UNDERSTANDING YOUR HEALTH INSURANCE
BY: BETSY CHANDLER
Traveling Outside the United States?
What you need to know about Medicare and your Medicare Supplement before you go.
If you are on Medicare, there are a few things you should be aware of it your travel plans are taking out of the U.S.
Medicare is a federally funded program, and as such, is designed to cover you here in the United States. Medicare generally does not cover you outside the United States, with few exceptions which we will get to shortly. If you have a Medicare Supplement, you may have limited coverage for “foreign travel emergency” benefits. Medicare Supplements plans were redesigned in 2010. If you have a Medicare Supplement purchased after 2010, the following plans offer a “foreign travel emergency benefit”: C,D,F,G,M and N. Post 2010 plans that DO NOT include Foreign Travel emergency benefits are: A,B,K, and L. If you have a Medicare Supplement that you enrolled in prior to 2010, please check with your carrier (insurance company) as to whether or not your plan contains this benefit if you will be traveling outside the U.S.
For those of you who have the foreign travel emergency benefit included in your post 2010 Medicare Supplement, here is what that coverage entails: $250 deductible (you pay this before benefits kick in) then you have 80% coverage up to a lifetime maximum of $50,000. You can anticipate paying the first $250 (deductible), then 20% of the expenses above that, and then any costs above $50,000.
If traveling abroad, you should give consideration as to how long you will be away, the cost of the trip, and whether or not you have used any of your life time foreign travel benefits already. Keep in mind $50,000 is a lot of money if it is your weekly paycheck, but if it is the total amount of coverage you have over the course of your lifetime it is not a lot of money. Consider travel insurance which should also include benefits for trip cancellation, and medical evacuation.
To address the question of when does Medicare cover you outside the United States, I have extrapolated the following directly from the Medicare website.
“Travel (when you need health care outside the U.S.)
How often is it covered?
In general, health care you get while traveling outside the U.S. isn’t covered. The 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa are considered part of the U.S.
Medicare may pay for inpatient hospital, doctor, ambulance services, or dialysis you get in a foreign country in these rare cases:
- You’re in the U.S. when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
- You’re traveling through Canada without unreasonable delay by 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 that can treat the emergency.
- You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.
In some cases, Medicare Part B (Medical Insurance) may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won’t pay for health care services you get when a ship is more than 6 hours away from a U.S. port.
Medicare drug plans don’t cover prescription drugs you buy outside the U.S.”
Betsy Chandler is a licensed insurance professional with MIC Insurance Services, a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828.