Retirement is an exciting time. Breaking free of the nine to five hustle and being able to spend your time the way you want to is something most retirees would likely say is the best part of retirement. If you’re like most retirees, you may be planning your next vacation. Depending on your destination, your Medicare plan may or may not cover you while on vacation.
Vacations within the United States
If you’re planning a vacation within the United States borders, you are more likely to be covered than if you were planning to vacation in a foreign country. However, the type of Medicare plan you have will play a big role in you bring covered in another state.
Original Medicare (Part A and Part B) covers you throughout the United States and its territories. As long as you see doctors who accept Original Medicare, then you’ll be protected outside your home state. You’ll also be covered in any state while on vacation if you have a Medigap plan and see doctors who accept Medicare.
Medigap plans don’t have networks like Medicare Advantage plans do. Therefore, as long as the doctor accepts Original Medicare, they have to accept your Medigap plan. If Medicare approves the service, so will your Medigap plan.
As mentioned above, Medicare Advantage plans have networks. Networks are groups of doctors and hospitals that accept specific plans from specific carriers. If you have a Medicare Advantage plan with only in-network benefits, such as an HMO plan, then you will have to see a doctor who is in-network with your plan. Generally, that means seeing a doctor in your plan’s service area of your home state.
However, if you have a Medicare Advantage plan with a larger network or both in and out-of-network benefits, then you may be able to vacation outside your home state and still receive coverage. For example, if you have a Medicare Advantage PPO plan from Florida and vacation in Montana, your plan may still cover you if you go to the doctor on vacation. However, the out-of-network doctor is not required to bill your plan since they are not in-network with the plan.
On the other hand, if you experience a medical emergency while on vacation, your Medicare Advantage plan will cover your emergency care, regardless of the type of plan.
Vacations outside the United States
Medicare does not cover you when vacationing outside the United States unless it is an emergency. And even then, coverage can be limited. How and when your emergency care is covered outside the United States will depend on the type of Medicare plan you have.
Original Medicare may cover your emergency care in a foreign hospital if you travel through Canada to get to or from Alaska or travel along the United States border as long as the foreign hospital is closer than an American one at the time of the emergency. Medicare Part A and Part B will pay normally until it is safe for you to be transferred to an American hospital.
As mentioned earlier, if Medicare approves the claim, so much your Medigap plan. Therefore, if Original Medicare covers your emergency care, your Medigap plan will cover the cost-sharing expenses it usually covers. However, some Medigap plans have an additional foreign travel emergency benefit that can be used in other scenarios aside from the scenarios above.
Medigap plans C, D, F, G, M, and N include an 80% foreign travel emergency benefit that can be used within your first 60 days of traveling outside the United States. The benefit has a $250 deductible and $50,000-lifetime limit. For example, if you vacation in Europe, and within your first 60 days of leaving the United States, experience a medical emergency, then after a $250 deductible, a Medigap Plan G will cover 80% of your medical costs up to $50,000.
Like Original Medicare and most Medigap plans, Medicare Advantage plans will also cover you outside the United States in the case of an emergency. However, it’s important to note that foreign hospitals are not required to bill your Medicare plan, whatever type it may be, Medigap or Medicare Advantage. Therefore, you’ll likely have to pay the hospital bill at 100% then request reimbursement from your Medicare plan later.
Because coverage isn’t guaranteed and you could be out thousands of dollars if sent to the hospital while on vacation outside the United States, it’s recommended you purchase a travel health insurance policy for the time you are expected to be outside the country. If you vacation within the United States, you have a better likelihood that the doctor will be able to bill your Medicare plan. Therefore, a travel health insurance policy isn’t necessary.