Medicare’s coverage of care when you travel depends on where you travel and how you receive your Medicare benefits.
Travel within the U.S.
If you have Original Medicare, you have coverage anywhere in the U.S. and its territories. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Most doctors and hospitals take Original Medicare.
If you have a Medicare Advantage Plan, your plan may or may not cover care outside of its service area The service area is the geographic area where a Medicare Advantage Plan or Part D plan provides medical services to its members. In many plans, the service area is where your network of providers is located. . Some plans may cover providers that are out-of-network Out-of-network means not part of a private health plan’s network of health care providers. If you use doctors, hospitals, or pharmacies that are not in your Medicare Advantage Plan or Part D plan’s network, you will likely have to pay the full cost out of pocket for the services you received. or out of your service area, but with higher cost-sharing Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs. (copayments, coinsurances). Your plan may also impose other rules or restrictions (like ). Contact your plan to see what rules and costs apply when you travel within the U.S.
Note: Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plans are required to cover emergency and urgent care Urgent care is immediate medical attention for a sudden illness or injury that is not life threatening. anywhere in the U.S. without imposing additional costs or coverage rules.
If you travel outside your Medicare Advantage Plan’s service area continuously for more than six months, you will automatically be disenrolled from most plans. You will have a Special Enrollment Period to join a different Medicare Advantage Plan. If you do not choose a new plan, you will automatically be enrolled in Original Medicare.
Some Medicare Advantage Plans provide special benefits that allow you to stay in the plan if you travel continuously in the U.S. or its territories for up to 12 months. Check the rules closely if your plan offers a visitor or travel benefit. Only certain areas may be included, certain care may not be covered, and/or you may pay more if you see providers that are outside the plan’s network A network is a group of doctors, hospitals, and pharmacies that contract with a Medicare Advantage Plan to provide health care services. Generally, plan members will have the lowest costs when using providers and facilities in the plan’s network. Networks may be made up of both preferred and non-preferred providers. .
Travel outside the U.S.
Medicare usually does not cover medical care you receive when traveling outside the U.S. and its territories. However, Original Medicare and Medicare Advantage Plans must cover care you receive outside the U.S. in certain circumstances:
- Medicare will pay for emergency services in Canada if you are traveling a direct route, without unreasonable delay, between Alaska and another state, and the closest hospital that can treat you is in Canada.
- Medicare will pay for medical care you get on a cruise ship if you get the care while the ship is in U.S. territorial waters. This means the ship is in a U.S. port or within six hours of arrival at or departure from a U.S. port.
- In limited situations, Medicare may pay for non-emergency inpatient An inpatient is a patient who has been formally admitted into the hospital by a doctor. Most inpatient care is covered under Medicare Part A (hospital insurance). services in a foreign hospital (and any connected provider See Health Care Provider. and ambulance costs). Your care is covered if the hospital is closer to your residence than the nearest available U.S. hospital. This may happen if, for example, you live near the border of Mexico or Canada.
Some Medigap policies provide coverage for travel abroad. Medigap plans C through G, M, and N cover 80% of the cost of emergency care abroad. Check with your policy for specific coverage rules.
Medicare Advantage Plans may also cover emergency care abroad. Contact your plan for more information about its costs and coverage rules.