Traveling is an exciting adventure that allows us to explore new places and create lasting memories. For individuals who rely on Medicare for their healthcare needs, it’s essential to understand how their coverage extends beyond their local area. In this article, we will explore the question, “Will Medicare cover my procedure?” and look into whether Medicare will cover you when you travel, ensuring you have the necessary information to enjoy your journeys worry-free.
Coverage is limited outside the U.S.
In most situations, Medicare won’t pay for or cover any health services that are received outside the U.S. “Outside the U.S.” means anywhere outside of the 50 states of the U.S., Puerto Rico, District of Columbia, US Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. There are a few instances where you could have coverage for your services received when out of the country, but it would need to be at least one of three circumstances.
- You have a medical emergency in the U.S., but a foreign hospital is closer than the nearest U.S. hospital that you could receive treatment at.
- You live in the U.S., but the closest hospital that can treat you is a foreign hospital, whether you have a medical emergency or not.
- You have a medical emergency while traveling through Canada without reasonable delay through the most direct route between Alaska and another state, and a Canadian hospital is closer than the nearest U.S. hospital that could provide treatment. Medicare would be the deciding factor and would determine what situations qualify as “without reasonable delay.”
It’s important to note that routine healthcare services obtained during international travel, such as check-ups or non-emergency procedures, are typically not covered by Medicare. Therefore, it’s crucial to explore other options to ensure you have adequate medical coverage when traveling abroad.
Medicare Part A and Part B
Medicare, a federal health insurance program, is primarily designed for individuals aged 65 and older. It consists of different parts, each covering specific healthcare services. To determine whether Medicare will cover you when traveling, we need to examine the different parts of Medicare and its provisions.
Medicare Part A covers hospital room and board when someone is admitted as an inpatient to the hospital, skilled nursing facility care, and some home healthcare services. As long as you receive medically necessary care from a Medicare-certified provider within the United States, including its territories, Part A will cover your expenses. However, outside of the three specific circumstances listed above, Medicare Part A would not cover your hospital costs when you’re outside the country.
Medicare Part B covers outpatient medical services, like doctor visits, diagnostic tests and services, and durable medical equipment (DME). The coverage under Part B may only cover your services outside the U.S. when you’re in the three circumstances listed above.
Medicare Part C: Medicare Advantage Plans
Medicare Advantage plans, also known as Medicare Part C, offer an alternative to Original Medicare. These plans are offered by Medicare approved private insurance companies and often provide additional coverage beyond what Original Medicare offers.
If you have a Medicare Advantage plan, it may provide coverage for emergency care received outside the United States. However, the extent of coverage may vary depending on your specific plan. You can review your plan’s details or contact your insurance provider to understand your coverage while traveling internationally.
Medicare Part D: Prescription Drug Coverage
Medicare Part D provides coverage for prescription drugs. Like Medicare Parts A and B, Part D coverage is primarily limited to the United States and its territories. However, some Medicare Advantage plans with prescription drug coverage may offer limited coverage for medications obtained abroad. Checking with your plan provider is essential to understand the scope of coverage for prescription drugs while traveling.
Medigap plan coverage
Medigap plans, also known as Medicare Supplement Insurance, help cover the gaps in Original Medicare. While Medigap plans do not provide coverage for healthcare services obtained outside the United States, they may cover certain emergency services during the first 60 days of international travel after a $250 deductible. There is also a lifetime maximum benefit amount of $50,000. Reviewing your Medigap plan’s details can clarify the extent of coverage available while traveling.
Additional Options for Travelers
Given the limitations of Medicare coverage when traveling internationally, it’s essential to consider additional options to ensure you are protected. Purchasing travel health insurance is a wise choice for individuals who plan to travel extensively or for extended periods outside the United States. Travel health insurance policies can provide coverage for emergency medical expenses, medical evacuation, and other essential services. These policies are available through private insurance companies and offer additional peace of mind when traveling abroad.
While Medicare coverage is limited when it comes to international travel, there are ways to protect yourself and mitigate the risks. By considering supplementary insurance and travel insurance options and researching the healthcare landscape of your destination, you can make informed choices that prioritize your well-being when venturing beyond U.S. borders.