If you have a Medicare Advantage plan (also known as a Medicare private health plan), your plan may not cover your care while you travel in the United States. What kind of Medicare Advantage plan you have, how long you travel for, where you travel, and the kind of care you need will impact if your plan will cover your care while traveling.
If you travel outside of your Medicare Advantage plan’s service area continuously for more than six months, you will automatically be disenrolled from most plans. A service area is the geographic region that you must live in to be enrolled in your plan. If you’re disenrolled, you will not lose coverage. You will automatically be put into Original Medicare if you do not choose another Medicare Advantage plan. You will have a Special Enrollment Period (SEP) to join this plan.
Not all plans will disenroll you if you leave the service area for six months in a row. Some plans provide special benefits that allow you to stay in the plan if you travel continuously in the United States or its territories for up to 12 months. If your plan offers a visitor/travel benefit, look at the rules closely. Only certain areas may be included, certain care may not be covered, or you may pay more if you see providers that are out of the plan’s network.
If you are traveling in the United States for six months or less, how your plan will cover your care depends on the kind of care you need and what type of plan you have.
Regardless of what type of plan you have, if you need emergency or urgent care, your plan must cover it. Your charges for emergency or urgent care services that are out-of-network will be no more than $65 or whatever you would have paid for emergency or urgent care services in-network.
If you need routine care, coverage will depend on the plan and your benefits:
If you have a PPO (Preferred Provider Organization), your plan must cover care you get from doctors who aren’t in the plan’s network or service area. This means that your plan must cover care you receive while traveling. However, you usually pay more for care you receive outside of the plan’s network or service area.
Most HMOs (Health Maintenance Organizations) don’t cover care you get from doctors who aren’t in the plan’s network or service area. If your HMO does cover out-of-network doctors, make sure you follow your plan’s rules or they may not pay for your care. As with PPOs, in an HMO you usually you pay more for care you receive outside of the plan’s network or service area.
When traveling in the United Stares or its territories you should always check your plan benefits carefully to see what costs and rules apply.