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By Derek Graham
The beginning of summer always makes me think of vacation. When sitting through a long, rainy afternoon at work in the months of April or May, one thing we can always daydream about for a pick-me-up is that summer vacation. Whether you are going to the beach or the mountains, who doesn’t like to get away with family and just recharge with a fun vacation?
But when you have Medicaid or Medicare, have you ever stopped to wonder whether the health care coverage with those programs travels with you?
Since the rules vary between Medicaid and Medicare, I am going to answer this question one program at a time.
Medicaid Travel from State to State
Medicaid coverage is less predictable out-of-state. If you get sick outside of your home state, there is a chance that Medicaid will not cover the cost of your healthcare. Generally, Medicaid health coverage is only available out-of-state, if necessary, in a true, life-threatening emergency that requires immediate care. Part of obtaining coverage will be showing that you did not have time to transport the individual back to their home state for care. This can be very subjective and at times frustrating for clients.
There are exceptions and you can always seek pre-approval of Medicaid coverage for out-of-state care.
One example of a frequent exception is for people who live close to a state border, and it is actually more economical to go to an out-of-state facility. But pre-approval is critical in getting Medicaid to cover out-of-state health care in non-life-threatening situations.
Medicaid International Travel
Medicaid provides no option for coverage outside of the United States.
In fact, if you remain outside the United States for more than 30 days, your Medicaid coverage can be suspended – and it can be hard to get it turned back on.
Medicare Travel from State to State
Medicare (regardless of the plan type) is required to cover urgent care and emergencies anywhere in the United States.
If it is not an emergency, it gets more complicated. If you have original Medicare, you are covered anywhere in the United States. If you have Medicare Advantage Plan, your plan may or may not cover care outside of the plan’s defined service area. You may also have to get prior authorization for coverage outside of your plan area. Be sure to read the fine print!
Medicare International Travel
In most circumstances, there is no coverage through Medicare for health care or supplies you get outside the U.S.
There are only 3 exceptions:
You are inside the U.S. when you have a medical emergency, and a foreign hospital is closer than the nearest U.S. Hospital (picture someone who is camping in the US but close to the border of Canada and has a medical emergency. There is a close-by Canadian hospital and not a close-by U.S. Hospital).
You are traveling through Canada on a direct route to/from Alaska at the time of the medical emergency (if you are staying in Canada or spending vacation time in Canada, there is no coverage—it has to be direct travel).
You live in the U.S. and there is a foreign hospital closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it is an emergency.
Outside of these three circumstances, there is no Medicare coverage outside of the United States.
Conclusion
At RRPG, we love vacations! And we assume our clients do as well. If you are looking to travel (especially internationally) we always encourage clients to explore travel insurance plans that are often affordable and fill in gaps of health care coverage while traveling abroad. If you are traveling within the US, plan ahead with medical supplies and doctor appointments so as to minimize the need for unexpected medical appointments while out of the state.