Medicare and Travel and Health Insurance Information

From the Nebraska Department of Insurance (SHIIP)

If you are planning a trip and rely on Medicare for your health insurance, there are a few things you should know before you hit the road. How Medicare will cover your healthcare needs when you travel will depend on where you are traveling and what type of Medicare coverage you have. Original Medicare (Medicare A and B plus a drug plan), provides hospital and medical coverage anywhere in the United States, District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Outside of these areas, Original Medicare A & B does not provide coverage, unless you meet the following criteria:

• A medical emergency occurs in the U.S., and the foreign hospital is closer than the nearest U.S. hospital that can treat the 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.
• You are a resident of the U.S. and a foreign hospital can treat your medical condition is closer to your residence than the nearest U.S. hospital, regardless of whether an emergency exists.

In some cases, Medicare Part B (Medical Insurance) may cover medically necessary health care services you receive on board a cruise ship within the territorial waters adjoining the U.S. land areas. Medicare won’t pay for health care services you receive when a ship is more than 6 hours away from a U.S. port.

If you have a Medicare Advantage (MA) plan and travel within the United States, you may only have coverage in an emergency or urgent care situation. If you have an HMO plan, most likely it will not cover routine care outside of the plan’s network of providers. If you have a PPO plan, your plan must cover care you receive from providers outside of your plan’s network, provided they accept your plan. You will most likely pay more for care received when out of your plan’s service area. Prior to travel, it is always a good idea to check with your MA plan to see what costs and rules apply.

Original Medicare does not cover care abroad. Some Medigap Supplement plans provide additional coverage for certain medically necessary emergency care outside the U.S. after a $250 deductible for the year, if the care begins within the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care. Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000. Check with your insurance company for details on what is actually covered by your plan.

If you are traveling abroad, you might want to purchase a short-term medical policy to cover medical evacuation and other expenses incurred overseas in the event you should become ill or injured while traveling.

If you are planning any physical activities while traveling (mountain climbing, water skiing, snow skiing, scuba diving, etc.) you might want to consider purchasing additional hazardous sports coverage.

In the event you should become ill overseas, you might want to contact the nearest U.S. embassy for help locating medical services, including doctors, hospital and air evacuation services. You might also want to check with the embassy or consulate of the country you plan to visit prior to traveling to make sure your medications are not considered illegal substances under local law.

The U.S. Department of State is an excellent resource for travel abroad for seniors, including companies selling short-term medical policies and U.S. embassy contact information. http://travel.state.gov/content/passports/english/go/older-traveler.html

Mary Loftis,

Extension Assistant
UNL Extension – Burt County
111 North 13th Street, Suite 6
Tekamah, NE 68061
Phone: (402) 374-2929

Fax: (402) 374-2930

Internet: mloftis2@unl.edu