Travel: A Medicare Customer Q&A

As the summer months and travel plans are in full swing, clients who are Medicare beneficiaries should check whether their health care plans are ready to embark on their trip with them – whether their journey is in the United States or abroad.

To avoid unexpected costs, clients who are Medicare beneficiaries should know where their coverage applies and how to fill in travel coverage gaps in case one needs to visit a doctor or provider away from home.

The Question:

Does your client's current Medicare plan have travel coverage?

The Answer:

A beneficiary with Original Medicare traveling in the United States can go to any doctor or hospital that accepts Medicare for routine care if needed.

Beneficiaries with a Medicare Advantage plan may have to foot the bill for routine services when traveling outside of their service area.

Under both plans, emergency care is generally covered nationwide.

International Travel

Some Medicare Advantage plans may offer a supplemental benefit that covers emergency services when traveling outside of the United States.

Beneficiaries of both plan types who are embarking on international travel are not covered, unless under very rare and specific circumstances, such as when a beneficiary is on a ship fewer than 6 hours from a U.S. port and needs emergency health care services.

Original Medicare recipients can opt into a Medigap policy such as Plans C, D, F, G, M, and N to fill in some coverage gaps for international travel.

Medigap plans are available only to beneficiaries on Original Medicare.

Beneficiaries who have Medicare Advantage cannot purchase one of these plans.

Medigap plans that offer international emergency health coverage (listed above) have up to $50,000 lifetime maximum benefits, and the beneficiary pays 20% of costs after meeting the yearly $250 deductible.

However, beneficiaries are covered only during the first 60 days of a trip and only toward medically necessary emergency care; this does not include prescription drug coverage.

Medigap International Coverage Details

Enrolling in a Medigap plan in order to have international coverage could be complicated because there are rules and timing to consider.

Costs depend on factors such as where a beneficiary lives and age.

The ideal time to purchase a Medigap policy is during the six-month open enrollment period, which automatically begins during the first month of a beneficiary's Medicare Part B effective date.

When a beneficiary with a Medigap policy is overseas and needs to seek care, it is important to keep in mind that foreign hospitals will not file a Medicare claim.

Beneficiaries will need to pay out of pocket and be reimbursed at a later time by the U.S. Centers for Medicare and Medicaid Services, so clients using Medigap coverage overseas should make sure to request an itemized bill from the provider in order to submit those expenses to CMS for reimbursement.

Travel Health Insurance

For more spontaneous trips, purchasing a travel health insurance plan may be a good option.

Travel policies are more customizable, with provisions that can be adjusted for single or multi-trip coverage depending on the client's short-term or long-term itinerary.

The insurer may pay be able to pay some providers directly, without the client having to pay for services up front and seek reimbursement later.

Bethany Cissell is a health care insurance services specialist at Allsup.