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Do homework to ensure away-from-home coverage

Agriculture.com Staff 11/12/2008 @ 11:00pm

As Thanksgiving recedes into the rearview mirror and Christmas looms around the corner, travel to warm climates is an inviting option for many Americans.

No one wants to imagine that a medical emergency or chronic health condition could spoil the trip of a lifetime. But it's wise to be prepared.

Your policy will protect you in the U.S., but coverage across state lines isn't likely to offer complete outside-of-network coverage.

Kay Winn, Rich Square, North Carolina, learned this truth the hard way. "When we bought our plan, I asked and was reassured it wouldn't be a problem," she says.

Several years ago their daughter was hospitalized with viral meningitis on a holiday weekend. "The insurer threw out $13,000 from the out-of-state medical center," she says. "I had to ask the admitting neurologist and the family doctor to write letters saying it wasn't possible to move her without endangering her life after I got her to a point of care.

"We got all but $800 covered," she adds. "But the moral of the story is no matter what a salesperson says, the policy is only what's written."

As more seniors pull up stakes for the entire winter, medical and prescription coverage is a major issue.

"Medical coverage will vary with how you receive your Medicare benefits and where you travel," says Kris Gross, Senior Health Insurance Information Program, Des Moines, Iowa. "In the U.S., Medicare covers care, but claims will be handled by the company that processes claims for the state where care is received."

If you're enrolled in a Medicare Advantage plan and travel outside your plan's service area in the U.S., urgent and emergency care must be covered by the plan.

Foreign travel is a different proposition. Medicare may pay for care in a foreign hospital in three situations:

1. You're in the U.S. when an emergency occurs and the foreign hospital is closer than the nearest U.S. hospital that can treat the illness or injury.

2. You're traveling through Canada on the most direct route between Alaska and another state when an emergency occurs and the closest hospital is Canadian.

3. You live in the U.S. and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat your condition, regardless of whether it's an emergency.

In most situations, Medicare will not pay for medical services provided on a cruise ship.

Some Medicare Advantage plans (Medicare HMO, PPO, or private fee-for-service plan) may include coverage for care outside the U.S.

Several Medicare supplement insurance policies cover foreign travel emergency coverage. Not all travel insurance includes health insurance.

"Very few health insurance companies will pay for a medical evacuation back to the U.S.," says Carol Mueller, AIG Travel Guard, Stevens Point, Wisconsin. "The cost easily could be $10,000 and up."

Ask if the insurer has a 24-7 travel medical assistance number that you can call prior to an evacuation.

Take a letter along from your physician describing any preexisting medical condition and listing prescriptions (include generic names).

Many Medicare drug (Part D) plans are national plans with pharmacy networks across the U.S. But before you travel, contact your plan to locate participating pharmacies or discuss shipping prescriptions. Part D plans don't cover the cost of prescriptions outside the U.S.

As Thanksgiving recedes into the rearview mirror and Christmas looms around the corner, travel to warm climates is an inviting option for many Americans.

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