What You Need to Know About Medicare While on Vacation

Will Medicare Advantage cover me on vacation?

The answer depends on the plan, the provider and the type of care you need.

Because most Medicare Advantage plans have provider networks, whom you see for care matters. If the doctor or place of care isn’t in network, you may have to foot the bill yourself or have a high copay. Each plan’s coverage varies.

All Medicare Advantage plans must cover emergency care and urgent care in the U.S. as in-network services, even if the facility isn’t in the plan’s network. Copayments may be different than original Medicare’s. For example, one plan may charge a $135 copay per visit for emergency care and $50 for urgent care whether the provider is in or out of network.

After your condition is stable, you or the doctor treating you should contact the plan and discuss the next steps for your care, says Chrissie Cooper, senior vice president of government programs for Kaiser Permanente. The member may need the plan’s approval for additional services.

Advantage plans may cover walk-in clinics, other providers

Some Medicare Advantage plans consider convenience care and walk-in clinics in their networks. Ali Khan, M.D., Medicare chief medical officer for Aetna, says members of Aetna’s Medicare Advantage preferred provider organization (PPO) and health maintenance organization (HMO) plans that don’t require a primary care provider can visit a nationally contracted retail health clinic and pay the same copay as for a regular visit to a primary care provider. This includes MinuteClinics, which contract with most Medicare Advantage plans. 

If you need to visit a doctor while you’re away from home, some MA plans have national or regional networks, so you may find a participating provider. 

For example, about 73 percent of UnitedHealthcare’s standard Medicare Advantage members have access to more than 1 million providers in its national network. But not all UnitedHealthcare contracted providers participate.

“Tools on our member website and mobile app are available for members to look up network providers in whatever zip code they happen to be in when they need care,” says Amanda Weigel, senior product director of UnitedHealthcare Medicare and retirement. She recommends downloading the plan’s mobile app and having your member ID and customer service phone number on hand while away. 

Most Humana MA PPO plan members have access to the national provider network when traveling. Some MA HMO plans include a visitor/traveler benefit that allows members to receive services when traveling that would be covered at home and pay in-network costs. Here, too, contact the plan to check on benefits and find providers.

Some plans, such as Kaiser Permanente, also cover 24/7 access to virtual care while traveling.

Can I use my Part D plan when traveling?

Yes, most Part D prescription plans are national and can be used anywhere in the U.S. You typically will have lower drug copayments if you use a preferred pharmacy; an in-network pharmacy’s won’t be as low but will be better than an out-of-network pharmacy’s.

“Medicare Part D plans are transportable and are national plans in most cases,” Greiner says. “It is important for a beneficiary to use a preferred pharmacy wherever they are located to ensure they have the lowest cost possible.”

If you need medication while traveling, call your health plan or visit its website for preferred or in-network pharmacies nearby. Many plans, including Aetna and UnitedHealthcare, have national chain pharmacies as part of their preferred network. 

“Medicare drug prices are based on the relationship between multiple factors, including the Part D plan, the pharmacy and the drug,” says Michelle Grochocinski, elder benefit specialist and SHIP program director for the Wisconsin Department of Health Services. “Drug prices can vary by pharmacy under the same Part D plan. In-network and preferred in-network pharmacies will have the lowest prices. Some Part D plans’ pharmacy networks are nationwide, but others are not.” 

If you take essential medications, look for a preferred pharmacy in your travel area before you go, in case you leave some pills at home or run out. Otherwise, ask your doctor about ordering a three-month supply of your prescriptions, or find out whether the plan’s mail order service will deliver to the area you’re traveling. 

Options for foreign travel emergency coverage

Medicare rarely covers foreign travel emergency care except in limited circumstances, but there are other options.

Some Medigap plans offer coverage with a lifetime limit of $50,000. They typically pay 80 percent of the cost for medically necessary emergency care you receive outside of the U.S.

Plans C, D, F, G, M and N cover emergency care outside of the country. Plans C and F are no longer available to new Medicare beneficiaries.

Medicare Advantage may have limited coverage.

Tricare for Life, which can supplement Medicare coverage for military retirees, provides the same foreign travel coverage that military retirees and their eligible dependents have before enrolling in Medicare.

Some travel insurance policies cover emergency care in a foreign country and medical evacuation to a nearby medical facility or back to the U.S. Find out about exclusions, preexisting condition limitations and coverage limits before choosing a policy.