Medicare Advantage plans, also known as Part C plans, are an alternative to Original Medicare that private insurance companies approved by Medicare offer. These plans offer all the benefits of Original Medicare, including hospital insurance (Part A) and medical insurance (Part B), as well as additional benefits such as vision, dental, and hearing coverage. But what about overseas travel? Do Medicare Advantage plans cover medical expenses incurred while traveling outside the United States?
The answer to that question is it depends. Let’s look at the different types of Medicare Advantage plans and what they may or may not cover regarding international travel.
Types of Medicare Advantage Plans
Before diving into the specifics of overseas travel coverage, it’s important to understand the different types of Medicare Advantage plans available. These plans include:
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Private Fee-for-Service (PFFS) plans
- Special Needs Plans (SNPs)
Each plan has different rules and restrictions regarding receiving medical care, both in and out of the network. Some plans may require a referral from your primary care physician before seeing a specialist, while others may allow you to see any doctor you choose without a referral. According to Clearmatch Medicare some plans may also have different networks of doctors and hospitals that you can choose from, impacting your coverage when traveling overseas.
Coverage for Overseas Travel
Now, let’s look at what Medicare Advantage plans may or may not cover regarding overseas travel.
HMO Plans
HMO plans typically only cover emergency medical services received outside the United States. This means that if you need medical care while traveling abroad, it must be an emergency for the plan to cover it. Non-emergency care, such as routine check-ups or elective procedures, will not be covered under an HMO plan overseas. Additionally, HMO plans may only cover services provided by doctors and hospitals within their network. If you receive care from a doctor or hospital outside of the network, you may be responsible for the entire cost of the service.
PPO Plans
PPO plans may offer more coverage for overseas travel than HMO plans. These plans may cover emergency medical services and non-emergency care outside the United States. However, there may be restrictions on the covered services, such as elective procedures or non-urgent care. PPO plans may also have different networks of doctors and hospitals that you can choose from, impacting your coverage when traveling overseas.
PFFS Plans
PFFS plans are similar to PPO plans in that they may offer more coverage for overseas travel than HMO plans. However, PFFS plans are optional to have a network of doctors and hospitals that you can choose from. This means that you may be able to receive care from any doctor or hospital that accepts the plan’s payment terms, regardless of whether they are in or out of the network. However, it’s important to note that not all doctors and hospitals may accept the plan’s payment terms, which could impact your coverage when traveling overseas.
SNPs
SNPs are designed for people with specific health conditions or circumstances, such as those with chronic illnesses or living in institutions. These plans may offer more coverage for overseas travel than other Medicare Advantage plans, but it will depend on your specific plan. Some SNPs may only cover emergency medical services received outside of the United States, while others may also cover non-emergency care.
Additional Coverage Options
If your Medicare Advantage plan does not provide sufficient coverage for overseas travel, additional coverage options are available. One option is purchasing a travel insurance policy that specifically covers medical expenses incurred while traveling outside the United States. These policies can vary in cost and coverage, so it’s important to shop around and read the fine print to ensure you get the coverage you need.
Another option is to consider enrolling in a Medigap policy known as Medicare Supplement Insurance. Medigap policies are designed to supplement Original Medicare and can help cover some out-of-pocket medical care costs. Some Medigap policies may also offer coverage for emergency medical services received outside of the United States.
Important Considerations
When planning for overseas travel, reviewing your Medicare Advantage plan’s coverage for medical expenses received outside of the United States is important. If your plan does not provide sufficient coverage, consider purchasing travel insurance or enrolling in a Medigap policy. It’s also important to review any restrictions or requirements your plan may have for receiving medical care, such as needing a referral from your primary care physician or using doctors and hospitals within the plan’s network.
Medicare Advantage plans may provide coverage for medical expenses incurred while traveling outside of the United States, but the extent of coverage will depend on your specific plan. HMO plans typically only cover emergency medical services, while PPO and PFFS programs may offer more coverage for non-emergency care. SNPs may also provide more coverage for overseas travel, but it will depend on the specific plan you have. If your plan does not provide sufficient coverage, consider purchasing a travel insurance policy or enrolling in a Medigap policy. It’s also important to review any restrictions or requirements that your plan may have for receiving medical care while traveling overseas.
