For many older Americans, retirement means freedom to explore beyond your backyard. Before you take off, however, check whether your health insurance travel with you.
Assuming you’re on Medicare — most adults age 65 or older are — coverage away from home depends partly on where you travel to, along with whether you’re on basic Medicare or get your benefits through an Advantage Plan. It also can depend on whether the care you get is routine or due to an emergency.
And while travel medical insurance can be the solution to plugging holes in coverage, it’s worthwhile first determining whether you need it.
Original Medicare consists of Part A (hospital coverage) and Part B (outpatient care). Retirees who choose to stick with that coverage — instead of going with an Advantage Plan — typically pair their coverage with a stand-alone prescription-drug plan (Part D).
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If this is your situation, coverage while traveling in the U.S. and its territories is fairly straightforward: You can go to any doctor or hospital that accepts Medicare (most do), whether for routine care or an emergency. It’s when you venture beyond U.S. borders that things get trickier.
Generally speaking, Medicare does not provide any coverage when you’re not in the U.S. There are a few exceptions, such as when you’re on a ship within the territorial waters adjoining the country — within six hours of a U.S. port — or you’re traveling from state to state but the closest hospital to treat you is in a foreign country (i.e., you’re in Canada while heading to Alaska from the 48 contiguous states).
About a third of retirees on original Medicare also purchase supplemental coverage through a Medigap policy (you cannot pair Medigap with an Advantage Plan). Those policies — which are standardized from state to state but vary in price — offer coverage for the cost-sharing parts of Medicare, such as copays and co-insurance.
Some Medigap policies — Plans C, D, F, G, M and N — offer coverage for travel. You pay a $250 annual deductible and then 20% of costs up to a lifetime maximum of $50,000.
But, that amount may not go very far, depending on the type of medical services you need.
“I tell our clients that a supplement is not designed for you to get a $50,000 surgery in France. It’s designed to get you healthy enough to get you back on U.S. soil to have the surgery,” said Roger Luchene, a Medicare agent with Hammer Financial Group in Schererville, Indiana.
Also be aware that there is no overseas coverage through a Part D prescription drug plan. And, Medigap policies do not cover any costs related to Part D, whether you’re in the U.S. or elsewhere.
For retirees who get their Medicare benefits — Parts A, B and typically D — through an Advantage Plan, it’s important to check your coverage even if you’re not leaving U.S. soil.
While these plans are required to cover your emergency care anywhere in the U.S., you may be on the hook for routine care outside of their service area. Or, other plans may let you visit out-of-network providers, but require you to pay more.
“Check to see if your plan has some sort of U.S. coverage outside of your area,” said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans. “The big carriers generally do, and depending on where you’re traveling, you could find in-network providers there.”
Some Advantage Plans might also offer coverage for emergencies overseas, so it’s important to know whether your plan does and to what extent.
Whether you have an Advantage Plan or original Medicare, travel medical insurance might be appropriate if you think your existing coverage is insufficient.
“That type of insurance is not too expensive — maybe $90 for two weeks — and you can get a pretty substantial policy,” Gavino said.
Such options are priced based on your age, the length of the coverage and the amount of it. On top of providing coverage for necessary health services, a policy typically includes extras such as non-medical required evacuation, lost luggage and even dental care required due to an injury.
The plans typically come with a deductible — say, $250 or more — and coverage could range from about $50,000 in maximum benefits to upwards of $1 million or more. However, if you’re age 70 or older, you might face a lower lifetime maximum.
You can get coverage for a single trip of a couple weeks or several months, or get a multi-trip policy, which could cover a longer period.
“The multi-trip policy is for when you think you’ll be traveling on and off throughout the year,” Gavino said.
She also said it’s also important to know whether your policy covers pre-existing conditions, because some don’t.
“In that case, say you have diabetes and you’re in Rome when you go into a diabetic coma,” said Gavino. “That wouldn’t be covered.
“But if you had a heart attack, or something else wrong unrelated to the diabetes, it would be covered.”
Also be aware that some Advantage Plans might disenroll you if you remain outside of their service area for a certain time — typically six months. In that situation, you’d be switched to original Medicare.
“If you get disenrolled, you’d have to wait for a special enrollment period to get another Advantage Plan,” Gavino said.