When you plan a vacation, you book your flight or plan your drive, pack your belongings, and plan the activities. However, you likely don’t think about your health and the chance of falling ill during the vacation. If you fall sick during a vacation and have Medicare, it is essential to understand that your coverage will depend on your plan and whether you are in the United States.
The coverage you receive from Medicare or your plan can be different if you are on vacation out of the country. Let’s go over how your coverage can vary.
Coverage inside the U.S. while on vacation
First, it is important to understand the difference between Original Medicare and Medicare Advantage. Original Medicare consists of Part A and Part B, which provide hospital and medical coverage. A Medicare Advantage plan is an alternative way to receive those benefits. When you enroll in an Advantage plan, you choose to receive your care through your plan, and it must be within the plan’s network. Advantage plans have a network, so their coverage can be pretty different from Original Medicare when you are vacationing.
Original Medicare does not have a network of providers and hospitals, so you will have the same coverage across the nation. You can see any provider or hospital within the U.S. when you are traveling if they accept Medicare. This also applies to anyone with a Medicare Supplement plan because any provider that accepts Original Medicare must accept a Medicare Supplement plan. So, if you fall ill while on vacation within the U.S., you will have the same coverage no matter if you are within the same state or a different one.
Medicare Advantage plan
If your Medicare Advantage plan is an HMO, you will only have coverage within your plan’s service area. Although most plans offer worldwide emergency coverage, it would need to fit the plan’s guidelines on “emergency.”
If your plan is a PPO, then your plan may cover you when you are out-of-network, but the provider or hospital must be willing to bill your plan. Most services that offer out-of-network coverage have a higher copay or coinsurance associated with that service.
It may be more challenging to get coverage when you fall ill and outside your Advantage plan’s service area.
Coverage outside the U.S. while on vacation
If you were to fall ill during a vacation and are not inside the U.S., your coverage could be considerably different than if you were in the U.S.
Original Medicare coverage is limited when you are outside of the U.S. There are traveling exceptions, such as traveling on a cruise ship within U.S. territorial waters or flying en route to the U.S., and a foreign hospital is closer than a U.S. hospital. Other than the few exceptions, Original Medicare generally does not cover you if you fall ill during a vacation outside of the U.S.
However, Medicare Supplement plans can offer foreign travel emergency coverage. Supplement plans C, D, F, G, M, and N, can cover 80% of your foreign travel emergency costs if the emergency happens within the first 60 days of travel. You will want to keep in mind that there is a lifetime limit of $50,000, so once your Supplement plan pays that much toward your emergency, you will be responsible for 100% of the cost.
Whether you have an HMO or PPO plan, your plan can offer worldwide foreign emergency coverage. However, this guideline generally means life or limb. So, your plan will likely not cover you if you have a cold and need antibiotics.
Falling ill during a vacation is not ideal and can ruin your entire vacation. When you plan a vacation, you will want to think about the chance of getting ill and how your health insurance may cover you. It will depend on if you have Original Medicare and a Medicare Supplement or a Medicare Advantage plan.