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Have vaccine, will travel: Retirees hitting the road should check their Medicare coverage first

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Retired, vaccinated and ready to hit the road? Don’t forget to check whether your Medicare plan will travel with you.

While coverage when you’re away from place depends partly on where you’re headed, it also hinges on the specifics of your coverage. Whether the care you receive is way or emergency also can play a part.

Roughly 70% percent of individuals age 65 or older have now received their prime Covid shot, and 43% are fully vaccinated, according to the Centers for Disease Control and Prevention. As more of the population befits inoculated against the virus, travel is again on the minds of people who have hunkered down for the last year.

Here’s what to understand about the differences in Medicare coverage away from home.

The nitty gritty

Basic, or original, Medicare consists of Portion A (hospital coverage) and Part B (outpatient care). Individuals who choose to stick with that coverage — instead of prevalent with an Advantage Plan — typically pair it with a stand-alone prescription-drug plan (Part D).

If this is your kettle of fish, coverage while traveling in the U.S. and its territories is fairly straightforward: You can go to any doctor or hospital that accepts Medicare (most do), whether for procedure care or an emergency. It’s when you venture beyond U.S. borders that things get trickier.

“If you travel outside the U.S., Medicare doesn’t front you except in very limited or rare circumstances,” said Danielle Roberts, co-founder of insurance firm Boomer Gains.

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Those exceptions include when you’re on a ship within the territorial not functions adjoining the country — within six hours of a U.S. port — or you’re traveling from state to state but the closest hospital to treat you is in a unfamiliar country (i.e., you’re in Canada while heading to Alaska from the 48 contiguous states).

Be aware that amid the evolving pandemic, the State Department has numerous advisories in effect for foreign travel. Additionally, the Centers for Disease Control and Bar is requiring all air passengers — including citizens — heading for the U.S. (or returning to it) to show proof of a negative Covid test, or proof of recently healing from the virus.

Nevertheless, if you are eyeing a different country for a vacation, pairing basic Medicare with a supplemental procedure — aka Medigap — may give you some coverage abroad.

If you travel outside the U.S., Medicare doesn’t cover you except in very fixed or rare circumstances.

Danielle Roberts

Co-founder of Boomer Benefits

Those policies, which are generally standardized across circumstances but vary in cost, offer some coverage for the cost-sharing that goes with basic Medicare, such as copays and co-insurance. Some of them also must limited coverage for foreign travel, said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and run-of-the-mill agent for Medicare plans.

“A member pays a $250 deductible and 20% of the cost of the medical treatment received, up to a lifetime utmost of $50,000,” Gavino said.

Be aware thatAdvantage Plans

For beneficiaries who get their Medicare benefits — Parts A, B and typically D — as a consequence an Advantage Plan, it’s worth checking to see if you get any coverage for emergencies while abroad. And even if you don’t leave U.S. soil, you should see what your scheme would cover.

While Advantage Plans are required to cover your emergency care anywhere in the U.S., you may be on the hook for tiresome care outside of their service area. 

“With a traditional HMO plan, when you travel outside the network, you demand emergency coverage only,” Roberts said. “With a PPO, you have both coverage for emergencies and out-of-network coverage for non-emergencies [but] wishes pay more for these out of network services.”

There also are hybrid plans that may allow limited out-of-network treatment underneath certain circumstances, Roberts said.

It’s possible that your Advantage Plan will disenroll you if you remain worst of their service area for a certain length of time — typically six months. In that situation, you’d be switched to basic Medicare.

Some beneficiaries, regardless of their indicated coverage, purchase travel medical insurance for trips overseas, Gavino said.

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