Medicare is accepted by over 90% of providers nationwide. If you have Original Medicare as your primary insurance and you are traveling to a different part of the US you do not need to worry about any networks, and you can continue to see any Medicare provider. Additionally, if you have a Medicare Supplement Plan that supplements your original Medicare benefits (these are the lettered plans like Plan G, Plan N, Plan F, ect.), these plans must be accepted by any doctor who accepts Medicare. Let’s say you have Original Medicare as your primary insurance, and then a Plan G with Aetna as your Medicare Supplement Plan. No matter where in the US you are traveling, you can see any Medicare provider – it does not matter whether or not they accept “Aetna” – as long as they accept Medicare patients, your Medicare Supplement Plan will be accepted by them no matter which insurance company it is with. That’s an important thing to stress – your Medicare doctor will accept a standardized Medicare Supplement or Medigap plan with ANY insurance company.
This is different however from how Medicare Advantage Plans work. When you have a Medicare Advantage Plan, you no longer have Original Medicare as your primary insurance. The Advantage Plan itself is your primary insurance. Medicare Advantage Plans are typically HMO or PPO plans that include drug coverage rolled into the plan. These plans utilize a specific provider network, which is usually specific to a certain region. With Medicare Advantage Plans, you typically have emergency/ER coverage nationwide, but for other services you may be required to use network providers which are generally specific to your region – either your state or your county. Additionally, you may need prior authorization for certain service, so you’ll want to check with your plan benefits prior to travel.
When it comes to traveling outside of the United States, usually Original Medicare and Medicare Advantage Plans do not cover medical costs incurred when traveling outside the US and its territories. However, there are certain situations when Original Medicare may pay for specific services you receive when traveling outside of the country. Keep in mind this is Original Medicare coverage, not Medicare Advantage coverage.
Medicare may pay for inpatient hospital, doctor, ambulance services, or dialysis you get in a foreign country in these rare cases:
- You’re in the U.S. when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
- You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
- You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.
In some cases, Medicare may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won’t pay for health care services you get when a ship is more than 6 hours away from a U.S. port.
Additionally, if you have a Medicare Supplement or Medigap Plan, the following Medigap Plans will cover foreign travel emergency services when traveling out of the US : Medicare Supplement Plans C, D, F, G, M and N.
These Medigap Plans cover foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care. The Plans pay 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year. Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.
It’s important to note that: Foreign hospitals aren’t required to file Medicare claims for your travel medical costs. You may need to submit an itemized bill to Medicare for your doctor, inpatient, and ambulance services.
If you have any additional questions about how your Medicare Plan will work when you travel, please give us a call at (888) 465-9728.