With so many Medicare beneficiaries taking to the road or traveling abroad, it’s important to know how your health coverage works when you’re not at home. The good news is Original Medicare covers you in all U.S. states and territories, but the bad news is your Medicare coverage is limited internationally. Read on to learn more about Medicare travel coverage and how it affects you.
Will Medicare Cover You if You Travel to Another State?
If you have Original Medicare, you can use it in any state and with any doctor that accepts Medicare in the U.S. and continue to have the same coverage. Medicare covers all 50 states, plus Washington, D.C., Puerto Rico, Guam, American Samoa, the U.S. Virgin Islands, and the Northern Mariana Islands.
Original Medicare participation in any state can be classified as the following:
- Participating providers: A health provider that participates accepts Medicare assignment, meaning that the provider will accept the Medicare-approved amount as payment in full.
- Non-participating providers: A non-participating provider may accept Medicare, but does not accept assignment. Providers in this designation can decide to accept the Medicare-approved amount as paid in full or charge up to 15% extra — known as Excess Charges — for services.
- Opted-out providers: A provider who opts out does not accept Medicare insurance, so you will be responsible for all service costs.
Will Medicare Cover You if You Travel to Another Country?
Generally speaking, Original Medicare will not cover you if you travel internationally and do not fall within specific rules that allow Medicare coverage if you travel to another country.
What will Medicare cover outside the US?
- Medicare will cover health care in a foreign hospital if you live in the U.S. and have a medical emergency, but only if the foreign hospital is closer to you than the nearest U.S. hospital.
- Medicare will provide coverage in Canada if you have a medical emergency while you’re traveling on a direct route between Alaska and another state. This only applies if the closest hospital that can treat you is in Canada and not in the U.S. and Medicare determines the direct route is without “unreasonable delay.”
- Medicare will also cover certain health services in a foreign hospital — regardless of if it’s an emergency or not if you live in the U.S. and the foreign hospital is closer. For example, if you need dialysis and live on the Alaska/Canada border, but the closest hospital that can provide these services is in Canada, Medicare may cover these expenses.
- Finally, if you’re on a cruise ship in U.S. waters or a U.S. port (or within six hours of arrival or departure from a U.S. port), Medicare will cover your medically necessary treatment if the physician is legally allowed to provide medical care on the ship.
Will Medicare Advantage Plans Cover You in Another State or Country?
Medicare Advantage Plans typically offer coverage in other states, though you may be subject to provider network limitations and might pay more if you’re visiting providers out of network. These plans play by different rules regarding services within the U.S., depending on which state you are from. This Medicare Advantage travel coverage is heavily influenced by the type of plan you have.
For example, Health Maintenance Organizations (HMOs) require that you use the plan’s network to receive routine care. You are allowed to use out-of-network hospitals and doctors for emergency services or out-of-area dialysis.
Preferred Provider Organizations (PPOs) allow you to use any doctor that will accept the insurance plan’s contracted rate. PPOs will give more flexibility in the providers and hospitals you use, but when you are out of network you will pay more than if you used an in-network provider.
What will Medicare Advantage cover outside the US?
Medicare Advantage Plans must cover at least the same level of coverage as Original Medicare when traveling internationally. Some Medicare Advantage Plans may offer additional coverage for global travel, so it is essential to check your plan’s regulations.
Will Medicare Supplement (Medigap) Plans Cover You in Another State or Country?
Medicare Supplements are private insurance plans that cover most of the copays, deductibles, and coinsurance that are left over after Original Medicare pays the program’s claim. Many Medigap plans offer additional coverages for international travel as well.
What will Medicare Supplement plans cover outside the US?
Certain Medigap plans offer what’s known as “foreign travel emergency” benefits. This offers coverage for emergency health care services or supplies outside of the U.S. or its territories.
This benefit has a lifetime limit of $50,000 and covers the first 60 days of your trip if Medicare doesn’t otherwise cover you. There is a deductible of $250 per year and coverage pays 80% of the charges.
|Offers Foreign Emergency Travel||No||No||Yes||Yes||Yes||Yes||No||No||Yes||Yes|
Will Medicare Part D Prescription Coverage Apply in Another State or Country?
Medicare Part D prescription coverage is sold by private insurance companies. Many plans contract with regional and national chain pharmacies, though others do not. While Part D may offer coverage from state to state, it will not offer coverage outside of the U.S.
What will Medicare Part D cover outside the US?
There is no Medicare Part D coverage outside of the U.S. If you’re planning to travel internationally, speak with your pharmacist or doctor about getting a large enough supply to cover your entire trip.
Learn More From Our Sources
- Medicare.gov | Medigap & travel | Last accessed November 2022
- Medicare.gov | Travel Medical Coverage | Last accessed November 2022
- Medicareplans.com | CMS.gov and How to Get Information About Medicare | Last accessed November 2022
- Medicareplans.com | Medicare Advantage Plans (Part C) | Last accessed November 2022
- Medicareplans.com | Medicare Supplement Insurance Plans | Last accessed November 2022