada on a direct route without reasonable delay, the closest provider in Canada should accept your Medicare coverage. But the provider 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 and within the U.S., should an emergency arise, you will be taken to the closest hospital for care. If a Canadian or Mexican hospital is closer than the nearest U.S. facility and is equipped to treat your condition, you will probably be taken there and should be fully covered.
Supplemental Insurance 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. 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 right before your trip. Consumer Reports recommends the website https://www.insuremytrip.com/ as a starting point for checking on travel insurance options.
Medicare Advantage Plans. All Advantage plans will cover you in case of a true emergency, for example a skiing accident in Vermont. All you generally need to do is inform your plan of the emergency within 24 to 48 after arriving at the emergency room (ER). Also, always show the ER your Advantage card. The hospital will bill the carrier based on the card you give them.
If you are traveling “out of network” other coverage will depend on the rules of your plan. Where, how long and what 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 winter 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. So, you still need to check to make sure that your plan has practitioners at your destination that are considered to be part of your network.
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.
Second COVID-19 Booster Shot. As announced on the Medicare.gov website, “If you’re 50 and older, or if you’re moderately to severely immunocompromised, you may get a second COVID-19 vaccine booster shot, at no cost to you.” It must be at least 4 months after your first booster. Also, this second booster must be a Pfizer or Moderna booster. It does not need to be the same as your initial COVID-19 vaccine, you can mix and match.
As with the other COVID-19 vaccinations, Medicare will pay the full cost for this second booster. There are no deductibles or copays and your provider can not charge you an administration fee to give you the shot. As with all medical procedures, if you have any questions about receiving this booster consult your physician or health care provider.
HIICAP in Oneida County. HIICAP counselors from the Oneida County Office for Aging/Continuing Care are available to assist you in providing more information about Medicare and all insurance related questions:
The Oneida County HIICAP Office is continuing to provide counseling services and in-person scheduling by phone as they have throughout the pandemic. If you would like to do a HIICAP counseling session over the phone or schedule an appointment at one of the two in-person locations call 315-798-5456 and select No. 2 from the choice list. In most cases you will be asked to leave your contact information on a voice mail and a staff member will return your call within 72 hours (3 business days).
Copper City Community Connection, 305 E. Locust St., Rome will offer assistance on Thursday afternoons. The HIICAP program will also be scheduling at Copper City.
North Utica Senior Citizens Center, 50 Riverside Drive, Utica has hours of operation from 9 a.m. to 3:15 p.m. on Friday only. Sessions are expected to run 45 minutes. Call the HIICAP office to schedule an appointment.
Contacting HIICAP Programs in Other Counties. Here is the contact information for HIICAP programs in several counties that border Oneida County. To reach the Madison County HIICAP program call 315-697-5700 and ask to speak to a HIICAP counselor. For Herkimer County, call Catholic Charities of Herkimer County at 315-894-9917. For Lewis County call 315-376-5013 and select No. 2 from the choice list.
Dr. William Lane is the owner of William Lane Associates, a gerontological consulting firm located in Homer, N.Y. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.
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