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If you’re going to travel, check your Medicare coverage first

Here’s what’s covered with Original Medicare and Medicare Advantage when you’re on the road

Medicare typically doesn’t cover health care outside the U.S.

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This article is reprinted by permission from NerdWallet

More than 44 million Americans 65 and older have gotten at least one dose of the COVID-19 vaccine, and over 36 million are fully vaccinated, according to recent data from the Centers for Disease Control and Prevention. And with that protection in hand, many are finding that the open road is again calling.

A survey earlier this year found that people 56 years and older are the most eager to get back to traveling, with nearly 9 out of 10 saying they’re more ready to travel this year than last, according to the travel site Virtuoso. As well, 82% said they were waiting until they were vaccinated before beginning a trip, and because this age group was prioritized for vaccine delivery, many now have a full vaccine dose on board.

Before you take off, however, be sure to confirm your Medicare coverage, since some plans may not provide coverage when you’re away from home.

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If you have Original Medicare

If you have Original Medicare and you’re traveling within the 50 states, Washington, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa or the Northern Mariana Islands, you’re covered for care from any provider that accepts Medicare. Outside the U.S., Medicare typically doesn’t cover health care unless:

  • A medical emergency occurs in the U.S., but a foreign hospital is closer than the nearest U.S. hospital that can help.
  • A medical emergency occurs while you’re traveling between Alaska and another U.S. state by way of Canada, and the Canadian hospital is closer than the nearest U.S. hospital that can help.
  • You live in the U.S., and a foreign hospital is closer than the nearest U.S. hospital that can help. (In this case, it doesn’t have to be an emergency.)
  • You receive medically necessary health care on a ship within territorial waters near the U.S. (But if the ship is more than six hours from a U.S. port, Medicare won’t cover it.)

Under all circumstances, Medicare drug plans won’t cover prescription drugs purchased outside the U.S.

Nerd tip: If your health care services outside the U.S. are covered, you’ll be responsible for your normal Medicare Part A and Part B deductibles, along with any copayment or coinsurance. Foreign hospitals won’t submit a claim to Medicare for you — you’ll need to get itemized bills and submit them.

Also see: Travel in 2021: Can we expect good deals, or will hotel and flight prices skyrocket?

If you have Medicare Advantage

Medicare Advantage plans, or Medicare Part C plans, are required to provide the same coverage that Original Medicare offers, so everything above is also true for these plans. You’re covered for emergency medical care if you’re traveling in the U.S. Beyond that, your coverage depends on your service area and the type of plan.

Medicare Advantage plans include a network of providers, and some plans (such as HMOs) are more restrictive about out-of-network services, so you’ll pay more for out-of-network care. Other plans (such as PPOs or Private Fee-for-Service plans) are more flexible, although you’ll probably still pay more for out-of-network health care.

If you travel regularly and for long periods — maybe you winter in a sunny spot each year or you own a ski condo in the mountains — some Medicare Advantage plans offer “visitor” or “travel” programs for coverage while you’re away.

UnitedHealthcare, UNH, +0.65% for instance, offers a Passport feature on some plans that allows members to receive care from participating providers away from home for up to nine consecutive months.

This is something to consider, since if a Medicare Advantage enrollee remains outside their plan’s service area for more than six months, the plan may involuntarily disenroll the enrollee, according to a spokesperson from the Centers for Medicare & Medicaid Services.

Some Medicare Advantage plans may also offer emergency coverage for foreign travel. Call your plan provider for more information about what’s covered.

How to cover yourself when traveling

For peace of mind, there are a few ways you can make sure you’re covered for medical care when you’re out of your policy’s service area:

Get Medigap coverage

If you have Original Medicare (or switch back to it), you may be able to purchase a Medicare Supplement Plan (or Medigap plan) that covers foreign travel emergency health care. Standard Medigap Plans C, D, F, G, M and N cover foreign travel emergency health care. Plans E, H, I and J also provide this coverage, but they’re no longer for sale. (If you bought one of these plans before June 1, 2010, you have this coverage.)

Also see: A vacation this year might be more stress than it’s worth

Under Medigap, you’re covered for foreign travel emergency care if it starts during the first 60 days of your trip. The plans pay 80% of billed charges after you meet a $250 deductible, and this coverage has a lifetime limit of $50,000.

Get travel insurance

Travel medical insurance acts like health insurance when you’re away from home, although it generally doesn’t cover routine medical care. (Need a checkup? Get that at home.) This is a policy you’d use if you broke a limb, needed emergency dentistry or required a medical evacuation, for example. If you’re traveling abroad, be sure to buy a policy that covers you internationally.

Get a Medicare Advantage plan with a travel benefit

Some travel benefits may come with a Medicare Advantage plan, but others are “opt-in” benefits, and the price may depend on where you’re traveling. Many aren’t intended to cover shorter vacations, so make sure you understand the terms.

Got questions about Medicare and travel? Contact Medicare at Medicare.gov or 800-MEDICARE (800-633-4227, TTY: 877-486-2048).

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Kate Ashford writes for NerdWallet. Email: [email protected] Twitter: @kateashford.

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