Medicare Advantage Plans

[Archman]

Will Medicare Advantage Plans cover emergencies and/or urgent care outside the network when travelling within the USA , Canada, overseas?

 

[nun]

Medicare does not pay for care outside the US. Some Advantage plans will cover you anywhere inside the US....some have networks and probably balance billing if you go out of network.

 

[haha]

Although Medicare does not cover outside US, many Medigap policies have some sort of coverage. Medigap policies belong to one or another letter classification. I think that the rules for all issuers under that Letter type are identical. OTOH Medicare Advantage is a form of subsidized private insurance. When enrolled in a Medigap Plan, the insurance company stands between you and Medicare, and the plan specifications vary. So you must look carefully at any plan that interests you.

Ha

 

[Ally]

Our Medicare advantage plans pays for emergencies outside the US. We haven't tried it, but it says it does.


Sent from my iPhone using Early Retirement Forum

 

[Archman]

After doing some research, I found on Humana's website:

"Humana Gold Plus plans cover all the benefits of Original Medicare and much more, including:..................................................
Emergency coverage when you travel outside the U.S."


On Anthem's website:

"........$75 copay for limited coverage of urgent and emergency care
outside of the United States. This plan may provide coverage
up to a $25,000 limit."

 

[travelover]

..............

"........$75 copay for limited coverage of urgent and emergency care
outside of the United States. This plan may provide coverage
up to a $25,000 limit."

How long does $25,000 last out of network? Overnight?

 

[meierlde]

After doing some research, I found on Humana's website:

"Humana Gold Plus plans cover all the benefits of Original Medicare and much more, including:..................................................
Emergency coverage when you travel outside the U.S."


On Anthem's website:

"........$75 copay for limited coverage of urgent and emergency care
outside of the United States. This plan may provide coverage
up to a $25,000 limit."

UHC/AARP limit for emergency care is 50k (lifetime).

 

[calico1597]

I'll be going on Medicare next spring, so I've started learning what I can and asking questions. We are snowbirds, going to AZ every winter. I was told by an insurance agent snowbirds should NEVER take out an Advantage Plan with Medicare.

 

[Peter]

How long does $25,000 last out of network? Overnight?

In many parts of the world that would pay for major surgery.

 

[MBSC]

Within the U.S.: MA plans cover Out-of-Network emergency and urgent care. You can not be balance billed if enrolled in a PPO or HMO plan, but may be balance billed in PFFS plans.

Outside the U.S.: Coverage depends on the MA plan. Refer to the plan documents or contact the plan's customer service number. Six of the ten Medigap plans cover foreign travel emergencies but have a lifetime limit of $50k. Where coverage is offered, you may be responsible for paying the provider then submitting bills and receipts to the plan for reimbursement.

Some Medicare Advantage plans may provide worldwide coverage benefits for health care needs when you travel outside the United States. You should check with your Medicare Advantage plan prior to traveling outside of the United States regarding worldwide coverage benefits.

Reference: Do I have Medicare coverage when travelling abroad? - AARP

Balance billing is prohibited for Medicare-covered services in the Medicare Advantage program, except in the case of private fee-for-service plans.

Reference: Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services | The Henry J. Kaiser Family Foundation

Under a Medicare Advantage plan, providers aren't allowed to use balance billing (except for PFFS plans).

Reference: https://www.ehealthmedicare.com/about-medicare/medicare-pffs-vs-medicare-advantage/?redirectFromHTTP

 

[Bikechuck]

UHC/AARP limit for emergency care is 50k (lifetime).

Thank you for posting this, I will be purchasing Medicare gap insurance in the next year or so and I was not aware that UHC/AARP had a $50K lifetime limit for emergency care.

Is that a lifetime limit for emergency care outside the U.S. or does the limit also apply to emergency care within the U.S.

This is something that I likely would not have thought to pay attention to when evaluating my choices so I am grateful for your post.

 

[travelover]

In many parts of the world that would pay for major surgery.

And in many parts of the US, it wouldn't get you out of the ER room.

 

[ivinsfan]

Sounds to me like the poster was just saying 25K gives you more coverage overseas then it does at home, not recommending that have your medical care done there regularly.

 

[travelover]

Sounds to me like the poster was just saying 25K gives you more coverage overseas then it does at home, not recommending that have your medical care done there regularly.

What I'd worry about is being out of network but within the USA.

 

[Gotadimple]

I'll be going on Medicare next spring, so I've started learning what I can and asking questions. We are snowbirds, going to AZ every winter. I was told by an insurance agent snowbirds should NEVER take out an Advantage Plan with Medicare.

True. That's because the plan expects that you will be living in the state where you took out the plan the majority of the year. You would be denied coverage if you are a snowbird.

 

[MichaelB]

I'll be going on Medicare next spring, so I've started learning what I can and asking questions. We are snowbirds, going to AZ every winter. I was told by an insurance agent snowbirds should NEVER take out an Advantage Plan with Medicare.

True. That's because the plan expects that you will be living in the state where you took out the plan the majority of the year. You would be denied coverage if you are a snowbird.

Definitely. The Medicare Advantage plans only have a couple of ways to carve out their profit, and a limited network is by far the easiest.

We spend our year between different locations and definitely intend to enroll in traditional Medicare with MediGap.