Healthcare Educators


What Medicare Covers When You Travel Out of State

by | May 25, 2023

Retirement means different things to different people, but the desire to travel is often at the top of retirees’ lists. In one survey, 62% of seniors listed travel as their number one retirement goal. The luxury of more time means seniors are able to travel for a variety of reasons, including to explore and learn about new places, to visit family, for relaxation, and to participate in leisure activities.

There are many benefits to gain from traveling. Seniors report that travel improves their general mood and overall outlook on life. It also promotes social interactions, which can improve mental and emotional health. Finally, traveling can help seniors stay physically active.

If travel is high on your list of retirement priorities, it’s important to know how Medicare will cover you before you hit the road to avoid any unpleasant surprises.

Traveling Within the U.S.

Medicare coverage while you are traveling within the U.S. is determined by the type of benefits you have. Original Medicare, Medigap, and Medicare Advantage each have different coverage and limitations.

Original Medicare Plus Medigap

With Original Medicare, you are covered everywhere in the U.S. and its territories. This consists of all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Since most doctors and hospitals accept Medicare, you don’t have to worry about finding a provider in the plan’s network like you do with most Medicare Advantage plans.

Since Original Medicare Parts A and B do not cover everything, most beneficiaries choose to also enroll in a Medigap (or Medicare Supplement) plan, which helps pay some of the health care costs Original Medicare does not cover. The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period. For most people, this is a six-month window that starts the first day of the month you turn 65. You’ll need to have signed up for Part B already. During this time, you have what is known as guaranteed issue rights, which means insurance companies cannot refuse to sell you a Medigap plan for any reason. In most states, if you miss this enrollment period and want to sign up for Medigap later, you may need to answer questions regarding your health. If you have pre-existing health conditions, you may be charged more for a policy or be denied altogether.

Medicare Advantage

If you have a Medicare Advantage plan, you have coverage for emergency and urgent care anywhere in the U.S. for no additional cost. If you have an HMO plan, you will not have coverage for non-emergency services outside your plan’s local service area. If you have a PPO plan and travel within the U.S. for less than six months a year, you will have access to out-of-network providers but for higher out-of-pocket costs.

If you spend part of the year at a second home out of state or travel for longer periods of time, it’s extra important to understand your plan’s rules. Many Medicare Advantage plans will automatically disenroll you if you spend more than six months outside the service area. This will trigger a Special Enrollment Period, during which time you can join another Medicare Advantage plan. If you don’t choose a new plan, you will be automatically enrolled in Original Medicare. Although six months is the typical limit, a few Medicare Advantage plans allow you to travel for up to one year within the U.S. and keep your benefits. Check your plan to see what rules apply.

Which Coverage Is Best?

If you travel extensively in the U.S. for long periods of time or live in multiple states during the course of the year, you may find Original Medicare with a Medigap plan is your best choice. If you are traveling for shorter periods of time and only need coverage for emergency and urgent care, a Medicare Advantage plan could work for you. It’s important to speak with your plan before traveling to know exactly how your benefits work. If you find you don’t have the right coverage, there are several Special Enrollment Periods throughout the year you can use to switch coverage.

Regardless of whether you have Original Medicare or a Medicare Advantage plan, your access to doctors and hospitals will be determined by where you are. Rural areas tend to have fewer choices for care than large cities and suburban areas.

Medicare Part D

No matter if you have a freestanding Medicare Part D plan or a Medicare Advantage plan that includes Part D coverage, your Part D plan will likely require you to use an in-network pharmacy. You should check with your plan before you travel to see if it has a nationwide pharmacy network and if you’ll be able to fill your prescriptions at your travel destinations. If you use mail order, check if you can use this delivery option while out of town. If a nationwide network is not available, ask if you can make arrangements to receive your medications ahead of time.

International Travel and Cruise Ships

Coverage is completely different for traveling abroad. Original Medicare does not cover treatment outside the U.S. and its foreign territories, minus a few exceptions. However, most Medigap plans offer some coverage for a foreign travel emergencies. Some Medicare Advantage plans cover foreign emergency care, but coverage depends on the type of plan, where you are traveling, and what type of care you need. There are also coverage limits. For instance, Medicare does not cover prescription drugs purchased outside the U.S.

Medicare will cover medically-necessary care you receive on a cruise ship in limited circumstances. One requirement is the ship must be in a U.S. port or within six hours of a U.S. port.

Travel Insurance

Depending on the type of trip you are taking, you might want to consider travel insurance. Most travel insurance includes some coverage for medical emergencies. You can use this in conjunction with other health insurance. It’s important to read the policy thoroughly to understand if there are exclusions and coverage limits. For instance, some policies reduce coverage for seniors over 70 years of age.

Be Prepared for the Unexpected

Even with the best preparation, unexpected healthcare situations can arise. Always carry your insurance card with you — this will have your ID number and the 800 number to reach a representative at the insurance company in the case you have questions or need assistance. As a backup, use your phone take photos of your insurance card(s) as well as of your prescriptions to have a complete list of your medications’ names and dosages. Send copies to someone you trust at home. Lastly, make sure you add the names and phone numbers of your local doctors to your phone’s contacts for the eventuality you need to reach them while you are away.

Gain Peace of Mind Knowing You Have the Right Coverage

At Medicare Educators, our experienced team can help you determine if you have the right Medicare coverage to suit your retirement lifestyle. Contact us today.