Traveling with Medicare: Your questions answered

If you have Original Medicare (Parts A and B) you are covered for care from any provider that accepts Medicare as long as you are traveling within the 50 states, Washington, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa or the Northern Mariana Islands. However, if you are traveling outside the U.S., your Medicare coverage options are limited to emergencies in certain situations. We’ll go into more detail later on.

There are three instances where Medicare may pay for healthcare services in a foreign hospital (outside the U.S.). In these situations, Medicare will only pay for Medicare-covered services – inpatient hospital, doctor, ambulance services or dialysis – that you get in a foreign hospital:

1. If you are in the U.S. when you experience a medical emergency, and a foreign hospital is closer than the nearest U.S. hospital to treat your illness or injury.
2. If you are traveling through Canada “without unreasonable delay” meaning 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 to treat your illness or injury. Medicare determines “without unreasonable delay” on a case-by-case basis.
3. If you live in the U.S. and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it is a medical emergency.

Medicare does not cover healthcare services that you get when the cruise ship is more than six hours away from a U.S port. However, Medicare may cover medically  necessary healthcare services that you get on a cruise ship if the ship is in a U.S. port or no more than six hours away from a U.S. port, regardless of whether or not it is an emergency. Also, Medicare may cover medically  necessary healthcare services if the doctor is legally allowed to provide medical care on the cruise ship.

Medicare Advantage (MA) plans are required to follow the rules set by Medicare above for healthcare services in a foreign hospital. They are also required to cover emergency and urgent care anywhere in the U.S. without any additional costs or coverage rules. Coverage for healthcare services received both outside of your plan’s preferred provider network and outside of the U.S. varies by plan. Check with your MA plan before traveling to see what you are covered for. Aspire Health Plan members can contact Member Services using the number on the back of your ID card.

Medicare supplement insurance plans (Medigap plans) work with Original Medicare to help with costs Parts A and B don’t pay for. Medigap Plans D, G, M and N provide foreign travel emergency healthcare. Medigap Plans C and F provide this coverage, but they are  no longer available to people new to Medicare as of January 1, 2020. You may keep this coverage if you were covered by one of these plans before January 1, 2020. Medigap Plans E, H, I and J provide this coverage, though they are no longer for sale. You may keep this coverage if you bought one of these plans before June 1, 2010. Medigap policies are standardized and pay for 80 percent of medically necessary emergency care outside of the U.S. after you meet a $250 annual deductible. Also, they only cover foreign travel emergency care during the first 60 days of your trip if Medicare doesn’t cover the care, and Medigap policies have a lifetime limit of $50,000 for foreign travel emergency coverage. Check with your Medigap plan before traveling to see what you are covered for.

Medicare prescription drug plans do not cover any prescription drugs you buy outside of the U.S. This means you will have to pay out-of-pocket for any prescriptions picked up or filled at a foreign pharmacy. Keeping this in mind, you should check on your prescriptions to make sure you have everything you need.

Aspire Health Plan offers four MA plans. For all of our plans, any urgent or emergency care that arises within the U.S. or its territories is covered, and you do not need to obtain authorization prior to seeking care. For our HMO Plans (Aspire Health Protect, Aspire Health Value, and Aspire Health Advantage) you generally must get your care and services from doctors, other healthcare providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or out-of-area dialysis). For our HMO-POS plan (Aspire Health Plus), you are still required to select a primary care provider (PCP) in our network, but if you are traveling or choose to seek care outside of Monterey County, you may still do so, as long as you’re in the U.S. or its territories , and use a Medicare approved provider.

Trip-specific travel health insurance is an option for you if you want short-term coverage while traveling abroad. Coverage varies by scope, price and factors such as travel age and trip length. If you decide to do this, make sure the plan covers medical emergencies and be aware of any policy exclusions such as preexisting conditions or penalties for cancellations or postponements of your trip.