How Does Medicare Work on Vacation

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Are you planning on going on a vacation soon? There are many senior citizens that are itching to get away, and you may be wondering if your Medicare coverage will travel alongside you. Say you are staying at a resort in Costa Rica and may have to go to the doctor. Will you have to take care of the bill, or will Medicare cover it for you? What about if you are visiting another state and may need to go to the hospital while you are there? Medicare’s coverage of care when you are on vacation depends on where you go and how you receive your Medicare benefits.

Going on Vacation Out of State

If you plan on traveling within the United States and have Original Medicare, then you are in good shape. Medicare Part A and Part B have coverage with no region restrictions within the 50 states. It also covers any U.S. territory, such as Puerto Rico.

Medicare does not have regional restrictions, but that does not mean all physicians will accept Medicare patients. Before your healthcare visit, make sure the physician accepts Medicare patients. If the physician does accept Medicare, just know they will also accept a Medigap plan.

If you have a Medicare Advantage plan, you will want to look at your plan’s Summary of Benefits to know if you can receive healthcare services out of state. For example, if you have an HMO Medicare Advantage plan, you can only receive your healthcare services in-network, unless you have an emergency. If you go out of your network for treatment and it’s not an emergency, you will pay your healthcare bill in full.

It can be easier to vacation out of state with a PPO Medicare Advantage plan, because PPO plans can allow you to go out-of-network for treatment. However, you will likely pay more for your services than if you were in-network and there still can be network restrictions. It is a great idea to speak with your primary physician before going on vacation to create an emergency health plan, just in case.

Going on Vacation Out of the Country

Original Medicare takes care of your coverage throughout the U.S. but rarely covers out-of-the-country costs. The only instances where Medicare may cover a doctor, ambulance services, inpatient services, or dialysis in another country is:

  • If a health emergency occurs in the U.S., but the closest hospital is in another country.
  • If you are traveling the route between Alaska and the U.S. and are in Canada when an emergency occurs.
  • If you are in the U.S. and a hospital in another country is closer to treat you than a U.S. hospital.
  • If you have an emergency and are on a cruise ship that’s within six hours of any U.S. port

If any of the above applies to you, and Medicare provides coverage, you will likely pay a 20% coinsurance of the approved medical costs. However, if the above situations do not apply to you and you receive healthcare services in another country, then you will be responsible for the bill in total.

With specific Medigap plans, you can still have coverage for emergencies during foreign travel. There are also some Medicare Advantage and Medigap plans that help cover costs outside of the United States. In either case, you will want to look over your plan’s Summary of Benefits or Outline of Coverage and see what you have covered.

If you use your Medicare Advantage plan while traveling internationally, make sure you save the itemized medical bills. There is a chance that a foreign hospital will not bill your Medicare Advantage plan. In this case, you would pay for your medical services and when you make it back to the states, you can submit your itemized receipts to your carrier and apply for a reimbursement.

Conclusion

Vacation is a fun time to experience new things and enjoy some time off. The last thing you want to worry about while on vacation is if your Medicare will cover you when traveling. If you have a vacation coming up, contact your carrier to make sure your plan covers you wherever you might be going. Or even create a customized emergency health plan to make sure you have all your bases covered. You do not want to get caught with no health plan while on vacation. Plan ahead and enjoy your time off! You deserve it.