Travel In Medicare

Medicare usually doesn’t cover health care while you’re traveling outside the U.S. Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands are considered part of the U.S. There are some exceptions, including some cases where Medicare Part B (Medical Insurance) may pay for services that you get on board a ship within the territorial waters adjoining the land areas of the U.S.
Travel In Medicare may pay for inpatient hospital, doctor, ambulance services, or dialysis you get in a foreign country in these rare cases:

You’re in the U.S. when a medical emergency occurs that requires immediate medical attention to prevent a disability or death, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
If you live in the U.S., a foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.

In some cases, Medicare may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won’t pay for health care services you get when a ship is more than 6 hours away from a U.S. port.
Medicare drug plans don’t cover prescription drugs you buy outside the U.S.
Medicare supplement insurance (Medigap) policies may cover you when you travel outside the U.S.
Your costs in Original Medicare You pay 100% of the costs, in most cases. In the situations described above, you pay 20% of the Medicare-approved amount, and the Part B deductible applies.
In the situations above, Medicare pays only for services covered under Original Medicare:

Medicare Part A (Hospital Insurance) covers hospital care (care you get when you’ve been formally admitted with a doctor’s order to the foreign hospital as an inpatient).
Medicare Part B– ( Medical Coverage) covers emergency and non-emergency ambulance and doctor services you get immediately before and during your covered foreign inpatient hospital stay. Medicare generally won’t pay for services (like return ambulance trips home) in either of these cases:
- Medicare didn’t cover your hospital stay.
- You got ambulance and doctor services outside the hospital after your covered hospital stay ended.
You pay the part of the charge you would normally pay for covered services. This includes any medically necessary doctor and ambulance services you get in a foreign country as part of a covered inpatient hospital stay. You also pay the coinsurance , copayments, and deductibles you’d normally pay if you got these same services or supplies inside the U.S.
Medicare Supplements– Some plans will give you a $50,000 lifetime benefit for international travel.

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:

Original Medicare (Parts A & B): Allows you to see any doctor or
hospital that accepts Medicare but does not include prescription drug
coverage (Part D) or additional benefits.
Medicare Advantage (Part C): Offers bundled coverage with
potential extra benefits but may require using a network of providers.
Medigap (Medicare Supplement Insurance): Helps cover
out-of-pocket costs not covered by Original Medicare, such as
copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:

Initial Enrollment Period (IEP): A seven-month window starting
three months before your 65th birthday month.
General Enrollment Period (GEP): From January 1 to March 31
each year for those who missed their IEP.
Annual Election Period (AEP): From October 15 to December 7,
allowing you to switch or enroll in Medicare Advantage and Part D
plans.
Open Enrollment Period(OEP): From January 1 to March 31 for
those who missed AEP and want to make certain changes.
Special Enrollment Period(SEP): Can be used anytime during the
calendar year for those that meet certain criteria such as moving to a
new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.

By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.

Do I have to sign up for Medicare?

It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.

Does Medicare cover Prescription Medications?

No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.

I want to be able to go to any doctor/hospital, are there networks with Medicare?

There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.

Mike Miligi- Owner

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental and Vision programs.

Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.

Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.