Hey Medicare Nation!
It's almost Spring time! For many people, this has been a terrible winter. Many Medicare Nation listeners have been emailing me to find out if Medicare covers "Emergencies" while traveling across the U.S. or abroad.
That's a great question!
Original Medicare and Medicare Advantage Plans Do cover "Emergency Care" AND Urgent Care ANYWHERE in the United States and it's Territories.
An "Emergency" is Life-Threatening. An example would be if you were having chest pain and you believed you were having a heart attack. In this situation.....you would go to the nearest hospital to seek emergency care.
Even if it turns out you were diagnosed with "heart burn," Original Medicare AND Medicare Advantage plans will cover the medically necessary treatment for this situation because you believed you were in a "life-threatening" situation.
"Urgent Care" is defined by Medicare as:
Care that you get outside of your Medicare health plan's service area for a sudden illness or injury that needs medical care right away but isn’t life threatening. If it’s not safe to wait until you get home to get care from a plan doctor, the health plan must pay for the care.
An "Urgent Care" example would be if you were walking in St. Peter's Square at the Vatican, and you slipped on a banana peel and fell onto the ground, breaking your ankle. That's an injury that isn't life threatening, but requires immediate medical care.
So......if you are traveling ANYWHERE in the U.S. or it's Territories, AND you have an Urgent Care or Emergency situation.....you can go to the nearest hospital or Urgent Care Center to receive care AND it will be covered by Original Medicare and Medicare Advantage Plans.
If you are traveling outside of the U.S. Medicare generally DOES NOT cover emergencies or urgent care needs.
There are a few circumstances where Original Medicare WILL cover Emergency Care AND Urgent Care.
1. If you are on a CRUISE and you require EMERGENCY care from a doctor who is stationed on the ship while the ship is in a U.S. port.....Your Emergency Care WILL be covered by Original Medicare.
2. If the ship is Departing or Arriving to/from a U.S. port within 6 hours and you have a medical emergency and require to be treated by the ship's doctor......Your Emergency Care will be covered by Original Medicare.
3. If you are in Alaska and you are traveling directly to another State without unreasonable delay, and you require Emergency Care at a hospital in Canada, because it was the closest hospital at the time of the emergency......Your Emergency Care will be covered by Original Medicare.
If you have a "Medicare Advantage Plan," you may have coverage for Emergency and/or Urgent Care Coverage on your plan.
You must do your own due dilligence to understand the benefits of your plan while you are traveling abroad.
Some Medicare Advantage Plans have a deductible for emergency care outside the U.S.
Some Medicare Advantage Plans have a deductible and a co-pay for emergency care outside the U.S.
There is an annual maximum out-of-pocket amount for your plan. Some are around $1,500.00 all the way up to $6,700.00
READ Your Plan's EVIDENCE OF COVERAGE Booklet.
Some of you have "Medi-Gap" or Supplement to Original Medicare Plans.
Plans "C" through "G" and also plan "M" and "N" have coverage for Emergency Care while traveling abroad.
Some Medi-Gap plans have a deductible. Some plans have "Maximum Lifetime Amounts." It is important to READ your Medi-Gap Policy to determine coverage while traveling abroad.
I always recommend purchasing "Travel Insurance," while traveling abroad.
I use these different websites to look for policies:
Cost will depend on -
a. Total Cost of the Trip
b. Your Age
c. What country you're visiting
d. Types of coverage you're adding (ex: Air evacuation, cancel for any reason etc.)
If you have ANY questions, and I can answer your question in ONE paragrapn, send them to me by email.
If I need to do research or write more than one paragraph, I will let you know that I am available for a consultation to solve your problem at $150.00 an hour.
Reach out to me.....I answer all emails personally!
Thanks soo much for listening to Medicare Nation!
I appreciate your time and I love to educate you on all things Medicare!