Retirees who love to travel should check their Medicare coverage before hitting the road
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For Covid-vaccinated individuals in the 65-and-over crowd, it may be more tempting to hit the streets (or to heaven) than in nearly a year.
Make sure to consider whether your Medicare plan will travel with you.
While coverage when away from home depends in part on your goal, it also depends on the specifics of your Medicare plan. Whether the care you receive is routine or an emergency result may also play a role.
In other words, it is worth knowing what to expect so that there are no surprises.
What to know
Basic or original Medicare consists of Part A (health insurance) and Part B (outpatient care). Individuals who choose to keep this coverage rather than opting for a benefit plan usually combine it with a standalone prescription drug plan (Part D).
If this is your situation, coverage when traveling in the United States and its territories is fairly straightforward: you can turn to any doctor or hospital that accepts Medicare (most do), be it for routine care or for you Emergency. When you venture beyond US borders, it gets tougher.
“When you travel outside of the US, Medicare only covers you in very limited or infrequent circumstances,” said Danielle Roberts, co-founder of insurance company Boomer Benefits.
If you are traveling outside of the United States, Medicare will only cover you in very limited or infrequent cases.
Co-founder of Boomer Benefits
These exceptions include when you are on a ship in the territorial waters bordering the country – within six hours of a U.S. port – or traveling from state to state, but the nearest hospital for treatment is in a foreign country ( i.e. you are in Canada while traveling to Alaska from the 48 contiguous states.
Note that in light of the ongoing pandemic, the State Department has plenty of advice to travel abroad. In addition, the Centers for Disease Control and Prevention require that all passengers – including citizens – flying to (or returning) to the United States have evidence of a negative Covid test or evidence of a recent recovery from the virus provide.
However, if you are considering another country for a vacation, combining basic Medicare with a supplemental policy – also known as Medigap – can give you some overseas coverage.
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These policies, which are generally standardized across states but differ in cost, provide some coverage for the cost sharing associated with basic Medicare such as medical insurance. B. Copays and Co-Insurances. Some of them also have limited overseas travel coverage, said Elizabeth Gavino, founder of Lewin & Gavino and independent broker and general agent for Medicare plans.
“A member pays a deductible of $ 250 and 20% of the cost of medical treatment, up to a lifetime maximum of $ 50,000,” said Gavino.
Note that this coverage is for emergency medical care and there may be other restrictions according to the Centers for Medicare & Medicaid Services.
For beneficiaries who receive their Medicare benefits – Parts A, B, and usually D – through a benefit plan, it is worth checking to see if you can get emergency cover abroad. And even if you didn’t leave U.S. soil, see what your plan would cover.
While benefit plans are required to cover your emergency care anywhere in the United States, you may be hooked for routine out-of-service care.
“With a traditional HMO plan, you only have emergency coverage when you travel outside of the network,” said Roberts. “With a PPO, you have both emergency coverage and off-network coverage for non-emergencies [but] will pay more for these out network services. “
There are also hybrid plans that may allow limited off-network treatment in certain circumstances, Roberts said.
It is possible for your benefit plan to deregister you if you are outside of the service area for a period of time – usually six months. In this situation, you would switch to Medicare.
Some beneficiaries, regardless of their specific coverage, take out travel health insurance for trips overseas, Gavino said.