Does My Health Insurance Cover Travel to Another State?

There’s no better way to clear a room than to start talking about health insurance. However, it becomes a little more interesting when your health is at risk, and it’s desperately needed. This article is the first in a series that covers health insurance for travelers. I’ll explore scenarios that range from the occasional U.S. vacationer to long-term ex-pat and explain what type of insurance you’ll need in each instance.

Vacations in the U.S.

Pre-Medicare:

If you are younger than 65 and have health insurance, it will most likely be through your employer, the Health Insurance Marketplace, or a private health insurance company. It’s always smart to check your policy before a vacation to verify you’re covered at your destination. I’ll try not to harp on this recommendation repeatedly, but each insurance policy is different, and you must refer to it for any questions you might have. I know reading through an insurance policy is the equivalent of chewing tinfoil, but it’s necessary. If you want to save time, call your insurance company’s customer service line and ask them any question on your mind – but if you’re paranoid like me, make sure they point you to the wording in your policy that confirms their answers.

Emergencies:

The good news is your health insurance policy should cover you in the case of an emergency as long as you are in the U.S. or its territories. HealthCare.gov defines an emergency as – “An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.” All health care policies in the U.S. should have similar language.

Sometimes you might get a surprise bill after receiving emergency treatment out of state.

Surprise Bill Balance Billing

This occurs when your insurance company is unwilling to pay the entire amount charged for the services you received. This procedure is called balance billing, and it happens approximately 20% of the time in emergencies. The good news is recent legislation has eliminated it starting in 2022.

Supplemental travel insurance can be purchased if you are concerned about receiving an unexpected bill before the law changes. You might also be covered for accidents through your travel credit card – check your agreement.

There are currently state laws that apply to balance billing, and you can find state-by-state information here. Your state may outlaw the practice. If your state lacks legislation and you experience balance billing, there are steps to reduce or eliminate the bill you can find here.

Non-Emergencies:

Your coverage area for non-emergency health care will be outlined in your insurance policy. Your service area is often limited to your state or region. These restrictions shouldn’t be a major concern to the occasional traveler worried about being covered in an emergency.

The COVID-19 pandemic has been a miserable experience, but a silver lining is improved telehealth technology and availability. You may be able to jump on a video conference with your doctor, receive a diagnosis, and even obtain a prescription, depending on state laws. Check with your health care provider for options.

Medicare:

Once you turn 65, you’re eligible for Medicare. Luckily, your situation simplifies as long as you remain in the United States.  

Emergencies:

Original Medicare and Medicare Advantage plans will cover you in an emergency throughout the U.S. and its territories. However, if you’re going on a cruise, consider supplemental insurance even if you’re staying in U.S. territorial waters.

Non-Emergencies:

As long as you visit doctors and hospitals that accept Medicare, you are covered in the U.S. and its territories for non-emergency care when traveling. Medicare also covers telehealth services if you’d like to work with your doctor from home.

Summary

Before traveling, check your health insurance policy and make sure you’re covered in your destination. Any holes in coverage can be filled with a travel insurance policy or potentially with your credit card. It also makes sense to familiarize yourself with the telehealth services offered by your doctor.


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    Financial Advisor David Tuzzolino

     

    David Tuzzolino, CFA, CFP®, is the Founder and CEO of PathBridge Financial, a firm that specializes in providing comprehensive financial planning and investment management services for clients that are nearing retirement and love to travel.