Medicare Advantage Plans and Travel

Q– I am enrolled in a Medicare Advantage plan and I’m planning on taking a road trip across the United States.  Will my Medicare Advantage Plan cover health care I get outside the state where I live?

A–

Each Medicare Advantage Plan, also known as a private health plan, has its own rules.  Most of the Medicare Advantage plans have set coverage areas.  This is the geographic area that you must live in to be enrolled with the plan.

Travel outside of the service area can affect both the eligibility to stay in the plan and coverage of care.

First, if you travel continuously outside your plan’s service are, for six months or more, most plans must automatically disenroll you from their plan.  If you are disenrolled from the plan you will automatically go back to Original Medicare, but if your plan included Medicare Drug Coverage you will have lost your drug coverage.  If this happens you have 63 days to choose a new drug plan because you were dropped from you Medicare Advantage Plan.

Some plans may offer special benefits that allow you to stay enrolled in the plan if you plan to travel continuously for six to 12 months.  This is sometimes called a visitor/travel benefit.  You will need to look at the rules closely to see how the care will be covered.  Only certain areas may be included. also the care may not be covered or they may pay more if they see providers that are not in the plan’s network.

If the plan is a HMO it more than likely will not cover care received from doctors who aren’t in the plan’s network without prior authorization, if they allow it at all.

If the plan is a PPO, the plan must pay for doctor’s who aren’t in the network, but you will pay a higher copay.

Even if the plan does not usually cover care when you travel within the US for six months or less, it must still cover urgent or emergency care.  Charges for the emergency room services must be no more than $50 or what you would have paid had you received services in network.

It is important to always look at the plan benefits carefully to see what the costs and rules are when traveling within the US and it’s territories. 

If the plan denies coverage you always have the right to appeal.

Posted on February 8, 2011, in FAQ's, Medicare Part C and tagged , , , , . Bookmark the permalink. Leave a comment.

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