The answer is: The coverage you receive while traveling with Medicare depends on both your destination and the specific type of Medicare policy you have.
Travelling within the US
Many retirees dream of exploring the world, but Medicare’s coverage has limitations.
Unfortunately, Medicare does not reimburse for international medical expenses. Services obtained outside the U.S. are not covered.
However, there are some exceptions:
- If emergency treatment is required in a foreign country while you’re in the U.S., Medicare may cover inpatient hospital costs, ambulance services, or dialysis.
- If you’re traveling through Canada between Alaska and another state, emergency situations may be covered.
- If a foreign hospital is closer to your U.S. residence than the nearest domestic facility, regardless of urgency, it may be covered.
Remember, foreign hospitals usually won’t file Medicare claims, so you may need to submit an itemized bill yourself.
Your Medicare coverage follows you if you travel to:
- Another state in the U.S
- District of Columbia
- Puerto Rico
- U.S. Virgin Islands
- Guam
- Northern Mariana Islands
- American Samoa
If you’re on a cruise in international waters, Medicare may cover necessary care if the ship is within 6 hours of a U.S. port. Confirm with the cruise company regarding medical services.
Do Medicare Advantage plans offer coverage while traveling?
If you’re enrolled in a Medicare Advantage Plan, coverage outside its service area may vary. Some plans offer out-of-network or out-of-area provider coverage, albeit with higher cost-sharing. Additional rules, like prior authorization, may apply. Contact your plan to learn about applicable rules and costs during U.S. travel.
Note: Emergency and urgent care within the U.S. are covered by Medicare Advantage Plans without extra costs or coverage restrictions.
Continuous travel outside your plan’s service area for over six months will lead to automatic disenrollment from most plans. You’ll have a Special Enrollment Period to join another Medicare Advantage Plan. Otherwise, you’ll be enrolled in Original Medicare automatically.
Certain Medicare Advantage Plans offer special benefits for continuous U.S. or territory travel for up to 12 months. Be sure to review the rules if your plan offers visitor or travel benefits. Coverage may be limited to specific areas, certain care may not be covered, and out-of-network providers could result in higher costs.
Travelling Outside the US
When traveling outside the U.S., Medicare typically doesn’t cover your medical care. However, there are specific circumstances in which Original Medicare and Medicare Advantage Plans provide coverage:
- Emergency services in Canada are covered if you’re traveling directly between Alaska and another state, without unreasonable delay, and the nearest treating hospital is in Canada.
- Medical care received on a cruise ship in U.S. territorial waters is covered. This includes being in a U.S. port or within six hours of arrival at/departure from a U.S. port.
- In certain cases, Medicare may pay for non-emergency inpatient services in a foreign hospital, along with provider and ambulance costs. This applies if the foreign hospital is closer to your residence than the nearest U.S. hospital, such as when living near the Mexico or Canada border.
Some Medigap policies (C through G, M, and N) offer coverage for emergency care abroad, covering 80% of the costs. Check your specific policy for coverage details.
Medicare Advantage Plans may also cover emergency care abroad. For information regarding costs and coverage rules, contact your plan.
How can I make sure I’m covered while abroad or away?
To ensure coverage while abroad or away, it’s important to understand that Medicare may not provide comprehensive international coverage. Individuals planning to travel internationally should review their private insurance plan to determine the extent of services and associated costs abroad.
Investing in travel health insurance, which includes healthcare coverage (unlike standard travel insurance policies), can be valuable if you anticipate frequent international travel during retirement. This is particularly crucial if you have ongoing healthcare needs, require specific medical supplies, prescription drugs, or treatments.
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