Don’t assume your health insurance will cover a medical
emergency while you’re abroad
In most cases traditional
Medicare stops at the U.S. border, but there are some other ways to protect
yourself while abroad.
A lot goes into
planning a foreign vacation: searching for the best prices on flights and
hotels, mapping out which sights to see, packing the right wardrobe. One thing
that may not be on your pre-trip to-do list is checking up on your health
insurance.
But if you’re 65 and
have Medicare, you can’t count on coverage outside of the U.S.
That’s because Original Medicare stops at the U.S.
border, in most cases, and not all Medicare Advantage and Medicare Supplement policies extend overseas
either.
To protect yourself
against crushing medical bills from emergency care if your vacation goes awry,
you may need additional insurance. Even then, shopping can be tricky.
Here’s what you need
to know before you leave on your next trip.
When Medicare helps
out
If you have
traditional Medicare, which consists of Part A (hospital insurance), and Part B
(medical insurance), your insurance does not cover care or supplies outside the
U.S. (though the U.S. includes territories such as Puerto Rico, the U.S. Virgin
Islands, and Guam as well as the 50 states and D.C.)
There are a few limited exceptions:
You have an emergency in the U.S. but a hospital in Canada or Mexico is closer;
you’re traveling through Canada between Alaska and another state when an
emergency arises; or you live in the U.S. but a foreign hospital is closer than
the nearest U.S. one that can treat you (emergency or not.)
Special rules also
apply if you are on a cruise ship and within six hours of a U.S. port. In that
case, Medicare may pay.
Plus, even if you
have a Medicare prescription drug plan (Part D), Medicare never covers
prescriptions that you obtain overseas.
When private policies
fill the gap
With a private
Medicare Supplement Insurance policy, also called Medigap (which helps with the
20% of costs that traditional Medicare doesn’t cover), you may be in luck.
Certain Medigap
plans, specifically those labeled C, D, E, F, G, H, I, J, M, and N, pay for 80% of the cost of
emergency care while you’re traveling overseas, up to a
lifetime maximum $50,000. You can no longer buy plans E, H, I, and J plans, but
if you enrolled in one before 2010, you can keep that coverage.
With a private
Medicare Advantage plan, also known as Part C, the same foreign travel
exceptions apply as you find with traditional Medicare. Some Advantage plans may
offer additional travel benefits, though, so check the details of your policy.
However, with
Medicare Advantage traveling within the U.S. could also cost
you. These plans will cover emergency care, but may not cover any other kind of
treatment outside of your service area. See a doctor for something routine on
your cross-country vacation, and the bill may be painful.
Generally, with
a preferred provider organization (PPO) Advantage
plan, you can visit doctors that are not in the plan’s network, though you may
pay more. With a health maintenance organization (HMO) plan,
you typically must visit in-network providers.
And if you travel
frequently, beware. Some Medicare Advantage plans will drop you if you travel
outside of your plan’s service area for more than six months a year.
How to be sure you’re
covered
Unless you have a
Medigap or Medicare Advantage policy that specifically covers medical
emergencies overseas, you need to buy travel insurance to protect yourself.
Comprehensive travel
insurance policies, which are the most popular plans, offer the most
protection, says Julie Loffredi, the manager of media relations at InsureMyTrip.com.
Benefits include trip cancellation and trip interruption coverage, emergency
medical evacuation, emergency medical coverage, 24/7 assistance, and lost
baggage protection.
Comprehensive plans
generally cost between 4% and 8% of your total trip cost, says Loffredi. You
can also buy just travel medical insurance, which covers emergency medical
expenses, evacuations, and assistance but does not include trip cancellation
coverage.
For a $5,000 two-week
vacation to Aruba, a comprehensive travel insurance plan will cost a couple in
their 50s around $200, says Loffredi. For that, you’ll get up to $50,000 in
medical care, $250,000 for medical evacuation, and trip cancellation coverage.
“Generally, travelers
can file a travel insurance claim for any doctor or hospital bills during a
trip,” says Loffredi.
How you can still be
at risk
Keep in mind that a
travel insurance policy may have gaps as well. “It’s important to understand
what is covered at the time of purchase—not wait until claim time,” says Megan
Cruz, executive director of the U.S. Travel Insurance Association.
If a plan says it
covers only emergencies, a visit to a doctor abroad for, say, a cough may not
be reimbursed. More importantly, even emergency treatment may not be covered if
it’s related to a pre-existing condition.
Many travel insurance
companies define a pre-existing condition as “any documented treatment,
diagnostic test or exam, medical recommendation for tests or exams, or a change
in prescribed medicine within the look-back period stated on the plan,”
according to InsureMyTrip.com.
When you submit a
claim, insurers can check your medical records for a certain window, usually
within 60 to 180 days of you purchasing a comprehensive plan or 90 days to
three years before your departure date for a medical plan.
Having a pre-existing
condition shouldn’t keep you from taking your dream trip to Paris—it’s not hard
to get around this limitation. “Travelers can request a pre-existing medical
conditions waiver to cover emergencies related to a pre-existing medical
condition while on a trip,” says Loffredi.
Most comprehensive
travel insurance plans come with a pre-existing conditions waiver at no extra
cost, but you must meet certain conditions, including purchasing your policy
when you book your trip, or within a certain number of days after your initial
deposit, and being fit to travel at that time, says Cruz.
So be sure to check
with a travel insurance agent before you book.
https://considerable.com/counting-on-medicare-when-you-travel-overseas-can-be-a-risky-move/
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