Question: My spouse and I are traveling across the USA 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. You can access healthcare throughout your traveling as necessary. Your Original Medicare is primary and your Medicare Supplement covers the cost shares exactly like it covers you at home, and it only depends on the letter plan you have.

Instead of a Medicare Supplement, you may have signed up for a Medicare Advantage plan. Medicare Advantage plans are usually structured like HMOs (Health Maintenance Organization) or PPOs (Preferred Provider Organization) plans. HMOs are typically more restrictive with their coverage “network,” and PPOs provide more nationwide options. HMOs require you to get your care through your “network.” PPOs allow you to go outside of your normal network, but if you go out of network then 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. You MUST check your individual plan, as each Medicare Advantage Plan defines its coverage differently. You can check your plan documents like the Evidence of Coverage or Summary of Benefits. You can access these by looking through the material your insurance company sent you, or on the company website. You can also call your company to review your benefits, or to request that they send you new documents, if you can’t find yours. If you have a broker, they may be able to assist you as well.

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. It is also important to remember that when an Urgent Care or Emergency Room is covered, the follow-up treatment doctors may recommend in the days after your initial treatment is very likely not considered urgent or emergency care, and therefore may be denied, and unfortunately this could be a correct denial of coverage, depending on the type of plan you have.

When thinking about the type of plan you have, remember that an HMO is more restrictive and therefore you must be more careful about our coverage decisions. PPOs general offer increased coverage across all states, but I still recommend checking your coverage network. If you can, call your customer service number on the back of the card to clarify the coverage you have before you travel.

Each instance where you need to use your insurance can change how your particular plan covers you, especially when travelling. So if you are in an emergency and it isn’t life-threatening, also 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 life-threatening

emergency, get care immediately, and once the situation stabilizes, call your insurance company to clarify what has happened and what they can do to help you.

In these emergencies when traveling out of your usually local area, coverage for your care might initially get denied. If your coverage is denied while traveling, 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.

In thinking about your drug coverage, this will most likely work just fine across the USA – the cost shares will be similar to what you are paying locally. However, remember that with prescription drug coverage, the Pharmacy you use makes a big difference. If you use a preferred pharmacy locally, and then when you travel you choose to use another preferred pharmacy, then your coverage will be the same. If you can’t find a preferred pharmacy, or choose to use a non-preferred pharmacy, then you will likely pay more for your medications than what you are used to. If the pharmacy is out of network, then you will pay full cost for the medication – your part d drug coverage will not pay any part of it. So again, I recommend calling the customer service number on the card to see what they recommend for pharmacies.

I have one final note if you are considering long-term anywhere outside of your usual coverage area of your Medicare Advantage plan: some, but not all Medicare Advantage plans will automatically DISENROLL you after you’ve left their network for 6 consecutive months. In this case, you are granted a Special Enrollment Period to secure new coverage, however you may have a gap in coverage. My tip, as usual, is to check with

your plan. It might be the type that won’t disenroll you in that time frame – it may allow you to travel in the US for up to 12 months. Keep in mind that if you plan to travel for long stretches or frequently, perhaps your current plan has a small network like an HMO, so a change in plan could be a good idea.