Medicare Coverage While Traveling
With the holidays coming up and travel on the rise again, many of our clients have asked us about whether they should “upgrade” their coverage in case they need care outside of their home state.
Takeaway: For most individuals (I would venture to say almost all), your plan will cover you if you travel.
Networks can be one of the most confusing aspects of Medicare plans (if Medicare wasn’t confusing enough). There’s a whole set of acronyms indicating whether a plan has a wide network of doctors or a narrow one.
Networks can be one of the most confusing aspects of Medicare plans (if Medicare wasn’t confusing enough). There’s a whole set of acronyms indicating whether a plan has a wide network of doctors or a narrow one.
HMO plans (health maintenance organizations) tend to be the most restrictive when it comes to networks. You typically will have to stay within the designated network of providers to receive care. Some plans will offer a POS option, which stands for point of service (not the other acronym many of you were thinking about). POS allows individuals to receive routine care out of the network.
PPO plans (preferred provider organizations) give members discounts to providers (doctors) who are in their preferred network. If you go outside of the preferred network, it’ll cost you more - but you’ll still have some coverage.
If you have a Medigap supplemental plan, you’ll have access to the national network of Medicare providers. This offers the greatest flexibility.
However, these network limitations (or freedoms) apply to routine care. The lay person’s definition of routine care is typically anything that can be scheduled. This includes scheduled office visits, labs, or surgeries.
Network limitations do not apply to emergencies. Regardless of whether you have an HMO, PPO, or original Medicare, you are covered nationally as if you were in-network in the case of emergencies.
If you are in a situation where you’re living in multiple states or would prefer to have the flexibility to go out of network for routine care, that’s when you ought to consider a PPO or original Medicare. Otherwise, your plan will cover you for emergencies anywhere in the U.S.
Although Medicare does not cover international travel, many Supplemental and Advantage plans have limited international coverage as part of the benefits as well.