Medicare Portability or, Am I Covered When I’m Away From Home?

Posted on Posted in Client Testimonial, Medicare supplement, Part C Medicare Advantage

With a middle schooler at home, retirement remains a few years away for me.  Still, I am looking forward to when the schedule may be a little less hectic and there’s more free time to travel and explore. (And with cell coverage and internet access I will still be serving clients like you, perhaps with a laptop by the poolside. 😎)

And since I’ll be over 65 when William finishes school I, too, will be wondering how my Medicare coverage will work while traveling outside of New York or the US. So what are your options today?

 

Option 1: Let’s start with Original Medicare

That’s your Red, White and Blue card. Original Medicare is accepted by participating providers and facilities throughout the US defined as the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.  (When traveling outside the US, Medicare may pay for doctor visits, inpatient hospital care in rare cases. It’s best to assume not and visit the Medicare web site for updates before traveling overseas.)

Ok, but Original Medicare Doesn’t Pay Everything

Since Medicare Parts A and B include deductible and unlimited co-insurance amounts (assume 20%) that are your responsibility, many retirees purchase a Medicare Supplement Insurance policy that is accepted by providers and facilities throughout the US alongside Orginal Medicare.  This combination of Original Medicare paying 80% with a Medicare Supplement plan paying the remaining 20% gives Medicare beneficiaries the greatest flexibility in seeking care at any provider or facility accepting Medicare anywhere in the US. This Option 1 provides the most flexibility as there are no in-network / out-of-network concerns. 

Option 2: Medicare Advantage Regional or Local PPO 

All Medicare Advantage PPO (Preferred Provider Organization) plans include a network of healthcare providers within a Regional (one or more states) or Local (one or more counties with a state) geography.  When you travel within the PPO network area (Buffalo to Albany to Manhattan, for example) your Regional PPO will include participating providers who can provide care “in network.”

Some national companies, like United Healthcare and Aetna, have plans and provider networks in all states and often allow members to seek elective (non-emergency) care when away from home from their providers in those other states where there is a comparable plan.  I was pleased to receive this note from my New York client who used the United Healthcare Regional PPO’s “Passport” feature enabling him to receive non-emergency care in Florida just as if he was home. While traveling outside of your local network area, Option 2 isn’t as convenient as Option 1 yet, with a national company, you may have access to providers at home, or in network, copay levels.

Option 3: Medicare Advantage HMO

A Medicare Advantage HMO (Health Maintenance Organization) requires you seek non-emergency care from providers and facilities in your home network.  Emergency service healthcare outside of your home region is always covered and considered “in network,’ however the definition of emergency may not be as broad as we like.  As with the PPO some national companies, like United Healthcare and Aetna with plans and provider networks in all states, allow local HMO members to seek non-emergency care when away from home from providers in those other states where there is a comparable plan.  Check around: you may find regional and local HMO plans not having a nationwide network available to you. If that’s the case, be prepared to have HMO coverage for emergency services only while traveling. 

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