A vacation is when you can let your hair down, relax, and not worry about a thing! The last thing you are thinking about is health insurance and how it will cover you while on vacation. When you’re 65 years or older, you likely have Medicare as health insurance. Medicare can be complex when you first enroll. For example, knowing the cost of Medicare and how it will cover you on vacation is not something many become familiar with before they reach Medicare age. If you are on Medicare and about to take a vacation, here is how your insurance works.
How Medicare works on U.S. vacations
Medicare is health insurance that comes from the American government. If you are planning a vacation in the United States, note that Medicare does not have network restrictions. Therefore, you can travel across the United States and use Medicare as insurance, no matter what state or zip code you’re in. But not all physicians accept Medicare. In 2020, 3% of doctors did not accept Medicare.[1] You will want to verify if a doctor accepts Medicare before you schedule your visit.
On top of having access to all U.S. doctors that accept Medicare, you can also use Medicare as insurance in the U.S. territories. Suppose you’re planning a vacation to either Puerto Rico, Guam, Northern Mariana Islands, American Samoa, or the U.S. Virgin Islands. In that case, Medicare will cover you as long as the doctor or facility accepts Medicare as insurance.
Does Medicare cover you outside the country?
Since Medicare is strictly American insurance, Medicare will not cover the care you receive outside the United States. But there are three scenarios where Medicare may cover you outside the country:
- You’re in America when you have a medical emergency, and a hospital outside the country is closer than the nearest U.S. hospital that can treat your injury or illness.
- You live in America, and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat your injury or illness, no matter if it’s an emergency.
- You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs. If a Canadian hospital is closer than the nearest U.S. hospital, you can visit the Canadian hospital for them to treat your injury or illness.
If you have a medical emergency outside of the country and these above scenarios do not apply to you, you will pay the total cost of your medical care.
How does a Medigap plan work while on vacation?
Many Medicare beneficiaries seek a Medigap plan (Medicare Supplement) for its flexible coverage. Medigap plans work alongside Original Medicare and pay as secondary. Since Medicare does not have network restrictions, neither does a Medigap plan. If a doctor accepts Medicare, they must accept a Medigap plan.
Private insurance companies sell ten Medigap plans, and a few include a foreign travel emergency benefit. Medigap Plans C, D, F, G, M, and N, offer a foreign travel benefit. Let’s discuss what this benefit entails!
When you purchase one of the Medigap plans mentioned above, you will have coverage for the first 60 days of your vacation in the case of a medical emergency outside of the U.S. If a medical emergency were to occur during the first 60 days of your trip, you will first pay a $250 deductible. After you pay the deductible, your Medigap plan will cover 80% of the emergency costs.
There is a catch! The foreign emergency travel benefit is a lifetime benefit of $50,000. So, once your plan pays out $50,000, your plan will no longer cover you outside the country. So, if you were to receive $50,000 of emergency services overseas, your benefit would be used up!
Vacationing with a Medicare Advantage plan
Private insurance carriers sell Medicare Advantage plans as an alternative to Medicare and Medigap plans. When you enroll in an Advantage plan, you will receive all your healthcare benefits from the insurance carrier and no longer the government. The carrier will set up a network of doctors and pharmacies where you can seek your healthcare. They will also create your cost-sharing amounts for approved services throughout the year.
Depending on the Advantage plan you have, it might not be easy to get covered while on vacation. There are two main types of Advantage plans. When you have an HMO Advantage plan, you can only visit the doctors in your network. You will only be covered outside the network in the case of an emergency.
PPO Advantage plans are more flexible, as you can go outside the network for your healthcare. But, your services will cost more out-of-network compared to in-network care. With that said, not all doctors accept Medicare Advantage plans. So, verifying with the doctor’s office that they accept your specific plan before you visit would be best. If not, you will be responsible for the whole bill.
Now, let’s say you are on vacation outside the country, and a medical emergency occurs. In this case, you will want to keep all itemized bills to submit them to your plan for reimbursement once you make it back to the states.
Wrapping up
Vacation is when you want to be the least stress-free, but you still want to be prepared for a medical emergency. Medicare will cover you when you vacation inside the U.S., but it gets trickier once you leave the country. For more information on traveling with Medicare, visit Medicare.gov.
[1] https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/