Vacation Travel and Medicare Coverage

At least 313,000 Florida residents travel north each July to escape the summer heat. Since Florida is a major relocation destination for retired adults, travel to visit family members in summer (as well as for vacation) is common – both in the US and abroad. According to the CDC, around 25,000 annual fatalities due to car accidents occur globally in US tourists.

Treatment for merely a sprained ankle or sunstroke can be costly without health insurance. Therefore, it is vital to understand whether your health plan will cover potential treatment costs outside of Florida. The following describes some options for older adults residing in Florida to ensure adequate coverage while traveling.

Difference Between Original Medicare Coverage in the US and Overseas

If you are insured under Original Medicare, you can obtain healthcare services in other states from any Medicare-accepting physician or facility. (This is assuming that you have both Part A and Part B of Original Medicare.)

However, Medicare only covers foreign travel in rare instances (such as when you are on a cruise ship within territorial waters adjoining US land areas). The Centers for Medicare and Medicaid Services (CMS) notes the following as three instances where Original Medicare pays for healthcare services outside of the US:

• You undergo a medical emergency in the US, and the nearest hospital that can treat your emergency is outside of the US.
• You sustain a medical emergency while traveling through Canada by the most direct route from Alaska to the US, and a Canadian hospital is closer than a US hospital to treat that emergency.
• You live in the US, and a foreign hospital is closer to your home than the nearest US hospital.

Medicare Advantage Plans – Do They Cover You While Traveling?

Some Medicare Advantage (Plan C) plans cover you while traveling, but others do not provide that coverage. The determining factor is whether you are required to utilize an “in-network” physician or hospital to be eligible for coverage. Meanwhile, some Medicare Advantage plans may allow you to use an “out-of-network” physician or hospital – but require you to pay a higher percentage of the total cost.

For this reason, it is crucial to understand the terms of your specific Medicare Advantage policy before you travel to another state or take an overseas vacation. Likewise, it is a good idea to assess whether you have a chronic disorder that may necessitate a physician visit or hospitalization while you are away from Florida.

Medigap Options and Vacation Travel

A Medigap plan can be purchased by any Medicare-eligible person at initial enrollment in Original Medicare. However, an Original Medicare beneficiary may be disallowed from a specific Medigap insurance plan desired at some future date beyond the year of initial Medicare enrollment.

Additionally, Medigap is not available to anyone covered by a Medicare Advantage (Plan C) plan. According to the Florida Division of Consumer Services, insurance companies in Florida can only sell standardized Medigap plans identified by letters A-N. Notably, a CMS booklet specifies as of 2019 that E, H, I, and J plans are no longer offered to Medicare recipients (but a person who is already covered under an E, H, I, or J plan may be able to keep those plans in some circumstances).

Moreover, that same CMS booklet notes that – beginning on January 1, 2020 – Medigap policies sold to people who are newly-enrolled in Original Medicare will no longer be able to cover the deductible for Original Medicare’s Part B.

For anyone covered by Original Medicare who expects to travel to another state or overseas frequently, it is a good idea to have a Medigap policy. If enrolled in a Medicare Advantage plan that does not cover travel and your foreign travel is infrequent, purchasing travel insurance (not related to Medicare) for a specific trip may be sufficient. The agents at UrHealth Benefits in Florida can assist you in choosing the best insurance for your overall needs.

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