Traveling With Medicare
If you have Original Medicare you have coverage anywhere in the U.S. and its territories. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Most doctors and hospitals take Original Medicare.
If you have a Medicare Advantage Plan, your plan may or may not cover care outside of its service area. Some plans may cover providers that are out-of-network or out of your service area, but with higher cost-sharing (copayments, coinsurances). Your plan may also impose other rules or restrictions (like prior authorization). Contact your plan to see what rules and costs apply when you travel within the U.S.
Medicare Advantage Plans are required to cover emergency and urgent care anywhere in the U.S. without imposing additional costs or coverage rules.
If you travel outside your Medicare Advantage Plan’s service area continuously for more than six months, you will automatically be disenrolled from most plans. You will have a Special Enrollment Period to join a different Medicare Advantage Plan. If you do not choose a new plan, you will automatically be enrolled in Original Medicare.
Some Medicare Advantage Plans provide special benefits that allow you to stay in the plan if you travel continuously in the U.S. or its territories for up to 12 months. Check the rules closely if your plan offers a visitor or travel benefit. Only certain areas may be included, certain care may not be covered, and/or you may pay more if you see providers that are outside the plan’s network.
Travel outside the U.S.
Medicare usually does not cover medical care you receive when traveling outside the U.S. and its territories. However, Original Medicare and Medicare Advantage Plans must cover care you receive outside the U.S. in certain circumstances:
¯ Medicare will pay for emergency services in Canada if you are traveling a direct route, without unreasonable delay, between Alaska and another state, and the closest hospital that can treat you is in Canada.
¯ Medicare will pay for medical care you get on a cruise ship if you get the care while the ship is in U.S. territorial waters. This means the ship is in a U.S. port or within six hours of arrival at or departure from a U.S. port.
¯ In limited situations, Medicare may pay for non-emergency inpatient services in a foreign hospital (and any connected provider and ambulance costs). Your care is covered if the hospital is closer to your residence than the nearest available U.S. hospital. This may happen if, for example, you live near the border of Mexico or Canada.
Some medigap plans provide coverage for travel abroad. Medigap plans C through G, M, and N cover 80 percent of the cost of emergency care abroad. Check with your policy for specific coverage rules.
Medicare Advantage Plans may also cover emergency care abroad. Contact your plan for more information about its costs and coverage rules.
For information or assistance with your Medicare health insurance needs, contact the Office for the Aging’s NY Connects helpline 753-4582 and make an appointment with one of our NYS Certified Health Insurance Counselors.