Q: I am planning a trip with friends this Summer. I am new to Medicare. What should I know before I go?
A: A few key factors will make a difference when answering this question. Do you have a Medicare Advantage Plan or Original Medicare (Parts A & B) with a Medigap Plan? Do you plan to travel outside of the United States?
If you have Original Medicare, you can travel anywhere in the U.S. and its territories and get the medical care you need from almost any doctor or hospital. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
Medicare generally doesn’t cover health care while you’re traveling outside the U.S. There are some exceptions.
Do you have a Medicare supplement insurance policy (Medigap) with your original Medicare?
A Medigap policy may offer additional coverage to Original Medicare for health care services or supplies that you get outside the U.S.
Standard Medigap Plans C, D, F, G, M, and N provide foreign travel emergency health care coverage when you travel outside of the U.S.
Plans E, H, I, and J are no longer for sale, but if you bought one before June 1, 2010 you may keep it. All of these plans also provide foreign travel emergency health care coverage when you travel outside the U.S.
Medigap Plans C, D, F, G, H, I, J, M, and N pay 80% of the billed charges for certain medically necessary emergency care outside of the U.S. after you meet a $250 deductible for the year. These Medigap policies cover foreign travel emergency care if it begins during the first 60 days of your trip and if Medicare doesn’t otherwise cover the care.
Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.
Medicare Advantage Plans
If you have a Medicare Advantage Plan, your plan may not cover your care while you travel within the United States unless you need emergency or urgent care. If your plan does allow you to see providers that are outside of your network or area, you will usually need to pay more for the care (except for emergency care). You may also need to follow other plan rules like obtaining prior authorization (except for emergency and urgent care). Contact your plan to see what rules and costs apply when you travel within the United States.
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