Once you reach Medicare age and begin your benefits, it is important to know exactly how your coverage will work. If you are an avid traveler, you may not realize that your coverage may change once you enter a different county, state, or country. Depending on the plan you choose, your Medicare coverage outside of the country might be limited. Whether you are in another country for work, family, or fun, you will want to look at the details of your Medicare plan to know how your coverage will work in the case of a medical incident.
Original Medicare in another country
Original Medicare consists of Part A and Part B. Part A is hospital coverage when admitted as an inpatient. Part A helps cover a semi-private room and three daily meals. Other Part A benefits include skilled nursing facility, hospice care, lab services, and more. Part B is outpatient medical coverage such as doctor visits, surgeries, tests, durable medical equipment, etc. Outpatient services that are considered medically necessary will fall under Part B.
Original Medicare covers you anywhere in the nation if the provider accepts Medicare. You also have coverage in the U.S territories. However, when you are outside of the United States, Medicare will generally not cover you. There can be some exceptions when you are traveling on a cruise ship while in territorial waters or en route to the U.S, and the closest hospital is in another country. However, you may want to plan ahead and not assume coverage outside of the country with Original Medicare.
Medicare Advantage plan coverage outside the U.S.
If you choose to receive your Medicare benefits through a Medicare Advantage plan, you will have worldwide emergency coverage. Typically, the foreign hospital will bill your plan when you present your card. However, there is a chance the hospital will not bill your plan, so it is important to keep all receipts for your record just in case. You want to remember this coverage is for unexpected medical emergencies.
Medigap plans and foreign travel
Several Medigap plans include foreign travel. Plans C, D, F, G, and N will cover 80% of a foreign travel emergency. There is a $250 deductible that needs to be met first before the plan will start to cover the medical procedure. The lifetime emergency benefit is capped at $50,000, which can quickly add up with emergencies. The medical incident does need to happen within the first 60 days of travel for the plan to provide coverage.
Prescription drug coverage and traveling outside the country
Medicare beneficiaries can enroll in a Part D plan for prescription coverage. The prescription plan is specific to your zip code and county. However, you can travel within the country and have coverage when you fill a prescription at a pharmacy. There is limited coverage near the U.S. border. Otherwise, there is no Part D coverage outside of the country. This means you will pay for prescriptions completely out-of-pocket when you are not in the United States. Before you leave the country for your trip, you may want to get your prescriptions filled if you can.
When you are creating your checklist and itinerary for your vacation outside of the U.S., you will want to make sure you know how your Medicare insurance will cover you. You can check your plan’s Summary of Benefits or Outline of Coverage for more foreign travel coverage information. Depending on the plan you have, your coverage can be limited to emergency coverage only. You may want to look into traveler insurance for any medical situations that are not considered an emergency.