Istravel anessential part ofyourretirement experience?If so, thenyou’llneed todosomeplanning.That includesmaking sure you have therightMedicare coverage. Luckily, there aremanydifferentMedicareplansto considerthat may offer you coverage during yourtravels.
So, whetheryou’repreparing fora month in France, a winter in Florida or a weekend away from home,you canget the peace of mind that comes from packing therighthealth coverage for yourjourney.
Exploring the United States
Medicarecan provide excellent health coverageduringyourtravelsinthe United States. Original Medicare,which is what many people call the combination of Medicare Parts A and B, iswidely accepted by health care providersacrossthe country.You just need to confirm that the provider you see accepts Medicare before you receive your care.
“Medicare Advantage plans can be an excellent option fortravelers who want coverage while on the road. Butmembers should check withtheirplansregarding the level of coverage they have while away from home.”
Medicare Advantage (MA) planscan also be a good way to get health coverage while on a trip. MA differsfrom Original Medicarein a few important ways.MA plansare sold byprivatecompanies, andmanyoffer benefits not included in Original Medicare,like dental, vision and hearing coverage.MA plans alsoincludeanetworkof providers.In Health MaintenanceOrganization (HMO)plans you generally need to use one of the health care providers in network to get coverage for a service. Members ofPreferredProviderOrganization (PPO)plans have coverage when they see providers who are out of their plan’s network, although they usually pay more.
Fortunately, there are MA plans that have networksthatincludedoctorsin many different parts of the country. That means if you pick the right MA plan,you’llbe able to find a care provider in your plan’s network in many of the places youtravelin the U.S. In fact,weoffera number ofMA plans designed to provideyouwithcoverage whiletraveling.
Comparing coverage away from home
Original Medicare | Aetna Prime HMO/PPO | Aetna HMO withTravel Advantage | Aetna PPO with Explorer | |
ER and urgent care covered in the U.S. | Yes | Yes | Yes | Yes |
ER and urgentcare covered outside the U.S. | No | Yes | Yes | Yes |
Network pharmacies are available throughout the U.S. | No | Yes | Yes | Yes |
Network providers are available throughout the U.S. | Yes –if the provider accepts Original Medicare | No | Yes –if the provider is in network | Yes –if the provider is in network |
PCP referral required | No | Varies based on plan | Yes | No |
Patient’s medical history provided to network doctors whiletraveling | No | No | No | Yes–whenmedical records are requested bythe planmember |
Comparing coverage away from home
Original Medicare | Aetna Prime HMO/PPO | Aetna HMO withTravel Advantage | Aetna PPO with Explorer | |
ER and urgent care covered in the U.S. | Yes | Yes | Yes | Yes |
ER and urgentcare covered outside the U.S. | No | Yes | Yes | Yes |
Network pharmacies are available throughout the U.S. | No | Yes | Yes | Yes |
Network providers are available throughout the U.S. | Yes –if the provider accepts Original Medicare | No | Yes –if the provider is in network | Yes –if the provider is in network |
PCP referral required | No | Varies based on plan | Yes | No |
Patient’s medical history provided to network doctors whiletraveling | No | No | No | Yes–whenmedical records are requested bythe planmember |
However, to be completely certain of the level of coverage you will receive while on the road,it’simportant tocheck withyourplanregarding the coverageyouhavebeforebeginningyourtravels.
A home away from home
Doestravel means spending an extended amount of time inyoursecond homeorwith family orina long-term vacation rental?During these longer stays,you may need to take an even closer look atyourMAcoverage.
MedicareAdvantageisanationalprogram, but MA plansareoffered to individualsbased ontheirZIPcodes.Thatmeansyou are only eligible to remaininaparticularMAplan if youarein aZIPcode where that plan is offered.In fact, the Centersfor Medicare & Medicaid Services(CMS)requirethat members be disenrolledfrom their MA planif theyliveoutside their plan’s service area for more than six months.
However,there are MA plansdesigned to allow you to stay on your plan even if you spend significant time outside the plan’s service area.Aetnaoffers MA planswith avisitortravel program. This programallowsyouto remainin your planfor anextrasix monthson top of what CMS rules allowwhenyou liveoutsideyourplan’s service area.
How to make sure your Medicare Advantage HMO plantravels with you
Monique C. has a Medicare Advantage HMO plan from Aetna that includes theTravel Advantage feature.Travel Advantage allows Monique to remain in her plan for an extra six months when out of her plan’s service area. It also offersa multistate provider network. She lives in Florida but is planning to spend three months in New York to visit her grandchildren. Here are some steps she should take to enjoyhercoverage away from home.
Before she leaves Florida she should:
- Confirm there is aprimary care provider (PCP)in New York who is in her plan’s network and is taking new patients.
- Find a hospital near where she will be staying in New York that is in her plan’s network.
- Locate a preferred pharmacy in New York near where she will be staying.
- Pack a digital or paper copy of important medical records.
When she arrives in New York she should:
- Change her PCP to a local doctor in her plan’s network.
- Take her medical records with her if she sees her local PCP.
- Make sure other providers are in her network if referred by her local PCP.
How to make sure your Medicare Advantage HMO plantravels with you
Monique C. has a Medicare Advantage HMO plan from Aetna that includes theTravel Advantage feature.Travel Advantage allows Monique to remain in her plan for an extra six months when out of her plan’s service area. It also offersa multistate provider network. She lives in Florida but is planning to spend three months in New York to visit her grandchildren. Here are some steps she should take to enjoyhercoverage away from home.
Before she leaves Florida she should:
- Confirm there is aprimary care provider (PCP)in New York who is in her plan’s network and is taking new patients.
- Find a hospital near where she will be staying in New York that is in her plan’s network.
- Locate a preferred pharmacy in New York near where she will be staying.
- Pack a digital or paper copy of important medical records.
When she arrives in New York she should:
- Change her PCP to a local doctor in her plan’s network.
- Take her medical records with her if she sees her local PCP.
- Make sure other providers are in her network if referred by her local PCP.
Regardless of which MA plan you choose,it’simportant to remember that you still need to follow your plan’s rules while enjoying an extended stay away from home. For example, if your plan requires you to haveyour PCPrefer youto a specialist for care, you need to make sure you select a new PCP near your second residence. Otherwise,you could have difficulty gettingreferredtoa specialist when you need one.
Foreigntravel
Are you planningtravel outside the United States? Youshould be aware that Medicare coveragecan bevery different whenabroad. For instance,Original Medicare generallydoesn’tcover any type of health care while you’retraveling outside the United States, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands. Thereare some exceptions, like a few specialized cases where Medicaremay pay for services that you get on board a ship within the territorial waters adjoining the land areas of the U.S.But for the most part, you havenocoverage for any health care you receive abroad with Original Medicare, including emergency care.
International coverage comparison
Original Medicare
What you need to know
- Provides coverage for any physician who accepts Original Medicare across the U.S.
- Generallydoes NOT provide care outside of the U.S.
Medicare Advantage
What you need to know
- Provides coverage for anydoctorin the Medicare Advantage plan’s network
- Provides emergency and urgent care outside of the U.S.
- Generallydoes NOT cover any follow-up procedures after urgent/emergent care while abroad
Before youtravel outside the U.S., talk with your plan provider or insurance agent to get more information about your coverage whiletraveling.
International coverage comparison
Original Medicare
What you need to know
- Provides coverage for any physician who accepts Original Medicare across the U.S.
- Generallydoes NOT provide care outside of the U.S.
Medicare Advantage
What you need to know
- Provides coverage for anydoctorin the Medicare Advantage plan’s network
- Provides emergency and urgent care outside of the U.S.
- Generallydoes NOT cover any follow-up procedures after urgent/emergent care while abroad
Before youtravel outside the U.S., talk with your plan provider or insurance agent to get more information about your coverage whiletraveling.
There areMedicareAdvantageplansthatoffer forms ofcoverageforemergencycareand urgent care servicesduring foreigntravel. However, coverage and rules vary, so it is important to check with the plan administratoror insurance agentto determine the details ofyourforeign coverage before youtravel.
Packyour prescriptions
Gettingyourprescriptions while on the road is a key part of maintaining your health.That’swhy certainMAplans come with a national pharmacy networkthatallowsyouto pick upyourprescription medications across the United States.
Having a preferred pharmacy network withnationwide reach can save you both time and money when it comes to getting your prescriptionswhileaway from home.
Hit the road
Are you dreaming oftraveling onceyouretire? Abig part of turning thatdream into a reality is choosing theplan that bestmeets yourhealthneedswhile you are on the road. An MAplan can be the right choice for coverage, giving youextrabenefits and access totravel-related perks. However, you need to do your homework to pick the plan that best fits your needs.After all, the right plan is one of the most important items you can take with you on your adventures.
Aetna Medicare isaHMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.The formulary, provider and/or pharmacy network may change at any time. You will receive notice when necessary.Plan features and availability may vary by service area.
About the author
Mark Pabsthas worked as a writer and researcher in the health care field for almost two decades. When not writing about health he tries to stay healthy through activities like hiking, climbing and paddling in the far flung corners of his native state of California. However, despite his best efforts he still has a few unhealthy habits he can’t shake, most notably a weakness for jelly donuts.
