Many people who are eligible for Medicare Part A and Part B find Medicare Advantage a good option because of the extras offered and the lower costs. However, for seniors who want to explore the country, or the world, during their retirement, these plans come with challenges. Medicare Advantage plans have service areas, a geographic area where the company accepts members. For plans that have a network of providers, this geographic area is generally where you can get routine services and you may find yourself with no options once you leave the service area, making affordable healthcare hard to find while you travel. This article offers some tips for finding a plan that offers good coverage for adventurous seniors.

The Basics of Medicare Advantage

Medicare Advantage is also known as Medicare Part C. It makes it possible for people receiving Medicare Part A and Part B to get that coverage through private insurance plans. The government pays a fixed amount to the company for your care. In general, you continue to pay your Medicare Part B premium, but other costs depend on several factors, including deductibles, co-payments and provider networks.

These plans must offer at least the same level of coverage as Part A and B, which is hospital and medical coverage. Often plans also offer additional benefits, such as vision or dental, not provided by traditional Medicare. In many cases the plans also offer Medicare Part D, or prescription drug coverage, as part of the plan.

Tip 1 – Know Your Travel Plans

Your options for using Medicare Advantage as you travel will change based on how long your trip is and where you plan to go. On top of this, there are limited options for changing your Medicare Advantage plan outside of the open enrollment period, which occurs from October 15 to December 7 each year.

The first decision to make is whether you’ll be traveling internationally or within the United States, as there are very different options available for each type of travel. Likewise, knowing whether you’re making a few two-week jaunts, or a 6-month road trip is important information to have when deciding on your plan.

Tip 2 – Choose a Travel-Friendly Medical Advantage Plan

Some Medical Advantage plans are more travel-friendly than others, so if you’re planning to travel, take time to research the plans you’re eligible for to find the best option. Plans that restrict you to in-network health providers may not have providers available once you’re outside of their service area. This may mean higher out-of-pocket costs. Others, such as those from Preferred Provider Organizations (PPO) may have more flexible networks, allowing you to find physicians as you travel.

Medicare Advantage providers can also offer services not provided by Medicare. In some cases, this includes health coverage while overseas. If you plan to travel internationally, look for this option or ask providers if they have overseas coverage. Other travel-friendly options are becoming more popular. Some providers have plans that allow you to travel within the U.S. for up to 12 months before disenrolling you, while sunbird coverage allows you to use insurance across two states. This is perfect for people who spend their summers in the north and go south for a warmer winter.

Tip 3 – Know What’s Covered

Medicare Advantage plans must cover emergency and urgent care anywhere in the U.S., which includes U.S. territories such as Puerto Rico and American Samoa. Coverage outside the U.S. and its territories is very limited on a traditional plan. For non-emergency care there are more possible limitations, such as requiring you use in-network healthcare providers.

Travel-friendly plans may still have limited coverage outside of their service areas. Some plans may only offer limited coverage overseas, such as emergency care. This would mean the cost of medication or non-emergency care remains your responsibility. Make sure you understand what is covered before leaving, so you know what you may be liable for as you travel.

Tip 4 – Know How Maximum Out of Pocket Expenses Work on Your Plan

Medicare Advantage plans have a maximum out-of-pocket spending limit, or MOOP, which keeps costs down for people who require a large amount of medical care. After you reach the MOOP, the plan covers 100% of your costs for the remainder of the year. However, out-of-network costs may not contribute to the limit or may see it increase. Check the fine print of your plan to see what counts towards the MOOP. It will generally have wording such as, “your yearly limit in this plan is $6,700 for services you receive from in-network providers.” Understanding your MOOP will ensure you’re not caught out by unexpected costs.

Tip 5 – Consider Other Insurance Options

If you can’t find a plan with the options you need for your journey, travel insurance is a good option. Even if you have a travel-friendly plan, travel insurance can give you some extra coverage and peace of mind, especially when traveling overseas. These plans often have options for medical transport back to the U.S. in case of emergency, so you can use your regular plan for the majority of your care. Keep in mind that costs may be high for older adults and you may have to pay extra to ensure you’re covered for existing conditions.

Frequently Asked Questions

I’m moving out of the country. What will happen to my insurance?

When you notify your Medicare Advantage plan of your change of address, you’ll be disenrolled due to being outside the service area and automatically enrolled in original Medicare Part A and Part B. When you move back to the United States, you will receive a Special Enrollment Period to join a new Medicare Advantage Plan.

You would still pay the Part B premium while living overseas. If you choose to drop your coverage and not pay the premium, you will have an enrollment penalty when you return to the U.S. The penalty is currently a 10% increase for each year you were eligible for Medicare, but not enrolled.

What is covered by all plans when overseas?

There are three circumstances where Medicare will cover medical care for people not in the United States. These circumstances are all also covered by Medicare Advantage plans.

  1. Medical care is covered on cruise ships that are still in U.S. territorial waters. This means if the ship is within six hours of a U.S. port.
  2. If emergency care is required by someone who is driving between Alaska and another state and the closest hospital is in Canada, it is covered by Medicare. The travel must be a direct route with no unreasonable delay.
  3. In some situations, Medicare will cover non-emergency inpatient costs in a foreign hospital, if that hospital is closer to your residence than a U.S. hospital. This may be the case for people living close to the Canadian or Mexican border.

Can I use my prescription medicine plan in other areas of the U.S?

This depends on your plan, but if you have to use in-network pharmacies for prescriptions, you may find you have limited or no options once outside your service area. Check with your plan to get details before you travel or take enough medication with you for your trip.

Can I buy prescription medicine overseas with Medicare Advantage?

It’s rare for prescription medications to be covered while in a foreign country. Some travel-friendly Medicare Advantage plans may include money for prescription drugs while overseas and some travel insurance plans may also assist with paying for medication. The other option is to speak to your doctor about an extended prescription so you can take enough medication for your journey.

If I make last-minute travel plans, can I change my Medicare Advantage plan?

In general, you can only change plans during enrollment periods. When you first sign up for Medicare Advantage, you can sign up for a plan and may also switch from one plan to another. This initial enrollment period lasts from three months before you’re eligible to three months after. During the open enrollment period, which occurs from October 15 to December 7 each year, you can also change plans.

Outside of these times are special enrollment periods when you can change plans. Choosing to go on vacation is not included as a special circumstance, but if your permanent residence is changing as part of your travel, you may be eligible for a special enrollment period.

How do I get reimbursed if I use Medicare Advantage while overseas?

Medicare Advantage plans that offer coverage overseas may have different rules for paying medical invoices. Foreign doctors won’t automatically invoice your insurance provider and you may have to pay the fees and request reimbursement at a later date. Your plan can provide specific information on what they need and how to make a claim. When being treated overseas, always request an itemized bill, including any ambulance fees, medications and service costs to simplify the claims process.