If you plan to travel outside the United States, you’re probably wondering if Medicare Advantage will cover medical services.
The answer depends on whether you’re seeking routine health care services, or you need emergency services. In most situations, Medicare Advantage does not cover health care that is not a medical emergency, but there are exceptions.
This article reveals when Medicare Advantage plans cover travel outside of the U.S. and how to ensure you have health coverage when you’re out of the country.
About Medicare Advantage Plans
As a reminder, Medicare Advantage is referred to as Medicare Part C, which provides the benefits of Original Medicare (Medicare Parts A and B) with additional coverage for health care services like routine dental and vision care, hearing care, prescription drugs, and more.
Medicare Advantage plans are sold by private insurance companies and require you to be eligible to enroll in original Medicare before seeking coverage.
As a general rule, Medicare Advantage plans do not cover routine medical treatments received outside the U.S. However, if a medical emergency occurs and you are in need of emergency care, Medicare Advantage will typically provide coverage.
How Medicare Defines International Traveling
International travel, as defined by Medicare, is any traveling outside the U.S. Though this might seem like common sense, there are some regions that are not classified as foreign travel, including:
- Puerto Rico
- U.S. Virgin Islands
- American Samoa
- Northern Mariana Islands
In a nutshell, you can travel outside the U.S. according to the predefined 50 states, but still be in U.S. territory.
When Will Medicare Advantage Plans Cover Foreign Travel?
Medicare benefits are available in a foreign country in the following circumstances:
- You become ill while traveling abroad, and the nearest hospital is a foreign hospital.
- You become ill in Canada while traveling between Alaska and another U.S. state, and a Canadian hospital is closer than a U.S. hospital.
Note that Medicare coverage isn’t available for leisurely travel between these two regions. Medicare stipulates that travel through Canada must meet the requirement of “without unreasonable delay” to provide medical coverage. This typically means you are on a direct route between states.
- You require emergency care on a cruise ship, and the nearest U.S. port is more than six hours away.
- You live in the U.S., but a foreign hospital is closer than a U.S. hospital to your official residence. You may receive covered medical care for both routine and emergency care.
Even in the above exceptions, Medicare pays only for services that are a part of your Medicare Advantage plan. You are also responsible for the cost of any coinsurance, copayments, and deductibles that are part of your health insurance plan.
Before traveling abroad, we recommend checking with your private insurance plan or plan provider to find out the scope of your covered services. Depending on your specific plan, you may need to pay your international medical bills upfront and seek reimbursement when you return home.
How Moving Abroad Affects Medicare Coverage
If you’re considering retiring outside the U.S., you can still enroll in Medicare Part A (hospital insurance) and Medicare Part B medical insurance, but you’ll likely pay a higher premium. Further, you must still be a U.S. citizen and ineligible for Social Security benefits to qualify for coverage.
Remember, to be eligible to enroll in a Medicare Advantage plan, you must already be enrolled in Original Medicare (Parts A and B).
If you plan on traveling for extended periods of time, you could be at risk of losing Medicare coverage. The reason is that Medicare Advantage plans have specific service areas. Traveling outside of your coverage area for more than six months could result in disenrollment.
Whether you are engaged in foreign or domestic travel, be sure to check your plan’s provisions. There’s nothing worse than losing prescription drug coverage or not having access to your preferred health care providers because of a simple oversight.
If you do get disenrolled from your Medicare Advantage plan due to extended travel, you’ll receive automatic enrollment in Original Medicare. You can re-enroll in a Medicare Advantage plan during the next special enrollment period.
How to Get Medical Coverage When Traveling Overseas
Even if your Medicare Advantage plan does not cover foreign travel, you still have options.
- Purchase Travel Insurance: You can get travel health insurance through an insurance agent before your trip to cover any medical treatment you might need while you’re away from home.
Though travel health insurance isn’t designed for routine care, it can be used for pre-existing and chronic health conditions. Even with a Medicare Advantage plan, having travel insurance can provide you with peace of mind because you’ll know that you can get access to medical care and prescription drugs without paying 100% out of pocket.
- Purchase Medicare Supplement Insurance: Also called Medigap, this type of Medicare supplements the coverage provided by Original Medicare. For example, Medigap plans can pay for some of the costs related to deductibles, coinsurance, copayments, and other expenses.
In terms of foreign travel, Medicare Supplement insurance covers hospital care and other urgent care services up to a lifetime limit of $50,000.
Before you embark on an overseas journey, make sure you know whether Medicare will provide benefits if you find yourself needing medical attention. Depending on your specific Medicare Advantage plan, you could have up to 80% of your medical expenses covered if they are deemed urgent.
When Medicare Advantage does cover urgent care, there may be additional requirements, including the appropriate window for receiving care. There is also likely to be a deductible and a lifetime maximum benefit value. A Medicare Advantage specialist can connect you with insurance providers that cover international travel.
The question, “Does Medicare cover international travel?” is one we field often, especially as retired Medicare beneficiaries are enjoying the freedom that comes with their golden years.
Our Medicare Advantage specialists are happy to answer any questions you have about Medicare, including shedding light on the difference between Medicare and Medicaid.