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Medicare Benefits While Traveling

December 12, 2013

One of our Aimfair members shared his experience with emergency care while in Nuevo Vallarta during his vacation. His wife and he were a long way from home.

Acute Pneumonia lead to a five day stay in the new hospital near Paradise Village. Excellent care was delivered. Health was restored. And although the most important thing in life we have is our health, sometimes it comes with a cost. In this case, the cost was about $10,000 USD. You can read more here: Are You Prepared?

As US citizens, some of us qualify for Medicare health expense reimbursement or payment. So what are the rules when you travel?

Here is what we found on Medicare Interactive http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=339:

Does Medicare cover my care when I travel?

Section IV.a. Medicare Coverage Overview
Question 4 of 5 (use "Last" or "Next" buttons to see more)
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Medicare’s coverage of care when you travel depends on where you travel and how you receive your Medicare benefits.
Travel within the US
If you have Original Medicare, you can travel anywhere in the U.S. and its territories and get the medical care you need from almost any doctor or hospital. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Medicare, in most cases, does not cover medical care you get outside the country.

If you have a Medicare Advantage plan (Medicare private health plan), your plan may not cover your care while you travel in the United States unless you need emergency or urgent care. If your plan does allow you to see providers that are outside of your network or area, you will usually need to pay more for the care (except for emergency care). You may also need to follow other plan rules like obtaining prior authorization (except for emergency and urgent care). Contact your plan to see what rules and costs apply when you travel within the United States.
Travel to a Foreign Country
If you will be traveling to a foreign country, Medicare will not usually cover your medical care.

However, Original Medicare and Medicare private health plans must cover your medical care you get outside of the U.S. in the following limited cases:
  • Medicare will pay for emergency services in Canada if you are traveling a direct route, without unreasonable delay, between Alaska and another state and the closest hospital that can treat you is in Canada.
  • Medicare will pay for medical care you get on a cruise ship if you get the care while the ship is in U.S. territorial waters. This means the ship is in a U.S. port or within six hours of arrival at or departure from a U.S. port.
  • Medicare may pay for non-emergency in-patient services in a foreign hospital (and connected physician and ambulance costs). It is covered if it is closer to your residence than the nearest U.S. hospital that is available and equipped to treat you medical condition. This may happen if, for example, you live near the border of Mexico or Canada.
  • Some supplemental insurance, such as Medigap plans, provide coverage for foreign travel. Medigap plans C through G and M and N cover 80 percent of the cost of emergency care abroad during the first two months of a trip with a $250 deductible and up to $50,000 in a lifetime.
Some Medicare private health plans also cover emergency care when you travel outside the United States. Check with your plan to see what costs and rules apply when you travel outside of the United States.

Learn more by following this link: http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=339

We will look into other discussions about heath cost coverage in the coming months.
In the meantime, let's all stay healthy....