MEDICARE ONLY COVERS HEALTH CARE IN THE U.S.
Under “Original Medicare,” you will be responsible for 100% of medical costs outside the U.S. Travel within the 50 states, the District of Columbia, Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, and the Northern Mariana Islands is covered under “Original Medicare.”
Medicare Advantage Plans
Some Medicare Advantage plans provide some coverage while you travel overseas. HMO plans typically require subscribers to obtain medical services from doctors and hospitals authorized by the plan (in-network providers). PPO plans are more flexible and let you see providers outside of the plan’s preferred providers.
Hever these rules are different once you leave the United States. Unlike Medicare Medigap or Supplemental Plans, Medicare Advantage plans have greater flexibility in designing their additional coverage options. So you have to read your plan details or talk with your Medicare Advantage agent to determine whether medical care outside the U.S. is covered, as well as what the deductibles and plan limits are.
Medicare Supplemental or Medigap Plans
Unlike Medicare Advantage plans, Medicare Supplemental Plans benefits are controlled or set by Medicare. Medicare Supplemental plans C, D, F, G, M and N provide some coverage while traveling overseas. These plans have a lifetime limit of $50,000, and cover 80% of certain medical expenses leaving you responsible for the 20% co-insurance, plus a $250 deductible. Again, check your plan documents or ask you Medicare Supplemental agent for detail.
Travel Insurance For Overseas Medical Coverage
Even if you have some coverage through a Medicare Advantage or Medicare Supplemental Plan, you still face a significant liability if your total costs exceed the plans maximum (typically $50,000 for Supplemental Plans) plus you are responsible for any co-insurance (20% of total costs if you have a Supplemental Plan that offers coverage).
What do look for in a travel insurance plan
First, look for a plan that offers “primary coverage” of at least $100,000. Experts agree that the $100,000 will cover most emergency medical expenses around the world. “Primary coverage” means the travel insurance company will be responsible as the first payer on the medical claim. “Secondary coverage” would pay after the limits of the “primary coverage” were reached.
For instance if you had a Medicare Supplemental Plan which covers foreign medical expenses up to lifetime limit of $50,000 coverage, plus 20% co-insurance, and if you purchased “primary coverage” through travel insurance, then your Medicare Supplemental Plan could pay secondarily on any eligible expenses above the $100,000 covered through the travel insurance plan.
Second, look for a plan offering at least $50,000 and preferably $100,000 or more for emergency medical evacuation coverage. This provides coverage for transportation to a hospital plus the additional cost for medical services required to return home if directed by a physician.
Third, by the time most people reach the age where they are covered by Medicare, they have pre-existing conditions. Most travel insurances policies do not cover pre-existing conditions unless the plan is purchased with 14 or 21 days of the first payment or deposit made for the trip (whether it is 14 or 21 days depends on the plan). For most travelers, this would be the date you make a deposit or payment for a cruise or purchase an airline ticket.
In all cases talk with the travel insurance company directly to fully understand the coverage being offered.
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