Medicare & Travel Insurance: What You Should Know

Most people who are enrolled in Medicare - the largest federal health insurance program - are 65 years old or older. This may be you. And if you are planning to spend your retirement years globetrotting and making the most of your passport, knowing how Medicare will and will not cover you while you are traveling abroad can be critical. This post will help you to answer these questions...

*How well does your Medicare coverage protect you when you are traveling outside the USA?

*How can purchasing travel medical insurance cover you most appropriately?

The most basic parts of Original Medicare coverage - known as Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) and Medicare Part D (prescription drug coverage) - are designed to cover you comprehensively and pay most of your medical expenses when you are physically located in the USA and its territories (Guam, Puerto Rico, US Virgin Islands, American Samoa, and Northern Mariana Islands). Parts A, B, and D are not designed to pay for medical care or medications in a foreign country.

Enrolling in a Medicare Supplement/Medigap plan can provide some comfort when you are traveling outside of the USA, but the limitations and exclusions can leave you exposed. A comprehensive travel insurance plan could effectively close the gap in coverage that Medicare and Medigap policies leave and provide you with much more peace of mind.

Where does Medicare cover me when I am traveling?
Medicare coverage for travelers is limited to health care in the USA. This means in all 50 states, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands. It is possible for Medicare to pay up to 80 percent of the cost of your emergency care outside the USA, but only in a few exceptional situations.

  • If you become ill or injured in the USA, but the nearest adequate hospital to care for you is in another country.
  • If you live in the USA, but the nearest adequate hospital to your home is in another country, regardless of whether it’s an emergency or not.
  • When you are driving through Canada while ONLY on a direct route between Alaska and the continental USA without reasonable delay. *Medicare determines what qualifies as “unreasonable delay”.
  • On a cruise ship, as long as you are no more than six hours sail from a port in the USA.

Unless you have a relevant Medicare Supplement or your situation fits those listed immediately above, basic Medicare coverage/enrollment will not pay for your medical care and emergency treatment while you are traveling outside of the USA. That’s where Medicare Supplements can help with overseas Medicare insurance. However, even the appropriate supplements have their limitations.

Which Medicare Supplements cover me when I am outside of the USA?
Medicare Supplement, or Medigap, policies can be enrolled in as value-added coverage for an extra premium. Some Medicare Supplement/Medigap policies provide coverage outside the USA, but they are primarily designed to protect and cover you in the case of an emergency. For those enrolled in Medicare, there are some ways to ensure that you are insured while traveling outside of the USA, and some work more smoothly than others.

  • Of all of the Medicare Supplement plans, six of the plans soon to be offered provide insurance coverage for foreign travel. These would be Plans C, D, F, G, M, and N, which all offer international coverage for emergency health care if your foreign care begins during the first 60 days after you leave the USA and if Medicare plan doesn’t otherwise cover the services rendered and received.
  • *Note...Plans E, H, I, and J also provide coverage for foreign travel coverage. However, these plans are no longer available for new enrollment. If you are already enrolled in one of these older plans thank you can be grandfathered in and continue to use it as long as you continue to pay your Medicare Supplement premium, along with your Part B premium, as applicable.

Which travel benefits do relevant Medicare Supplement policies include?

  • coverage for any travel emergency that begins during the first 60 days of your trip outside of the USA.
  • a Lifetime maximum benefit of $50,000.
  • a $250 deductible.
  • coverage up to 80% of the invoiced fee/charge for medically necessary emergency care.

Are there limitations to the Medicare Supplement policies?
Medicare Supplement policies do have limitations, including the following:

  • Coverage is limited to emergencies (with a few exceptions).
  • Coverage is limited to treatment beginning during the first 60 days of your trip outside of the USA. If you plan to take lengthier trips you may need to purchase separate travel insurance or apply for an international major medical plan or buy into an insurance plan or the universal care system in the new country in which they are living. (Retirees, Expats, anyone living outside of their home country)
  • Lifetime maximum benefit of $50,000.
  • No Preventive Care coverage when outside of the USA.The Medicare Supplement will cover care if your illness or injury needs emergency care, but it will not pay for you to have your annual physical exam, a routine mammogram, or a routine colonoscopy in a country outside of the USA.

I have a Medicare Advantage plan rather than a standard Medicare plan. Will it cover me while I am traveling outside of the USA?
If you are enrolled in a Medicare Advantage Plan (HMO or PPO) or other Medicare policy, your coverage may include additional benefits for health care treatment and services you receive while outside of the USA. Make sure to check with your plan and carrier before traveling abroad to confirm what is included in your coverage. You can specifically ask whether or not your plan covers “Worldwide Emergency Coverage” benefits.Some general and additional questions to ask your Medicare Supplement and Medicare Advantage carrier, as well as your Medicare insurance agent:

  • What medical services are included in worldwide coverage?
  • Does the Medicare plan(s) I am enrolled in have limitations or restrictions on travel coverage? If so, what are those limitations?
  • What is the amount I am responsible for paying for each service/care received while I am traveling outside of the USA?
  • When does my plan or Medicare carrier need to be informed of the care that was received?
  • What is the maximum benefit or lifetime limit to coverage for services/care received outside of the USA?
  • How are medical claims processed for medical services/care received outside of the USA?

Should I buy a separate Travel Insurance policy?

The appropriate Medicare Supplement/Medigap plan can provide some comfort when you are traveling outside of the USA, but the limitations and exclusions can leave you exposed. A comprehensive travel insurance plan could effectively close the gap in coverage that Medicare and Medigap policies leave and provide you with much more peace of mind.

Some highlights include:

  • Global connections to assist with emergency medical evacuations.
  • $0 deductible options.
  • Coverage for trips more than 60 days in length.
  • Some companies and plans include a global network of contracted and recommended providers.

Types of Travel Insurance

There are two types of plans that may be appropriate for your trip...Travel Medical-only coverage and Trip Protection coverage.

1.Travel Medical-only style plans are known to be reliable, comprehensive plans that should include a global network of contracted doctors and hospitals, direct payment options, Emergency Medical Evacuation coverage, and more. They generally come in one of two forms:

  • Single-trip travel medical plans generally include coverage for trips lasting 1 day to 360 days in length.
  • Annual Multi-trip travel medical plans can include coverage for all trips within a 360-day period, as long as each individual trip is less than a limited amount of days expressed in the policy.

2.Trip Protection style plans are designed to insure the investment of your trip in the case of trip cancellation, delay, or interruption due to illness, injury, or death to the traveler, a traveling companion, and/or an immediate family member not traveling. Most policies can also include:

  • Cancellation and interruption coverage in the event of financial default of a tour operator or airline or a labor strike, unforeseen terror event, unforeseen inclement weather.
  • Baggage and personal effects
  • Coverage for pre-existing conditions can be included based on the timing of your purchase relative to the date of your initial trip payment of any kind.
  • "Cancel for Any Reason" upgrade available on the Preferred plan only (eligibility requirements apply)
  • Coverage for Medical expenses (ask whether or not it is limited to emergencies)
  • Emergency Medical Evacuation

Wanderwell can help with your travel insurance search. Let us know about your travel plans and needs.