After a long year of being in quarantine, we all are ready to go on a long-awaited vacation. However, you may be wondering if you will be covered if you have an unexpected medical event while outside of New Jersey. Whether you are escaping to the Rocky Mountains or a sunny, tropical beach outside the United States, your travel destination will determine how you are covered while traveling with Medicare health insurance. Additionally, the type of coverage you have on top of Original Medicare, a Medicare Supplement or Medicare Advantage plan, will dictate how you are covered during your time outside of New Jersey.
If you experience a medical emergency event while traveling with Medicare coverage within the United States & its territories, you will be covered. Most, but not all, Medicare Advantage and Medicare Supplement plans will cover an emergency medical event outside of the United States as well.
A medical emergency event is an unforeseen situation that poses an immediate risk to your health and your symptoms require immediate medical attention. Medical emergencies can be an injury, illness, severe pain, or a health condition which is quickly getting worse.
If you have a medical emergency get immediate help. You do not need approval from your plan prior to going to an Emergency Room. Once you are in stable condition you should inform your health insurance coverage.
If you are traveling with Medicare Advantage coverage within the United States & its territories, your Medicare Advantage plan will cover a medical emergency event. Non-emergency coverage is dependent on the Medicare Advantage plan you are enrolled in and whether it is an HMO or a PPO. If you are in an HMO Medicare Advantage plan, there are established medical networks of doctors and hospitals. For non-emergency coverage, you must see a provider within your plan’s established network for that area. If you have a PPO Medicare Advantage plan, you may see an out-of-network provider, but there may be additional cost-sharing applied.
Most, but not all, Medicare Advantage plans have worldwide emergency coverage included. Check with your plan’s evidence of coverage (EOC) to determine if you are covered for an emergency outside of the United States and its territories. Some plans have a maximum benefit of $50,000 for foreign emergency coverage. Your plan will charge you the in-network fees until the doctors providing emergency care decide your condition is stable. Follow-up care will be covered by coordinating with your plan.
When traveling with Medicare coverage within the United States & its territories, Medicare Supplement plans will cover a medical emergency event and non-emergency care. Medicare Supplement plans are accepted at any doctor who accepts Original Medicare and at all hospitals. This is regardless of which insurance carrier you have your Medicare Supplement plan through.
When traveling out of the country, your emergency medical coverage is dependent on which Medicare supplement plan you are enrolled in. If you are enrolled in a Medicare supplement C, D, F, G, M, or N plan then you have worldwide emergency coverage included in your Supplemental insurance. In an emergency, your plan will pay 80% of any medical emergency bill after a $250 calendar year deductible. This benefit has a $50,000 lifetime maximum. Foreign travel emergency coverage is not included in the other Medicare Supplement plans.
If you have a medical emergency event while traveling with Medicare coverage you will be responsible for out-of-pocket expenses. You have the option to purchase additional insurance coverage prior to leaving for your trip. This insurance can pay for the expenses that Medicare Supplement and Medicare Advantage plans do not cover. Be sure to read the fine print when buying a travel insurance package to look for exclusions including coverage for pre-existing conditions.
Want to know more about how your Medicare coverage will cover you while traveling? Feel free to call New Jersey Medicare Brokers at 800-797-0605 or schedule an appointment with our online calendar.