Retirees traveling check Medicare coverage to avoid costly surprises

If you’re a retiree on Medicare and feel the itch to travel, be sure you know whether your insurance plan can go with you.

Whether you want to hit the road for a U.S.-based trip or head overseas, coverage at your destination hinges on the specifics of your Medicare plan. The nature of your care — routine or emergency — also may play a role.

Just over a quarter of Americans (28%) say they’ve fallen ill or been hurt while vacationing, according to a recent study from personal finance website ValuePenguin. Among that group, bacterial or food-borne illnesses were most common (33%), followed by respiratory illnesses (28%) and bodily injuries (24%). Additionally, 12% of them said they contracted Covid while on vacation.

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In other words, it’s worth knowing what to expect from your Medicare coverage so there are no surprises if you need to visit a doctor or other health-care provider while away from home.

Basic Medicare is Part A (hospital coverage) and Part B (outpatient care). Beneficiaries who choose to stick with that coverage — instead of going with an Advantage Plan — typically pair it with a stand-alone prescription-drug plan (Part D).

If this is your situation, coverage while traveling in the U.S. and its territories is fairly straightforward: You can go to any doctor or hospital that accepts Medicare (most do), whether for routine care or an emergency. It’s when you venture beyond U.S. borders that things get trickier.

Basic Medicare does not cover travel outside the U.S. except in limited circumstances. Those exceptions include when you’re on a ship within the territorial waters adjoining the country — within six hours of a U.S. port — or you’re traveling from state to state but the closest hospital to treat you is in a foreign country (i.e., you’re in Canada while heading to Alaska from the 48 contiguous states).

Also be aware that Part D plans won’t cover medications filled outside the U.S., said Elizabeth Gavino,  founder of Lewin & Gavino and an independent broker and general agent for Medicare plans.

“Be sure to bring enough medication with you,” she said.

If you have a supplement policy — aka “Medigap” — alongside basic Medicare, it could give you some coverage abroad.

Those policies, which are generally standardized across states, offer some coverage for the cost-sharing that goes with basic Medicare, such as copays and co-insurance. 

Some Medigap policies include some coverage outside the U.S. Plans C, D, F, G, M and N have up to $50,000 lifetime maximum benefits, with the beneficiary paying 20% of costs after a $250 deductible, and you are covered only for the first 60 days of your trip. 

This coverage applies only to medically necessary emergency care and there may be other restrictions, according to the Centers for Medicare & Medicaid Services.

Some older Medigap policies that beneficiaries still have — E, H, I and J — also come with travel coverage abroad, Gavino said.

Be aware that Medigap plans come with their own rules for enrolling, and policies can be pricey depending on where you live, your age and other factors. For example, for a 65-year-old female, the least expensive Plan G policy in Dallas runs just under $100 monthly compared with about $278 in New York, according to the American Association for Medicare Supplement Insurance.

For beneficiaries who get their Medicare benefits — Parts A, B and typically D — through an Advantage Plan, it’s worth checking to see if your plan is among those that include coverage for emergencies abroad.

And even if you aren’t planning to leave U.S. soil, you should see what your plan would cover. While Advantage Plans are required to cover your emergency care anywhere in the U.S., you may be on the hook for routine care outside of their service area. 

“With a traditional HMO plan, when you travel outside the network, you have emergency coverage only,” said Danielle Roberts, co-founder of insurance firm Boomer Benefits.

“With a PPO, you have both coverage for emergencies and out-of-network coverage for non-emergencies [but] will pay more for these out of network services,” Roberts said.

There also are hybrid plans that may allow limited out-of-network treatment under certain circumstances, she said.

It’s possible that your Advantage Plan will disenroll you if you remain outside of their service area for a certain length of time — typically six months. In that situation, you’d be switched to basic Medicare.

If you do have some coverage overseas, you may need to pay out of pocket and be reimbursed, Gavino said.

“Foreign hospitals will not file a Medicare claim for you,” Gavino said. “Get an itemized bill to submit for reimbursement from your plan.”

Additionally, depending on your overseas coverage and your level of comfortability with it, you may want to purchase a travel medical plan.

Such options are priced based on factors including your age, and the length of the coverage. You can get coverage for a single trip of a couple weeks or several months, or get a multi-trip policy, which could cover a longer period.

The plans typically come with a deductible — say, $250 or more — and coverage could range from about $50,000 in maximum benefits to upwards of $1 million or more. Policies average between $40 and $80, although higher coverage limits and longer coverage terms typically increase the cost, according to insurance company Travelers.

“Be sure to find out if the plan covers pre-existing conditions and Covid,” Gavino said.