Question: I am traveling to Europe this summer. How will my Medicare insurance cover me?

Answer: As with most questions I get, my answer is: it depends! So, let’s run down a couple of common situations.

When you are using your Original Medicare Part A & B with a Medicare Supplement you have very comprehensive insurance wherever you go within the USA and our Territories. You don’t need to think about networks and finding participating providers. That makes travel within the USA very easy.

When thinking of travel outside the USA, Original Medicare Part A & B do NOT cover you. Some of the Medigap Plans do give you emergency coverage outside the USA. Those plans, remember, are “lettered” plans, so Plans C, D, F, G, M and N give you that emergency coverage outside of USA. That emergency coverage is defined as $250 deductible and then an 80%/20% cost share up to a maximum lifetime benefit of $50,000. So, the Insurance company will NOT cover the deductible, nor 20% of the costs after you’ve met your deductible. The Insurance company’s 80% will max out at $50,000. It is also important to understand that it covers you for the first 60 days of each trip – anything that happens after the first 60 days of your trip will NOT be covered at all.

The other common insurance situation is having Original Medicare, but you have signed up for a Medicare Advantage Plan. Those Medicare Advantage Plans are usually HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) plans. These plans require you to get your care within the network (like with an HMO) or make it optional (like with a PPO). Note that you may go outside the network with a PPO, but you usually have to pay a larger share of the cost.

When you travel with either of these types of plans, you ALMOST always have Emergency Care as an additional benefit anywhere, which can include other countries. But you MUST check your individual plan, as each Medicare Advantage Plan defines its coverage in the Evidence of Coverage document or Summary of Benefits documents.

You can access these by looking through the material they have sent to you, or on the company website. You can also call the plan to review your benefits, and/ or to request new documents if you can’t find yours. If you use a broker, you may also contact them for assistance.

When you travel with a Medicare Advantage Plan, you need to understand what would be considered Emergency Care. It usually includes Emergency Room, Ambulance Ride, Urgent Care, and in some situations Hospital Admissions. You can call your customer service number on the back of the card to clarify the coverage you have before you travel.

If you are in an emergency and it isn’t life-threatening, take the time to call the customer service number on the back of the card to clarify the situation you are in, and the coverage that you have.

If it is a true life-threatening emergency, get care immediately, and once the situation stabilizes, call your insurance company and clarify what has happened and what they can do to help you. In these out-of-area emergencies, coverage for care might get denied initially. If you get denied like this, I recommend you call the insurance company and explain what happened and where you were. They will usually re-evaluate the claim and send it through a different process to determine coverage.

If you do get any care from a doctor while abroad, you should be able to request itemized billing from them. This can be helpful in instances where your insurance company requires additional information or initially denies coverage.

In thinking about your prescription drug coverage, you probably will not get any assistance from your coverage while traveling across Europe. Again you should clarify with your plan, but Medicare Part D was designed for the USA. It is also important to remember that in many other countries the cost of medications is significantly cheaper than the USA, as we have all heard about for years. So the cost of your medications may be cheaper in Europe than you pay here, even with the assistance of insurance.

Medicare can be difficult to navigate, no matter where you are, so it always helps to be prepared by understanding your plan and other plans available in your coverage area.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.