Around two-thirds (63%) of Americans ages 50 years and older say travel is an important retirement goal for them. This statistic makes sense considering these seniors have worked most of their lives, so they want to celebrate by visiting the beach or mountains. If this applies to you, you might have your bags already packed and ready for take-off! As eager as you are to go on vacation, you might want to prepare for the worst, such as having a medical emergency while on vacation. If you have Medicare for health insurance, you might be thinking, “Will Medicare cover me on vacation?” Keep reading to learn how Medicare will cover you while vacationing in the United States and a foreign country.
Medicare coverage while on vacation in the United States
Original Medicare
Medicare is American health insurance for those ages 65 years and older and for others who qualify due to disability. Since this type of health insurance is federal insurance, you can access medical care across the United States and are not restricted to a network. According to the Kaiser Family Foundation (KFF), about 93% of doctors accept Medicare. If you are on vacation in the United States and the doctor or hospital accepts Medicare, you can receive care there without a problem.
If you are traveling among the United States territories – Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands – Medicare will likely cover your medical care as well. But not all doctors and hospitals are required to accept Medicare. So, before you make your appointment, call ahead to see if they take Medicare for insurance.
Medigap (Medicare Supplement)
Medigap plans, also known as Medicare Supplement, are secondary insurance to Medicare. Therefore, when a doctor takes Medicare for insurance, they will also accept your Medigap plan. Medigap plans do not have service areas, so no matter which type of Medigap plan or carrier you have, the doctor must take your Medigap plan if they take Medicare.
Medigap plans are ideal secondary coverage if you often plan on vacationing throughout the United States.
Medicare Advantage (Part C)
Medicare Advantage plans, also known as Medicare Part C, work differently than Medicare and Medigap plans. When you opt for a Medicare Advantage plan, you will receive your healthcare benefits solely from the private insurance carrier, not the government.
These plans have service areas, so depending on the type of plan you choose, you may or may not be covered when you are outside of your service area. For example, if you have an HMO Medicare Advantage plan, you will only be covered when you receive healthcare services in network. However, you will be covered if there is a medical emergency when you are out of network.
PPO Medicare Advantage plans are more flexible, as you can go out-of-network for your healthcare, regardless of if it’s a medical emergency or not. However, you will pay more for out-of-network services. So, if a Medicare Advantage plan interests you, you may want to consider a PPO plan if you plan on taking many vacations throughout the year in the states.
How Medicare works with an international vacation
Original Medicare
With Original Medicare being American health insurance, it’s unlikely Medicare will cover you on an international vacation. However, there are a few scenarios where Medicare will likely cover you outside of the United States:
- You are traveling across the U.S., and a medical emergency occurs. If a foreign hospital is closer than a hospital in the states, Medicare will likely cover you if they can treat your injury or illness.
- Suppose you are traveling through Canada on a direct route to Alaska, and without unreasonable delay, there is a medical emergency that occurs. In that case, Medicare will cover you if a Canadian hospital is closer than one in the United States.
- When a foreign hospital is closer to your home than a U.S. hospital, Medicare will cover you if they can treat your medical condition, whether it’s an emergency or not.
Now, if any of the above scenarios were to happen to you, be aware doctors in other countries do not have to accept Medicare since it’s American insurance. But, if the doctor bills Medicare, Medicare will likely provide coverage if it applies to any of the scenarios mentioned.
Medigap (Medicare Supplement)
Even if Medicare does not provide coverage for a medical emergency internationally, most Medigap plans will. Medigap policies C, D, F, G, M, and N, provide foreign emergency healthcare coverage. This foreign emergency benefit will pay 80% of your healthcare bill after paying a $250 deductible. But this benefit will run out entirely after it pays out $50,000. So, if you have multiple hospital visits throughout your vacation, you might meet $50,000 quickly.
Again, this coverage is for medical emergencies only. So, do not travel out of the country for a planned surgery and expect your Medigap plan to foot the bill because it won’t. The foreign emergency travel benefit will only apply for medical emergencies that happen within 60 days of your vacation. If a medical emergency occurs on day 70, you will likely be responsible for the whole medical bill.
Medicare Advantage (Part C)
As mentioned earlier, Medicare Advantage plans are different from Medicare and Medigap plans. So, depending on the plan you enroll in, you may or may not have an emergency travel benefit. Many Medicare Advantage plans offer a worldwide emergency coverage benefit. Again, this benefit would only apply to a medical emergency, not routine care.
If you plan on taking vacationing often outside of the country, you should keep this type of benefit in mind when researching Medicare Advantage plans to enroll in.
Final point
Many seniors don’t plan for medical emergencies to happen when on vacation, but accidents do happen! It’s always beneficial to check with your insurance carrier and look over your plan’s Summary of Benefits to know precisely what your coverage will be if a medical emergency occurs in and outside of the country.
