Retirement means different visions for each individual, but for many, the prospect of travel is a significant consideration. If your plan for enjoying newfound freedom from the 9-to-5 routine involves exploring the world, it’s important to take this into account when enrolling in Medicare and choosing supplementary coverage.

Generally, Original Medicare does not extend coverage to medical treatments outside the United States and its territories (Guam, Puerto Rico, U.S. Virgin Islands, American Samoa, and Northern Mariana Islands). Additionally, Medicare prescription drug plans do not include coverage for outpatient medications acquired outside the United States.

There are limited instances where Medicare might partially cover some costs. However, it’s crucial to note that foreign hospitals are not obligated to submit claims to Medicare. If you meet the criteria for coverage, you may need to submit your own detailed bill for reimbursement.

Which countries accept U.S. Medicare?

Original Medicare coverage beyond the borders of the United States and its territories is confined to specific situations:

1. If you are in the U.S. during a medical emergency but close enough to its border that the nearest hospital is outside the United States, or if you reside near the border and the closest hospital capable of treating you, whether an emergency or not, is situated outside the United States.

2. If you are traveling between Alaska and another U.S. state via a direct route through Canada “without unreasonable delay,” and a medical emergency occurs while you are in Canada. It’s important to note that Medicare assesses cases individually to determine what qualifies as an “unreasonable delay.” Therefore, if you are on an extended road trip through Canada en route to Alaska, you may not be covered if an incident happens while you are in Canada.

3. If you are on a cruise ship within six hours of a U.S. port.

Apart from these situations, Medicare does not reimburse for healthcare provided outside the United States. Hence, if you are nearing Medicare enrollment and have a desire for travel, it is crucial to explore supplemental coverage options that safeguard you in the event of a medical emergency beyond the United States.

Will Medigap provide coverage when I am traveling outside the U.S.?

If you are considering a Medigap plan to enhance your Original Medicare coverage, six Medigap plan design options (C, D, F, G, M, and N) offer coverage for medical emergencies outside the United States. These plans provide coverage as long as medical care commences within 60 days of leaving the United States.

(Note that Plans C and F are not available to new Medicare beneficiaries as of 2020 or later. However, those eligible for Medicare before 2020 can retain or apply to enroll in these plans. Four older Medigap plans – E, H, I, and J – also cover emergencies outside the United States. While no longer available for new enrollment, existing enrollees can continue using them.)

In most states, Medigap plans are only available without medical underwriting during your initial enrollment period (and very limited special enrollment periods). Therefore, it is advisable to plan ahead and select Medigap coverage with international emergency benefits if you anticipate traveling during retirement.

With a Medigap plan covering foreign travel emergencies, the patient is responsible for a $250 deductible plus 20% coinsurance, and there is a lifetime benefit maximum of $50,000.

Which Medicare Advantage plans provide coverage for international travel?

Certain Medicare Advantage plans extend coverage to medical emergencies that occur during foreign travel. If you are considering Medicare Advantage and have plans to travel outside the United States, it is advisable to inquire with the carrier regarding their coverage for emergency care outside the United States. It’s important to note that Medigap plans cannot be used concurrently with a Medicare Advantage plan.

If your Medicare coverage is supplemented by retiree health benefits from your employer, it is recommended to check with your plan to determine if there is coverage for emergencies during foreign travel.

If you have Medicaid in addition to Medicare, it’s essential to be aware that Medicaid does not offer coverage outside of the U.S. or even outside of your home state in most cases.

What other supplemental plans provide coverage for international travel emergencies?

For added peace of mind, many Medicare beneficiaries opt to purchase travel medical insurance before embarking on a trip. While travel medical plans are widely available, it’s important to note that, in many cases, they may limit the coverage available to seniors.

Though travel plans often come with medical benefit maximums as high as seven figures, this limit is frequently reduced to $50,000 or less for applicants over 70 years old. Travel medical insurance can be used in conjunction with other health insurance plans.

Many travel medical insurance plans include separate medevac coverage, which can also be obtained on a stand-alone basis from private carriers. It’s worth mentioning that medevac return to the United States is not included in the foreign travel emergency coverage provided by Medigap plans. Consequently, beneficiaries with Original Medicare plus Medigap coverage may consider purchasing separate medevac coverage before traveling abroad.

Should I keep my Medicare coverage if I retire abroad?

To secure coverage in your new country, you would need to purchase private health insurance or enroll in the country’s public health plan, if available. If you are willing and able to return to the United States for hospital care, you will still have access to coverage under Medicare Part A, provided you qualify for premium-free Part A by having worked at least 10 years in the U.S.

However, you would need to purchase Medicare Part B for outpatient coverage, and there is a 10% premium increase for each year that you were eligible for Part B but not enrolled. Advocacy groups have sought portable Medicare coverage for retirees living overseas, but currently, this option is not available.

Can I consult a doctor in another state with Medicare?

For Medicare beneficiaries with a penchant for domestic travel, Original Medicare plus a Medigap plan (and a Medicare Part D prescription plan) will provide nationwide coverage, including U.S. territories.

Approximately 93% of all U.S. doctors providing Medicare-covered services are participating providers with Original Medicare. However, it’s important to note that not all participating providers accept new patients, so reaching out to doctors in the area where you plan to travel is advisable. Only about 1% of all non-pediatric physicians in the U.S. have opted out of Medicare entirely.

Understanding that Medicare Part D plans may require members to use in-network pharmacies, and some may have localized networks rather than nationwide networks, it’s advisable to check with your Part D plan before traveling. This will help you determine whether you need to make arrangements to purchase medication in advance or use a mail-order pharmacy.

While Medicare Advantage plans cover emergency care anywhere in the United States or its territories, routine care typically requires enrollees to use a local provider network. If you travel outside your plan’s service area for more than six months, you may be disenrolled from the Medicare Advantage plan and switched to Original Medicare. In Medicare Advantage PPOs, if you travel within the U.S. for less than six months, you may have access to out-of-network providers for routine care, but you may incur higher out-of-pocket costs. HMOs, on the other hand, may not provide coverage for non-emergency care when outside your service area.