Will You Need Non-Emergency Medical Care While Traveling?
This is the second in this series. To start at the beginning, go to 5 Questions to Ask Before Enrolling.
Imagine yourself in an emergency room far from home. The ER doctor wants you to undergo an expensive test after your accident. You thought you were fine, but the nurses look worried. So, you’re worried. You’re worried that you’ll have to pay 100% of the cost of this emergency room visit because you are in an out of network hospital and your plan has network restrictions.
Maybe you don’t need the test. But maybe you do. You want to make the right decision, but you’re worried about the cost.
Then suddenly the worry goes away because you remember reading this next sentence. Network restrictions vanish in a puff of smoke during medical emergencies so long as you are in the US. Now you can relax and make a clear-headed decision about the tests the doctors want.
Fear of network restrictions shouldn’t keep you from enrolling in a low-cost Medicare Advantage policy even if it is an HMO. At least not until you understand how and when they apply.
A Medicare Supplement Plan will give you the freedom of getting medical care from any US doctor who accepts Medicare (which is almost all of them). Most Medicare Advantage Plans limit you to a network of doctors and other providers. So, if you will need non-emergency care when visiting your sister in another state, you will probably be better served with a plan with no network restrictions
During a medical emergency, your network restrictions will disappear so long as you are in the United States. You will be responsible for the same copay or other cost-share you’d pay if you visited your local in-urgent care center or hospital
Most Medicare Advantage Plans are less expensive than most Medicare Supplement Plans, but they restrict you to the doctors and other providers in their network. Those that don’t have network restrictions have other restrictions or additional costs if you need non-emergency care away from home.
Some network-based Medicare Advantage Plans (PPO and similar plans) will cover out-of-network visits, but you will pay a higher copay or other cost share for services. Also, some Medicare Advantage Plans (PFFS plans) do not have network restrictions, but doctors are allowed to refuse to honor your coverage on a case-by-case basis.
Freedom or cost, which is more important? This is the main question to ask when selecting between the two categories. A Medicare Supplement Plan will give you the freedom to see virtually any US doctor. Most Medicare Advantage plans will restrict you to a network for non-emergency care, but will probably cost less.
The Bottom Line
If you think you will need scheduled or non-emergency care while traveling you will be probably be better served with a Medicare Supplement plan (Medigap Plan) than with a Medicare Advantage Plan.
In the next post we will answer the question “Which policies include your prescriptions on their formulary (list of covered drugs)?”
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To start at the beginning of this series click here.