Retirees ready to take to the streets should check their Medicare coverage
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Retired, vaccinated and ready to travel? Don’t forget to check if your Medicare plan will travel with you.
While coverage when you are away from home depends in part on where you are going, it also depends on the specifics of your coverage. Whether it is routine or emergency care can also play a role.
According to the Centers for Disease Control and Prevention, around 70% of people aged 65 or older have now had their first Covid shot, and 43% are fully vaccinated. As more people get vaccinated against the virus, travel is back on the minds of people who settled down in the last year.
Here’s what you should know about the differences in Medicare coverage outside the home.
Basic or original Medicare consists of Part A (hospital insurance) and Part B (outpatient care). Individuals who choose this coverage – rather than opting for an Advantage plan – typically combine it with a standalone prescription drug plan (Part D).
If this is your situation, insurance coverage for travel around the US and its territories is pretty straightforward: you can go to any doctor or hospital that Medicare accepts (most do), be it for routine care or an emergency. When you venture beyond US borders, it gets tougher.
“When you travel outside of the US, Medicare has very limited or infrequent coverage for you,” said Danielle Roberts, co-founder of insurance company Boomer Benefits.
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These exceptions include if you are on a ship in bordering territorial waters – within six hours of a U.S. port – or if you are traveling from state to state but the closest hospital to treat you is: is in a foreign country (i.e., you are in Canada while traveling to Alaska from the 48 bordering states).
Note that amid the ongoing pandemic, the State Department has numerous recommendations for overseas travel. In addition, the Centers for Disease Control and Prevention requires all passengers – including citizens – traveling to (or returning) to the United States, proof of a negative Covid test or proof of recent recovery from the virus.
However, if you are planning a vacation in another country, you can get some protection abroad by combining basic Medicare with a supplementary policy – also known as Medigap.
These policies, which are generally standardized across states but vary in cost, provide some coverage for the cost sharing associated with Medicare basic insurance, such as medical insurance. B. Co-payments and co-insurance. Some of them also have limited overseas travel coverage, said Elizabeth Gavino, founder of Lewin & Gavino and independent broker and general agent for Medicare plans.
“A member pays a deductible of $ 250 and 20% of the cost of medical treatment received, up to a lifetime maximum of $ 50,000,” said Gavino.
Note that this coverage is for medically necessary emergency care and other restrictions may apply according to the Centers for Medicare & Medicaid Services.
For beneficiaries who receive their Medicare benefits – Parts A, B, and usually D – through an Advantage Plan, it is worth checking to see if you can get emergency coverage abroad. And even if you didn’t leave U.S. soil, see what your plan would cover.
While Advantage plans are required to cover your emergency care anywhere in the United States, you may be hooked for routine care outside of their coverage area.
“With a traditional HMO plan, you only have emergency coverage when you travel outside of the network,” said Roberts. “With a PPO you have both emergency coverage and non-emergency coverage outside the network [but] will pay more for it from network services. “
There are also hybrid plans that could allow limited treatment outside of the network under certain circumstances, Roberts said.
It is possible that your Advantage Plan will de-register you if you are out of service for a period of time – typically six months. In this situation you would be switched to Basic Medicare.
Some beneficiaries take out travel health insurance for overseas travel regardless of their specific coverage, Gavino said.