Many seniors begin planning their retirement vacation before they even retire. According to an RBC Wealth Management poll, nearly 63% of senior Americans say travel is an important retirement goal. Seniors typically want to travel somewhere they have never been before, which could be a U.S. state or a different country across the world. Although vacations are supposed to be a great time filled with new memories, accidents happen, and a medical emergency is inevitable. So, if you are asking yourself, “What does Medicare cover when I’m on vacation,” keep reading to find out.
Vacationing with Original Medicare
Medicare is American health insurance for seniors aged 65 and older and for people who qualify earlier due to disability. Medicare has two parts: Part A covering inpatient hospital services and Part B, which covers outpatient services.
Travel within the United States
Original Medicare does not have a network of providers you have to seek your care from. You can visit any doctor or hospital in the United States and use your Medicare insurance if the doctor or facility is willing to bill Medicare.
This also applies to America’s territories:
- S. Virgin Islands
- Puerto Rico
- American Samoa
- The Northern Mariana Islands
If you vacation in any of the above U.S. territories, Medicare will cover your healthcare if the doctor takes Medicare. However, if you travel outside the U.S. and its territories, there is a chance Medicare will not cover you.
Medicare typically does not cover healthcare services outside of the United States. However, there are limited exceptions on when Medicare will cover you in emergencies:
- You are driving a direct route to Alaska and driving through Canada. Medicare would likely cover your care in Canada if a medical emergency were to occur and a Canadian hospital is closer than an American one.
- Suppose you are in the United States and a medical emergency occurs. In that case, you can visit a foreign hospital to treat your illness or injury when the foreign hospital is closer than an American one.
- You live in the United States, and a foreign hospital is closer to your home than a U.S. hospital to treat your health conditions – regardless of if it’s an emergency.
- You are on a cruise ship that is no more than six hours away from a U.S. port and must be treated for a health condition. If you are more than six hours away, Medicare won’t provide coverage.
In the above situations, Medicare would only cover the Medicare-approved amount for your care. Medicare only covers medically necessary services, as well. So, if you were to travel to a different country for cosmetic surgery, Medicare would not cover the costs.
How Medigap plans work on vacation
Medigap plans are sold by private insurance companies and are 100% optional. A Medigap plan works alongside Original Medicare and will help pick up costs Medicare does not cover.
Travel within the United States
Since Medigap plans pair with Medicare, you can use a Medigap plan when you are traveling the United States. If a doctor or hospital accepts Original Medicare, they will take your Medigap plan, no matter the plan or carrier.
A Medigap plan could be ideal coverage for you if you plan on taking many vacations throughout your retirement.
Medigap plans only payout when Medicare covers their share first. So, since Medicare does not cover healthcare services outside the U.S. and its territories, neither would a Medigap plan. However, there are a few Medigap plans on the market that have a foreign travel emergency benefit.
Medigap Plans C, D, F, G, M, and N provide foreign travel emergency coverage when traveling abroad. If a medical emergency occurs in a different country, you will first pay a $250 deductible. After you pay the $250 deductible, your Medigap plan would cover 80% of your medical costs.
The Medigap plans mentioned above will only provide emergency coverage. So, you cannot visit a different country and receive a non-emergency surgery and expect your Medigap plan to payout. These emergency benefits also have a lifetime limit, which is $50,000. So, once the plan covers $50,000, you will no longer have this foreign travel emergency benefit.
Vacationing with Medicare Advantage
Private insurance companies sell Medicare Advantage plans, but these plans do not work like Medigap plans. When you purchase a Medicare Advantage plan, you will receive your Part A, Part B, and Part D benefits through the carrier instead of the government.
Travel within the United States
Medicare Advantage plans have a network of doctors and pharmacies you receive your healthcare services from. HMO and PPO Medicare Advantage plans are the most purchased Medicare Advantage plans.
HMO Medicare Advantage plans have a service area. Therefore, you can only receive your healthcare services within that network unless it’s an emergency. For example, if you live in Texas and take a vacation in Florida, you will pay 100% of your medical costs in Florida unless it was an emergency.
Medicare Advantage PPO plans are more flexible, as you can receive healthcare services in and out of network, regardless of if it’s an emergency or not. However, the costs for your healthcare services out-of-network will cost more than if you were in-network.
There are thousands of Medicare Advantage plans across the country, and each one has a different set of benefits. Therefore, you would need to check your plan’s Summary of Benefits to know if your plan would cover you in emergencies internationally.
Keep in mind, if you have a Medicare Advantage plan and take a vacation outside your service area for more than six months, you will likely be dis-enrolled from your plan. In this case, you would return to Original Medicare and could enroll in a different Medicare Advantage plan during an election period once you return home.
Original Medicare will provide healthcare coverage for medically necessary services whenever you travel within the United States and its territories, and the doctor accepts Medicare. If you plan on vacationing during retirement and aren’t sure which plan is the right one for you, you can reach out to a Medicare expert representing both types of plans and representing multiple companies. That way, you can be sure you are enrolling in the most cost-effective plan that meets your healthcare needs.
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