Travel and Medicare
According to Lonely Planet America’s 10 Top Wonders are:
1. Grand Canyon National Park
2. Yosemite National Park
3. Redwood Forest
4. Denali National Park in Alaska
5. Niagara Falls
6. Yellowstone National Park
7. Kentucky’s Mammoth Cave
8. Acadia National Park
9. Monument Valley
10. Hawaii’s Kilauea Volcanoes, or in my opinion Hawaii in general.
Some of us might add to that list of America’s Top Wonders:
2. A photo opportunity with a moose
3. Any place that has casinos.
4. Any gasoline station that has a really clean restroom.
Whether your top traveling pleasure is seeing beaches, moose or slot machines the one attraction that none of us want to see is the inside of an urgent care center or hospital emergency room. We don’t want to see them but at the same time we also want to know that if we do need to see them, our Medicare plan is going to pony up the cost for it, and not us.
Travel medical coverage is handled a little differently depending on whether you have Medicare Advantage or Original Medicare with a Medigap plan.
Medicare Advantage and Travel
Medicare itself makes the rules that all plans must follow. Medicare Advantage plans are required to cover Urgent Care and Emergency Care anywhere in the USA in the same way they would cover you back home. In other words, you won’t have any more costs or restrictions if you break your toe in a hotel bathroom as you would in your tub at home.
It is however important to note that you must think of “Baseball” and touch “Home Base” at least every six months. If you travel continuously outside of your plans service area for longer than six months, you could face automatic disenrollment. This can be especially important for people who may divide their time equally between two locations. Often these are the folks that we who live in Arizona or Florida affectionately call “snowbirds”.
There is an important restriction to know about when you do travel. If you have a medical emergency then your two treatment choices are either an Urgent Care Center or a Hospital Emergency room. If you are admitted to the hospital you will also be covered the same as your plan would charge you back home.
Your treatment option though is only an Urgent Care facility or a hospital. If your friend says to you, “Why don’t you see my doctor,” that is usually not an option.
One of the differences between an HMO and a PPO is that a PPO will allow you to see doctors within their network on a routine basis anywhere in the USA where they have a network. So if you have a PPO and your friend’s doctor is in that PPO’s network then you could see that doctor.
If you need medical attention that is routine and non-urgent or elective surgery then this will usually not be covered and you will have to wait until you get back to your plan’s service area to get it done. But then, most of us do not find ourselves on vacation thinking, “I’m bored, why don’t I go have some elective surgery done.”
Many Medicare Advantage plans also cover international travel so if you are in Iceland and trip on the ice that Iceland was named for, you can head to the local Hospital or Sjukrahus as they call it Iceland or to an Icelandic Urgent Care Center. If international travel is something you are looking to do consultant your plan for specific coverage and copay details.
Original Medicare and Travel
There is only one question to ask when it comes to Original Medicare and travel anywhere in the United States and that is whether a doctor or medical facility takes Medicare at all. If they answer “yes,” as 90 plus percent of doctors and clinics do, then your visit will be covered by your plan.
This means that you can see doctors, have a medical condition monitored or checked out, or get any kind of surgery done, including elective surgery, anywhere in the United States. So if you have a friend in a place your visiting offer, “Why don’t I get you into my doctor,” this becomes perfectly acceptable.
There is another reason having the entire USA as your medical network could be of value. I recall reading Lance Armstrong’s biography where he talked about going to the University of Indiana Medical Center to treat his testicular cancer. He went there because they were the world leader in treating his type of cancer.
With Original Medicare, you can get a diagnosis or surgery done anywhere in the USA. Doing so may be because a clinic elsewhere is leading edge in treating a condition you have. Of course, you will still need to confirm that they take Medicare all together. Check this carefully because some doctors or clinics may take Medicare only from existing patients.
Another reason people often choose to get medical treatments, most especially surgeries, done in elsewhere from where they live is if when they have family who can take care of them in another place, such as an adult child who lives out of state. If this is your situation then Original Medicare with a Medigap supplement could be your best option.
Original Medicare does not cover foreign travel directly, but some Medigap supplements including Plan G do cover foreign travel. The coverage is limited to 80% (your copay will be 20%). There is a $250 annual deductible and a $50,000 lifetime coverage limit as well. Note that Plans A, B, K and L do not cover foreign travel.