Entering retirement sparks diverse visions for each individual, yet for many, the prospect of travel is an integral component. If your intention is to leverage the newfound liberty from the traditional 9-to-5 routine to explore the world, factor this in when enrolling in Medicare and selecting supplementary coverage.
Original Medicare typically excludes coverage for medical treatment beyond the borders of the United States and its territories (including Guam, Puerto Rico, U.S. Virgin Islands, American Samoa, and Northern Mariana Islands). Moreover, Medicare prescription drug plans do not encompass outpatient medications acquired outside the United States.
While there are minimal exceptions where Medicare may contribute to the costs, foreign hospitals are not obligated to submit claims to Medicare. If you meet the criteria for coverage, you may need to submit your detailed bill for reimbursement independently.
Wondering about the countries that accept U.S. Medicare?
Original Medicare coverage outside the United States and its territories is restricted to specific scenarios:
- You experience a medical emergency while in the U.S., but the nearest hospital is outside the United States.
- You reside near the U.S. border, and the closest hospital capable of treating you, whether it’s an emergency or not, is outside the United States.
- You’re on a cruise ship within six hours of a U.S. port.
Apart from these situations, Medicare does not reimburse for healthcare provided outside the United States. Therefore, if you’re on the brink of Medicare enrollment and possess a desire for travel, it is imperative to explore supplemental coverage options that can safeguard you in the event of a medical emergency beyond the United States.
Will Medigap provide coverage while I’m traveling outside the U.S.?
If you’re incorporating a Medigap plan to supplement your Original Medicare, six of the Medigap plan design options offer coverage for medical emergencies beyond the United States. Plans C, D, F, G, M, and N extend coverage for medical emergencies during travel, provided medical care commences within 60 days of departing the United States.
(Plans C and F are no longer available for new Medicare eligibles from 2020 onwards. However, individuals eligible for Medicare before 2020 can retain these plans or apply for enrollment. Older Medigap plans – E, H, I, and J – also cover emergencies outside the United States but are no longer sold. Existing enrollees can continue using them.)
In most states, Medigap plans are solely available without medical underwriting during your initial enrollment period (and very limited special enrollment periods). Therefore, it’s prudent to plan ahead and choose Medigap coverage inclusive of international emergency benefits if travel is on your retirement agenda.
With a Medigap plan covering foreign travel emergencies, the patient is responsible for a $250 deductible plus 20% coinsurance, with a lifetime benefit maximum of $50,000.
Which Medicare Advantage plans include international travel coverage?
Certain Medicare Advantage plans has coverage for medical emergencies occurring during foreign travel. If you’re contemplating Medicare Advantage and intend to travel outside the United States, check with the carrier to confirm coverage for emergency care beyond U.S. borders. Notably, Medigap plans cannot be utilized concurrently with a Medicare Advantage plan.
For individuals with employer-provided retiree health benefits supplementing their Medicare coverage, it’s advisable to inquire about coverage for emergencies during foreign travel.
If you have Medicaid alongside Medicare, be aware that Medicaid does not offer coverage outside the U.S. (or even beyond your home state in most cases).
What other supplemental plans address international travel emergencies?
For added assurance, many Medicare beneficiaries opt to purchase travel medical insurance before embarking on a trip. While travel medical plans are readily available, they often impose coverage limitations for seniors.
Although travel plans frequently provide medical benefit maximums reaching seven figures, this limit is commonly reduced to $50,000 or less for applicants aged 70 and above. Travel medical insurance can be used in conjunction with other health insurance.
Numerous travel medical insurance plans incorporate separate medevac coverage, obtainable as a stand-alone from private carriers. Notably, Medevac return to the United States is not included in the foreign travel emergency coverage provided by Medigap plans. Therefore, beneficiaries with Original Medicare plus Medigap coverage may consider acquiring Medevac coverage before traveling abroad.
Should I maintain Medicare coverage if I retire abroad?
For coverage in your new country, securing private health insurance or participating in the country’s public health plan is essential. If you’re open to returning to the United States for hospital care, access to coverage under Medicare Part A is retained (assuming eligibility for premium-free Part A by meeting the 10-year work requirement in the U.S.).
However, Medicare Part B must be purchased for outpatient coverage, with a 10% premium increase for each year eligible for Part B but not enrolled. Advocacy groups have advocated for portable Medicare coverage for retirees residing overseas, but this provision is not yet in place.
Can I consult a doctor in another state with Medicare?
For Medicare beneficiaries envisioning travel within the U.S., Original Medicare supplemented with a Medigap plan (and a Medicare Part D prescription plan) ensures nationwide coverage. A substantial percentage of U.S. doctors providing Medicare-covered services are participating providers with Original Medicare.
It’s crucial to note that Medicare Part D plans may mandate the use of in-network pharmacies, with some featuring localized networks rather than nationwide options. Before traveling, check with your Part D plan to ascertain whether you need to plan ahead for medication or use a mail-order pharmacy.
While Medicare Advantage plans cover emergency care nationwide, routine care often requires enrollees to utilize a local provider network. Most Medicare Advantage plans stipulate disenrollment from the plan to Original Medicare if you travel outside the plan’s service area for more than six months. If you have an HMO, non-emergency care may not be covered when outside your service area.
Plan in advance
While Original Medicare alone may not provide coverage for most travelers outside the United States, several private coverage alternatives can bridge that gap. No one wishes to encounter a medical emergency while on a trip, but thoughtful planning – both at the initial Medicare enrollment stage and before your journey – can alleviate potential complications wherever your journey leads you.
Ready to start a plan? Call us (971) 233-3637. Our assistance is at no cost to you.