Traveling retirees check Medicare coverage to avoid costly surprises

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If you’re a Medicare retiree and want to travel, be sure to find out if your insurance plan can go with you.

Whether you want to hit the road for a trip to the United States or go abroad, coverage at your destination depends on the specifics of your health insurance plan. The nature of your care – routine or emergency – may also play a role.

Just over a quarter of Americans (28%) report becoming ill or injured while on vacation, according to a recent study from the ValuePenguin personal finance website. Among this group, bacterial or food-borne illnesses were the most common (33%), followed by respiratory illnesses (28%) and personal injuries (24%). In addition, 12% of them said they contracted Covid while on vacation.

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In other words, it’s worth knowing what to expect from your Medicare coverage so there are no surprises if you need to see a doctor or other healthcare provider while you’re away. from your place.

With Basic Medicare, travel to the United States is simple

Basic health insurance consists of Part A (hospital coverage) and Part B (outpatient care). Beneficiaries who choose to stick with this coverage—instead of opting for an Advantage plan—usually bundle it with a standalone prescription drug plan (Part D).

If this is your situation, coverage while traveling in the United States and its territories is quite simple: you can go to any doctor or hospital that accepts Medicare (most do), whether for routine or emergency care. It is when one ventures beyond the American borders that things get complicated.

Basic health insurance does not cover travel outside the United States except in limited circumstances. These exceptions include when you’re on a ship in territorial waters adjacent to the country — less than six hours from a U.S. port — or traveling interstate, but the nearest hospital for your treatment is in a foreign country (i.e., you are in Canada heading to Alaska from the contiguous 48 states).

Also be aware that Part D plans won’t cover medications filled outside the United States, said Elizabeth Gavino, founder of Lewin & Gavino and independent broker and general agent for Medicare plans.

“Make sure you bring enough medication with you,” she said.

A Medigap policy could help abroad

If you have a supplement policy – aka “Medigap” – alongside basic health insurance, it might give you some coverage abroad.

These policies, which are generally standardized across states, provide some coverage for the cost sharing that accompanies basic health insurance, such as co-payments and coinsurance.

Some Medigap policies include coverage outside of the United States Plans C, D, F, G, M, and N have up to $50,000 lifetime maximum benefits, with beneficiary paying 20% ​​of costs after a $250 deductible $, and you are only covered for the first 60 days of your trip.

This coverage only applies to medically necessary emergency care and there may be other restrictions, according to the Centers for Medicare & Medicaid Services.

Some older Medigap policies that beneficiaries still have — E, H, I and J — also come with overseas travel coverage, Gavino said.

Be aware that Medigap plans come with their own registration rules, and policies can be expensive depending on where you live, your age and other factors. For example, for a 65-year-old woman, the cheapest Plan G policy in Dallas costs just under $100 per month, compared to around $278 in New York, according to the American Association for Medicare Supplement Insurance.

Check coverage details on Advantage plans

For beneficiaries who receive their Medicare benefits — Parts A, B, and usually D — through an Advantage plan, it’s worth checking to see if your plan is one that includes coverage for emergencies abroad.

And even if you don’t plan to leave US soil, you should see what your plan would cover. Although Advantage plans are required to cover your emergency care anywhere in the United States, you may be required to receive routine care outside of their service area.

“With a traditional HMO plan, when you travel outside the network, you only have emergency coverage,” said Danielle Roberts, co-founder of insurance company Boomer Benefits.

“With a PPO, you have both emergency coverage and off-grid coverage for non-emergencies. [but] will pay more for these off-grid services,” Roberts said.

There are also hybrid plans that may allow limited off-grid processing in certain circumstances, she said.

Your Advantage plan may unsubscribe you if you stay outside of its service area for a period of time, usually six months. In this situation, you would be switched to basic health insurance.

Important tips for traveling abroad

If you have overseas coverage, you may have to pay out of pocket and be reimbursed, Gavino said.

“Foreign hospitals won’t file a health insurance claim for you,” Gavino said. “Get an itemized invoice to submit for reimbursement from your plan.”

Also, depending on your overseas coverage and your comfort level with it, you may want to purchase travel medical insurance.

Foreign hospitals will not apply for health insurance for you.

Elizabeth Gavino

Founder of Lewin & Gavino

These options are priced based on factors such as your age and length of coverage. You can get cover for a single trip of a few weeks or months, or get a multi-trip policy, which could cover a longer period.

Plans typically come with a deductible — say, $250 or more — and coverage can range from around $50,000 in maximum benefits to over $1 million or more. Policies average between $40 and $80, though higher coverage limits and longer coverage durations generally increase the cost, according to insurance company Travelers.

“Make sure you know if the plan covers pre-existing conditions and Covid,” Gavino said.

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