William C. Lane, Ph.D.
Health insurance coverage is probably the last thing on your mind when you jump in the car and head to Pennsylvania for a festival or Canada for a short weekend.
But emergencies arise. So, before embarking on that dream vacation or just taking a quick trip outside of New York, you need to understand the travel benefits provided by Medicare.
Using original health insurance outside of New York. Original Medicare works in all states and will be accepted by any provider that accepts Medicare. However, always make sure that the practitioner providing the service accepts the assignment from Medicare. If they don’t accept the Medicare assignment, you may be asked to pay for the service up front and collect it later from Medicare. If you are traveling to a foreign country, including Canada and Mexico, Original Medicare will generally not cover your care. However, there are exceptions.
If you are traveling through Canada on a direct route without reasonable delay, the nearest provider in Canada should accept your Medicare coverage. But the provider has no obligation to file the health insurance claim, so you may have to file the claim yourself. If you are traveling along the Canadian or Mexican borders and within the United States, in the event of an emergency, you will be taken to the nearest hospital for treatment. If a Canadian or Mexican hospital is closer than the nearest US facility and is equipped to treat your condition, you will likely be taken there and should be fully covered.
Additional insurance cover. If you are traveling to the United States, any type of supplementary insurance policy is generally valid throughout the country. These plans must be accepted by any provider that accepts Medicare, even if the hospital or clinic tells you they’ve never heard of your plan. The premiums for adding coverage outside the United States to your supplemental plan can be quite expensive. So, if you rarely travel abroad, you might want to consider getting travel insurance right before your trip.. Consumer Reports recommends the https://www.insuremytrip.com/ website as a starting point for checking out travel insurance options.
Medicare Advantage Plans. All Advantage plans will cover you in the event of a true emergency, such as a skiing accident in Vermont. You usually only need to inform your plan of the emergency within 24 to 48 hours of arriving at the emergency room. Also, always show the emergency room your Advantage card. The hospital will bill the carrier based on the card you give them.
If you are traveling “off the grid”, further coverage will depend on your plan rules. The location, duration and type of treatment you need will all be specified in the rules. You should be aware that if you travel outside the network area for more than six months, you will automatically be unenrolled and reinstated in Original Medicare if you do not choose another Advantage plan. If you spend more than six months a year outside New York (long winter stays in Florida for example) make sure you have a plan that will cover your needs without the possibility of unsubscribing.
If your Advantage plan says it’s a “national plan”, are you still covered? You will certainly be covered for an emergency but not necessarily for the management of a chronic condition. So you should always check that your plan has practitioners at your destination who are considered part of your network.
Prescription drug refills for travel. Travel rules for Original Medicare and Advantage plans also apply to Part D drug plans. You should always carry extra medications with you when you travel. If you need to get an early refill, see your pharmacist for help.
Second COVID-19 booster shot. As advertised on the Medicare.gov website, “If you are 50 or older, or moderately to severely immunocompromised, you may receive a second booster of the COVID-19 vaccine at no cost to you.” This must be at least 4 months after your first reminder. Also, this second booster must be a Pfizer or Moderna booster. It doesn’t have to be the same as your original COVID-19 vaccine, you can mix and match it.
As with other COVID-19 vaccinations, Medicare will pay the full cost of this second booster. There are no deductibles or copays and your provider cannot charge you an administration fee to give you the shot. As with all medical procedures, if you have any questions about receiving this reminder, consult your physician or health care provider.
HIICAP in Oneida County. HIICAP counselors at the Oneida County Office for Aging/Continuing Care are available to help provide more information about Medicare and all insurance-related questions:
The Oneida County HIICAP Office continues to provide in-person counseling and appointment services over the phone, as they have done throughout the pandemic. If you would like to do a HIICAP counseling session over the phone or schedule an appointment at either of the two in-person locations, call 315-798-5456 and select number 2 from the list of choices. In most cases, you will be asked to leave your details on a voicemail and a member of staff will call you back within 72 hours (3 working days).
Copper City Community Connection, 305 E. Locust St., Rome will offer support on Thursday afternoons. The HIICAP program will also be scheduled in Copper City.
NOTNorth Utica Senior Citizens Center, 50 Riverside Drive, Utica has hours of operation from 9 a.m. to 3:15 p.m. on Fridays only. Sessions should last 45 minutes. Call the HIICAP office to make an appointment.
Contact HIICAP programs in other counties. Here is contact information for HIICAP programs in several counties that border Oneida County. To reach the Madison County HIICAP program, call 315-697-5700 and ask to speak with a HIICAP counselor. For Herkimer County, call Catholic Charities of Herkimer County at 315-894-9917. For Lewis County call 315-376-5013 and select number 2 from the list of choices.
Dr. William Lane is the owner of William Lane Associates, a gerontology consulting firm located in Homer, NY. He writes a monthly column on HIICAP issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company, or recommend any insurance product.
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