Ready to travel? Know what Medicare covers before you go

It’s 2022 and as COVID-19 restrictions ease, the idea of booking that long-awaited trip to distant places seems like the thing to do. While no one expects a medical emergency during travel, it’s always smart to be prepared. And if you have Medicare — the federal health insurance program for people age 65 and older and some younger people — there are things you should know before you go.

What Medicare covers during travel
If your travel plans don’t take you beyond the U.S. border, Original Medicare should cover most health care needs, as long as you use hospitals and doctors that accept Medicare. Medicare Parts A and B and Medicare Supplement plans can be used in any state. But you may face regional restrictions on where you can use Medicare Advantage or Medicare Part D drug plans.

On the other hand, Medicare usually does not cover health care while you are traveling outside the United States. Alternative — and tropical — destination options include Puerto Rico, the U.S. Virgin Islands, Guam and American Samoa because they are U.S. territories. But if your wanderlust extends beyond these places, you would be responsible for 100% of your medical and prescription drug costs in most situations.

In some rare cases, Medicare may pay for inpatient hospital, doctor, ambulance services or dialysis in a foreign country:

• When a foreign hospital is closer: While in the U.S., if you experience a medical emergency that requires immediate medical attention to prevent disability or death, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition, Medicare will provide coverage. Medicare will also cover your expenses if 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 it is an emergency or not.
   

• Between Alaska and the continental U.S.: If you are traveling through Canada by the most direct route between Alaska and another state and you experience a medical emergency, Medicare will cover your care. But this is only if the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
   

• Aboard a ship in U.S. territorial waters: Medicare may cover medically necessary health care services you receive onboard a ship within the territorial waters adjoining the land areas of the U.S. However, Medicare won’t pay for health care services received when your ship is more than six hours away from a U.S. port.

In these rare cases, you would pay 20% of the Medicare-approved amount as well as the Part B deductible. Medicare Part A would cover the hospital care once you are admitted to the foreign hospital as an inpatient. Medicare Part B will cover the emergency and nonemergency ambulance and medical services you receive immediately before and during your covered foreign inpatient hospital stay. You would pay the part of the charge you normally would pay for covered services, the coinsurance, copayments and deductibles as if you received these services or supplies in the U.S.

Medicare generally will not pay for other services. This includes your return ambulance trip home if Medicare did not cover your hospital stay or if your ambulance and doctor services were outside of the hospital after your covered hospital services ended.

Many Medicare Advantage Plans include worldwide emergency coverage and the extent of coverage depends on the plan you choose. Most Medicare Supplement/Medigap plans have emergency coverage as well. If you have an Advantage or Supplement plan, be sure to check the worldwide emergency services in your policy. Travel insurance is always good to consider when thinking of traveling abroad.

To learn more about Medicare, visit our website or contact a Sharp Medicare Specialist by calling 1-800-82-SHARP.