Medicare and Health Insurance: The Traveller's Dilemma

By Elie Harriett

Whether you want to visit your grandchildren, your children, take that dream vacation you’ve been planning for, or just want to get away for a little while, a common concern people have is whether or not they can use their health insurance when they are away from home.  The answer to that is determined by the type of insurance you have chosen for yourself.

Before we get into the differences in network flexibility, a moment of reassurance: as long as you have some type of Medicare-related health insurance or major medical insurance, if you have an EMERGENCY situation, your plan will cover you in the United States.  Many, but not all plans, go further and say that if you have need of URGENT care, they will also cover you regardless of where you are in this country.  You can rest assured that at bare minimum, if you have at least some coverage, your plan will cover you while you are traveling and an emergency arises.

When you exclude emergency coverage, things can get a little more complicated.

• Employer plans: if your insurance is covered by your employer, check with your plan administrator to find out the extent of using your coverage on a non-emergency basis when you travel.  Even if you have Medicare as a primary payor, you should check to see how your secondary coverage will work.
• Medicare only: If you are enrolled in Medicare Parts A & B and pay the remaining co-pays on your own, you will have very few problems when you travel.  Medicare is a national program and will work with the majority of doctors or hospitals throughout in the United States.  Not 100% of doctors and hospitals, but a great majority of them.  It is always a good practice to ask rather than simply assume.
• Traditional Medicare Supplements: Very similar to Medicare only.  Medicare supplements typically follow along with Medicare, meaning that if a doctor takes Medicare, they’ll take the supplement too.  There are very few issues with doctors and hospitals not taking a supplement because there are very few doctors and hospitals that do not take Medicare (an important exception to this rule is people who have plans called Medicare SELECT.  These alternatives to traditional Medicare supplements contain hospital networks).  Many Medicare Supplements go a step further in their travel coverage than Medicare in that they will give limited coverage for foreign travel emergencies.  You will have a $250 deductible and then many supplements will pay 80% of the bill up to $50,000 and you’ll have the remaining 20% to pay on your own, plus everything over $50,000.
• Medicare Advantage: Advantage plans are networked.  The three main types of plans are:
•    HMO: There’s a network of doctors and hospitals. Except for emergencies, you must typically stay within this network.
•    PPO: There’s a network of doctors and hospitals. You are free to use other doctors and hospitals that accept Medicare outside of the network, but you will be responsible for additional deductibles and cost-sharing.
•    Private-Fee-For-Service (PFFS): There’s a network of doctors and hospitals. You are free to use other doctors and hospitals as long as they agree to accept your plan, and they must agree on a visit by visit basis.  Outside of the network, additional deductibles and cost-sharing MAY apply to you.

Some Medicare Advantage plans offer additional flexibility, such as extended networks or partnerships with networks in other areas.  But they may require you to contact them BEFORE leaving the area so they can switch you over in case you need to use the plan on a non-emergency basis. 

Whenever in doubt, it is always a good idea to contact your insurance company or your representative to find out your options for travelling or seeing a doctor in an area beyond where you live. 

For more information, or to have your personal situation evaluated, contact us today.