You have a few options when it comes to your Medicare coverage. You can get coverage through Original Medicare Part A and Part B and enroll in a Medigap plan to pay after Part A and Part B. Alternatively, , you can enroll in a Medicare Advantage plan for your Part A, Part B, and Part D coverage.
How you get Medicare coverage will dictate how you’re covered while you travel. If you plan to travel often in retirement, you need to know which coverage is best suited to your needs.
Original Medicare (Part A and Part B) is administered by the Social Security Administration (SSA). You must enroll in both of these parts in order to enroll in a Medigap or Medicare Advantage plan. However, if you only have Part A and Part B and no supplemental coverage, this is how Original Medicare will cover you while you travel.
Domestic travel with Original Medicare
Original Medicare does not have a network, so you can go to any doctor or hospital in the country as long as they accept Medicare. Part A and Part B coverage is exactly the same no matter where you travel in the U.S. Original Medicare will also cover you in these U.S. territories: American Samoa, Guam, the Northern Marina Islands, Puerto Rico, and the U.S. Virgin Islands.
Foreign travel with Original Medicare
Since Original Medicare is an American program, it does not cover you outside the country. However, it may cover you in emergency cases under certain circumstances. For example, if you’re traveling straight through Canada from or to Alaska, without unreasonable delay and an emergency occurs, Original Medicare may cover you at a Canadian hospital.
Original Medicare may also cover an emergency hospital stay in a foreign country if you are traveling near the U.S. border when the emergency occurs, and the foreign hospital is closer than any American hospital. The same rules apply if you live near the border, and an emergency occurs.
Medigap plans are optional and pay secondary to Original Medicare. Therefore, if Original Medicare approves a claim, so must your Medigap plan. There are various Medigap plan options, each of which covers a different combination of Part A and Part B expenses. Some include additional benefits as well.
Domestic travel with Medigap plans
As mentioned above, Medigap plans pay secondary to Original Medicare. Therefore, you can go to any doctor or hospital in the country that accepts Original Medicare and your Medigap plan will cover you. Medigap plans, like Original Medicare, have no network. If you have a Medigap plan, you only need to ask doctors if they accept Original Medicare.
If a doctor accepts Original Medicare, he or she is required to accept your Medigap plan.
Foreign travel with Medigap plans
If Original Medicare covers you at a foreign hospital, so will Medigap. However, Original Medicare only covers emergencies in the three circumstances mentioned above. Therefore, if you are on vacation in Spain, Original Medicare won’t cover you, regardless of whether there is an emergency or not.
Some Medigap plans include an additional foreign travel benefit. Medigap plans C*, D, F*, G, M, and N all cover 80% of foreign travel emergencies that occur outside the circumstances mentioned above. This benefit has a $50,000lifetime limit and a $250 deductible. You can also only access this benefit within the first 60 days you’re outside the United States.
Medicare Advantage plans
Medicare Advantage plans, also called Part C plans, are also optional, but you can’t have both a Medigap and Medicare Advantage plan – it’s one or the other. When you have a Medicare Advantage plan, your insurance carrier will determine your coverage and costs, not Original Medicare. However, Medicare Advantage plans are required to cover you at least as well as Original Medicare.
Domestic travel with Medicare Advantage plans
Unlike Original Medicare and Medigap plans, most Medicare Advantage plans have networks. Depending on the type of Medicare Advantage network you have, you may be limited to only seeing doctors within the network. Traveling outside the network could mean you’re responsible for 100% of the cost.
For example, if you have a Medicare Advantage HMO plan and see a doctor who isn’t in-network with your plan, your plan won’t cover you unless it’s an emergency. However, if you have a Medicare Advantage PPO plan and see a doctor who isn’t in-network with your plan, your plan may cover you but with a greater cost-sharing expense. Though, the doctor must be willing to bill out of network.
Foreign travel with Medicare Advantage plans
Like most Medigap plans, most Medicare Advantage plans have a worldwide emergency benefit. Your copays and deductible for this benefit will depend on the plan you’re enrolled in. However, foreign hospitals are not required to bill your Medigap or Medicare Advantage plan. Therefore, you may have to pay out of pocket for your services and then file for reimbursement later.
Which plan is best for frequent travelers?
Now that you know how each type of coverage covers you while traveling, you may be able to tell which type of plan is the safer option if you’re a frequent traveler. Medigap plans travel better than Medicare Advantage plans throughout the states. However, if you plan on traveling outside the states, you may consider purchasing a short-term travel health insurance policy, regardless of the type of Medicare plan you have.