As seniors venture overseas whether for recreation or new living arrangements, a key question to ask is what benefits travel with them. While Social Security benefits follow Americans to other countries, basic Medicare likely will not and seniors may need to be prepared for alternate arrangements.
First, while Medicare does cover residents of Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands, except for some rare cases of inpatient hospital services in Canada or Mexico, traditional basic Medicare does not provide coverage for hospital or medical costs outside the United States.
These rare cases for inpatient hospital services in Canada or Mexico relate to three possibilities. One is that you live in the U.S. near a foreign hospital and need emergency or non-emergency treatment and the foreign hospital is closer or easier to get to from home than the nearest U.S. hospital. Secondly, if you are in the U.S. when you have a medical emergency and the hospital in Mexico or Canada is closer than the nearest U.S. hospital that can treat the emergency, Medicare might cover. Third, if you are crossing through Canada on your way between Alaska and another state and experience an emergency and the Canadian hospital is closer than any hospital in the U.S., there might be coverage.
Since most circumstances do not involve these three exceptions, other alternatives need to be explored.
Examine the plan and get information first before travelling. First, travelers and Americans living overseas should review their Medicare Advantage or Medicare Supplement plans before leaving home and call to ask if there are questions. Some Medicare Advantage coverage may come with worldwide travel benefits. However, generally speaking Medicare Advantage plans do not travel well. They might not even cover in other locations in the U.S. outside their territory. Even if it does, you might need to pay first and file a claim. Some Medigap (also referred to as Medicare Supplement) plans might also provide Foreign Travel emergency health care for travel outside the United States. Find out first.
Consider travel insurance. Medicare recipients who are traveling might also seriously consider buying a short term travel insurance policy to cover health care expenses in other countries. Travel coverage could include evacuations such as when an accident or illness occurs on a cruise ship or in remote or difficult areas with limited access to health care.
One source for information regarding health insurance for traveling and for living abroad is the U.S. Department of State website, Bureau of Consular Affairs at www.travel.state.gov, International Travel/Before You Go/YourHealth Abroad. You can also check www.aarp.org. Another, obviously is your own insurance company or insurance agent.
Answers could be sought for such questions as: What questions should I ask my health insurance company? Can the U.S. government assist me if I become disabled overseas? Where do I find a list of physicians abroad? What insurance information should I carry with me abroad? Where do I find a list of U.S.-based air ambulance/med-evac companies? Or foreign-based air ambulance/med-evac companies? Or U.S.-based travel insurance companies?
For Americans considering moving to other countries, options are limited. If the retiree is moving to a country with strong national health insurance coverage, he or she could explore buying into a plan in the country of destination to receive coverage comparable to other residents. Also, some insurers may offer “expatriate” health insurance plans. All of these plans would need to be investigated to insure that they handle the needs of the American moving abroad.
On returning to the United States, Medicare enrollees who lived overseas should remember that they are returning to the U.S. Medicare system or Medicare Advantage with all of the usual Medicare rules.
If the American living overseas did not keep up his or her Medicare Part B payments and Medicare Part D while living or traveling in other countries, he or she would be subject to the same rules regarding penalties as Americans who remained at home. So, if there is a likelihood of return, consider paying Medicare B and D premiums while abroad.
In brief, if you are traveling or moving overseas, you should spend some time determining health insurance options. Do not leave home without them.
Janet Colliton, Esq. is a certified elder law attorney. Her practice, Colliton Elder Law Associate, PC is limited to elder law, life care, special needs and estate planning and administration, with offices at 790 East Market St., Suite 250, West Chester, 610-436-6674, [email protected] She is a member of the National Academy of Elder Law Attorneys and, with Jeffrey Jones, CSA, co-founder of Life Transition Services LLC, a service for families with long term care needs.