Many Americans look forward to vacations, whether it’s vacationing to get away from work, spending quality time with family, or enjoying some alone time. As exciting as a vacation is, there are some things to consider before hitting the roads. A few things you must plan before your vacation is your hotel, transportation, and excursions. Now, if you fall ill while on vacation, do you know if your health insurance covers you?
Traditional Medicare
Medicare is a United States federal government health insurance program. American citizens who are aged 65 and older and people who have certain disabilities qualify for traditional Medicare. Medicare has two parts that cover your inpatient coverage, known as Part A, and outpatient coverage, known as Part B.
Vacation inside the United States
If you have traditional Medicare, you can visit any doctor, facility, or hospital that accepts Medicare in the United States. You will not have a network of providers with Medicare. Therefore, if you have a Medicare-approved service and your doctor is willing to bill Medicare, then you are covered.
Vacation outside the United States
Medicare typically does not cover healthcare outside the United States. However, Medicare will cover your care if you are inside one of the United States territories: The Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, and Puerto Rico.
There are other limited exceptions for Medicare covering you outside the United States. For example, Medicare will cover your care in Mexico and Canada in one of these scenarios:
- You are traveling through Canada without unreasonable delay, and your direct route is to Alaska. If a medical emergency occurs inside Canada and a Canadian hospital is closer than an American hospital, you can go to the Canadian hospital to treat your condition.
- You live in the United States and have a medical emergency, and a foreign hospital is closer than an American; you can go to a foreign hospital to treat your condition.
- You live in the United States, and a foreign hospital is closer to your home than a United States hospital; you can go there to treat your condition, whether it’s a medical emergency or not.
Remember, Medicare only covers medically necessary services in the above circumstances. So do not go outside the country for cosmetic surgery and expect Medicare to provide coverage.
Medigap
Medigap plans, also known as a Medicare Supplement, are sold by private health insurance carriers. There are ten Medigap plans on the market, and each plan provides a different set of benefits.
Vacation inside the United States
Similar to Medicare, a Medigap plan does not have a network. Medigap plans are secondary to Medicare. If a doctor accepts Medicare, they must accept your Medigap plan, no matter the plan or carrier you have. Therefore, you can visit any doctor in the United States that accepts Medicare and use your Medigap plan as secondary coverage.
A Medigap plan is an ideal plan for someone who vacations in the United States frequently.
Vacation outside the United States
Among the ten Medigap plans, six of the plans provide a foreign coverage benefit. Medigap Plans C, D, F, G, M, and N have a lifetime benefit of $50,000 and a $250 deductible. If you are outside the country and receive medically necessary healthcare, you will pay the deductible first, and then Medicare will pay 80% of the remaining costs.
The foreign coverage benefit has limitations, though. You will only receive coverage if you use the benefit within the first 60 days of your vacation. Therefore, if you have a medical emergency on day 70, your Medigap plan will not pay. Take note that the $50,000 is a lifetime benefit. Therefore, if you go outside the country and have expensive emergency surgery, that $50,000 benefit can go quickly.
Medicare Advantage
Private health insurance carriers also sell Medicare Advantage plans. However, Medicare Advantage plans work very differently than Medigap and traditional Medicare. When you enroll in a Medicare Advantage plan, you will receive your Part A, Part B, and Part D benefits through that carrier, and you will abide by their cost-sharing and network rules.
Vacation inside the United States
Unlike Medigap plans, Medicare Advantage plans have a network of providers. Therefore, making it a little bit more difficult to travel with. The two most common Medicare Advantage plans are HMO and PPO plans.
HMO plans are stricter than PPO plans, as you can only visit doctors within your network. The only exception of going outside the network is in the case of an emergency. Other than emergencies, you will pay all your medical costs when you go outside the network.
Medicare Advantage PPO plans are more lenient than HMO plans, as you can go outside your network for healthcare. However, your cost-sharing amount will likely be more costly than if you were in-network. If you are interested in a Medicare Advantage plan and plan to vacation often, a PPO plan might be the best option for you.
Vacation outside the United States
Since each Medicare Advantage carriers create your plan’s benefits, there is no definite answer if your plan will cover you while on vacation outside the United States. Many Medicare Advantage plans offer a worldwide emergency coverage benefit, but many factors go into play to know if it will pay out or not.
Analyze your Medicare Advantage plan’s Summary of Benefits to know if you have a worldwide emergency benefit or if you will have any other coverage when traveling internationally.
Medicare Part D
Medicare Part D is solely coverage for prescription medications. You can purchase a Part D plan through a private insurance carrier. These plans follow federal guidelines, but also have their own set of rules.
Vacation inside the United States
Part D drug plans have a network of pharmacies where you can order your medications from. However, you can travel anywhere in the United States and still order and receive your medications. Within your plan’s network, you will have standard and preferred pharmacies, such as Walmart and CVS. Therefore, when you travel to a new state and there is a CVS pharmacy, you can order your prescriptions there at no extra cost. The only requirement is for you to pick up your medications from a pharmacy that participates in your plan.
Vacation outside the United States
When you vacation outside the country, expect to pay 100% of your drug’s cost when visiting a pharmacy. Since Medicare Part D is American drug coverage, a foreign pharmacy does not have to accept it as insurance.
Before you head off for your vacation, notify your pharmacy that you will be traveling outside the United States. Your pharmacy may allow you to have a prescription refill ahead of time.
Conclusion
Preparing for a vacation is always a thrilling time. However, not many people prepare or plan for a medical emergency. Refer back to your Medicare plan’s Summary of Benefits to become more knowledgeable when vacationing with Medicare and know when you will be covered.
