You are planning a vacation and want to know if Medicare will cost more during your trip. Maybe you are eager to travel as it has been a while since your last vacation? Or perhaps you have planned a family vacation but worry about your Medicare covering the costs. Vacations can be costly on their own, and the last thing you want to worry about is your Medicare costs. If you have any of the above thoughts, look no further, as we will discuss if Medicare costs more while on vacation.
Vacationing within the United States
If you are going on vacation within the United States, Original Medicare will cover the Medicare-approved costs. For example, if you have Original Medicare, can visit any doctor that accepts Medicare when traveling within the U.S. and U.S. territories. The U.S.’s territories consist of the U.S. Virgin Islands, Guam, Puerto Rico, Northern Mariana Islands, and the American Samoa. Most hospitals and doctors within the U.S will accept Original Medicare.
If you are on a Medicare Advantage plan, your situation may be different. Medicare Advantage Plans might or might not be able to cover your vacation because of the areas that it serves. Your Medicare Advantage plan may cover certain providers that are out of your area of service for an additional and higher cost on your copayments and coinsurances.
Your Medicare Advantage plan also may have some restrictions on it, like needing a prior authorization to be seen. However, your plan is required to cover urgent and emergency care anywhere in the United States, without additional coverage rules or costs.
Vacationing Outside the United States
Medicare usually won’t cover medical treatment during travel outside of the U.S. There are only three circumstances where Medicare and Medicare Advantage Plans may cover your care received during foreign travel. The three circumstances are:
- If a health emergency occurs in the U.S., but the closest hospital is in another country. I.E., Being on a cruise ship and the ship is within six hours of arrival or departure from a U.S. port.
- If you are traveling the route between Alaska and the U.S. and are in Canada, an emergency occurs. I.E., The closest hospital to treat you is in Canada while you are traveling to Alaska.
- If you are in the U.S. and a hospital in another country is closer to treat you than a U.S. hospital. I.E., If you are near the border of Mexico or Canada.
There are certain Medigap policies offer coverage for international travel to resolve the lack of Medicare coverage. Medigap plans C, D, F, G, M, and N cover 80% of emergency medical care abroad. You will want to double-check your policy to make sure this is true for you.
Another thing to note is that Medicare Advantage Plans might disenroll you if you are outside their service area for more than six months. If you are disenrolled from your Medicare Advantage plan, you will be switched to Original Medicare. You can choose to switch back to an Advantage Plan after going on Medicare. However, you will have to wait for the special enrollment period.
Any Costs Associated with Original Medicare?
While traveling abroad with Original Medicare, you will pay 100% of the costs in most cases. In any of the three situations above, you will pay only 20% of the Medicare-approved amount and pay your Part B deductible.
Going on vacation is a great time and fills you with many memories to take home! If you are going on vacation within the U.S. and its territories, Original Medicare should cover your Medicare-approved services. If you have a Medicare Advantage plan, double-check your plan’s Summary of Benefits and service areas.
If you are going on vacation outside of the U.S. and its territories, Medicare usually will not cover your healthcare services. A way around that is to get a Medigap policy; they can offer coverage for international travels. Before traveling, review your policy and get in touch with a Medicare specialist to make sure you have all your ducks in a row. Safe travels!