Retirement can give you more time to see friends and family, go to your favorite get away spot or explore new areas. But what happens if you need medical care or need to fill a prescription while away from your city or state and in the U.S.?
The answer depends on what plan type you are enrolled in. We will break down coverage details below so you can get the coverage you need and enjoy your time away.
Original Medicare Parts A and B
You can visit any provider across the United States that accepts Medicare. Just show the provider your red, white and blue Medicare card. Coverage is the same as being in your home state.
Medicare Supplement Plans
Medicare Supplement Plans pay second to Medicare Parts A and B and follow the same network rules. You can see any provider that accepts Medicare. When you check in with the provider show your red,white and blue Medicare card first and then show your Medicare Supplement Plan card.
Medicare Advantage Plans (Part C)
Medicare Advantage Plans are network based and have different rules deepening on which plan type you are enrolled in.
HMO- Health Maintenance Organization
If your plan is an HMO you are required to use In-Network providers unless in an emergency situation. If you need to seek medical care outside the plan's network you would need to go to the Emergency Room. Some plans may offer a travel benefit. Consult your plan's Evidence of Coverage for details or call the plan's customer service number before you leave for your trip.
PPO- Preferred Provider Organization
If your plan is a PPO you can use In-Network or Out-of-Network providers. Out-of-Network providers may have higher copays or coinsurance however these plans do offer more flexibility. You also can visit any Emergency Room across the U.S. and obtain care. Some plans may offer a travel benefit. Consult your plan's Evidence of Coverage for details or call the plan's customer service number before you leave for your trip.
Part D - Drug Coverage
If you are enrolled in a stand-alone Part D Drug plan or your Part D Drug coverage is included with your Medicare Advantage Plan, the same rules apply to how you can fill scripts while traveling in the U.S.
You can fill your prescriptions at any preferred or standard In-Network pharmacy across the U.S. If you do choose to fill at an Out-of-Network pharmacy, you are responsible for all retail costs and your expenses are not included in the calculations towards the coverage gap.
Speak With a Licensed Agent
Perfiniti knows Medicare can be confusing and there are a lot of rules to remember. You can reach out to a Perfinit Licensed Agent at any time you have questions about your plan options and coverage at 888.885.8361