Original Medicare can be used in all 50 states, as well as in the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the Virgin Islands. The same isn’t true for Medicare Advantage plans. These plans have defined service areas and may not cover out-of-state care, with the exception of emergency and urgent care situations.
Generally, seniors need to see doctors who are in their Medicare Advantage plan’s network. Before traveling out of state, seniors should contact their plan to find out if there are any in-network providers at their destination.
Seniors who see out-of-network providers may need to pay the full cost of any services they receive. Some Medicare Advantage plans may offer coverage for out-of-network providers. Depending on the plan’s terms, seniors may pay a higher co-payment or coinsurance for these services.
Urgent and emergency situations are exceptions to these rules. Medicare Advantage plans must cover these situations anywhere in the United States. The plans can’t charge additional costs for these services.
Some Medicare Advantage plans provide special coverage for travelers. These benefits may be called visitor or travel benefits, depending on the plan. Seniors who are enrolled in these plans may be able to use their coverage outside of their home state.
Visitor or travel benefits may vary between plans. Coverage may only be available in certain areas, and the plan may not cover some types of care. To learn what travel or visitor benefits their plan offers, seniors can check their Evidence of Coverage. This document provides detailed information about covered services. They can also call their plan for more details.
While some Medicare Advantage plans can be used out of state, these plans usually don’t provide coverage outside of the U.S. Seniors who are traveling out of the country may choose to purchase travel medical insurance.
In limited circumstances, Medicare Advantage plans provide coverage outside of the U.S. For example, if seniors are traveling between Alaska and another state and must pass through Canada, Medicare may pay for emergency care provided in a Canadian hospital. Medicare also pays for medical care seniors receive on cruise ships, provided the ship is in U.S. territorial waters.