A cruise ship vacation is an exciting way to see multiple places while coasting on the water. There can be many activities that you can participate in both on and off the ship. However, before you plan out your next cruise ship vacation, you will want to know how your Medicare insurance will cover you if you need medical attention. Medicare coverage is limited when you are traveling outside of the United States. It will also depend on whether you are traveling on U.S. territorial waters.

Medicare coverage inside the U.S.

Original Medicare consists of Part A, and Part B. Part A is inpatient hospital coverage, and Part B is outpatient coverage. When you are admitted as an inpatient, there is a $1,484 deductible per admittance, and Part B has a $203 annual deductible for all Medicare-approved Part B services.

These services include doctor office visits, tests, surgeries, lab work, physical therapy, and more. If the provider accepts Medicare, you will pay the Part B deductible first. Medicare will cover 80% of the service after reaching the deductible, leaving you responsible for the remaining 20%. The remaining 20% has no limit, so beneficiaries will also purchase a Medicare Supplement or Advantage plan to help with the out-of-pocket costs. You would want to enroll in a Part D plan since Medicare does not cover prescriptions.

Part D

 A Part D drug plan will provide you with prescription coverage. The available plans vary by zip code and county. All Part D plans must follow federal guidelines and cover at least two drugs for each therapeutic group. The plans can set their premiums and cost-sharing amounts.

Every Part D plan has two categories of pharmacies you can use. If you pick up your prescriptions from a preferred pharmacy, you will likely have more cost-effective copays. If you were to pick up your medications from a standard pharmacy, then you will likely pay a higher copay or coinsurance for your prescription. You will want to use a pharmacy that is preferred or standard. Otherwise, you will pay the full cost for your medication if you pick up your drugs from an out-of-network pharmacy.

Medicare Supplement (Medigap)

These plans are designed to cover the gaps in Medicare. A Medigap plan will be secondary to your Medicare and help pay the remaining balance, which leaves you with little to no out-of-pocket. When Medicare covers a procedure, your Medigap plan will cover it as well. If Medicare chooses not to cover a procedure, then your Medigap plan won’t cover it either.

Medicare Advantage

You will have the same benefits as Part A and Part B when you enroll in a Medicare Advantage plan. However, you agree to receive your benefits through a private insurance carrier in the form of a network plan. This means you must use your plan’s doctors and hospitals’ network for the plan to be cost-effective. An Advantage plan has copays or coinsurance for each service, so you pay-as-you-go.

Medicare coverage outside the U.S.

Original Medicare generally does not cover you outside the United States. There are few exceptions when you travel outside the U.S., where Medicare will provide coverage. However, if you have a Medigap plan or an Advantage plan, you may have additional coverage outside the U.S.

Five Medigap plans will provide you with 80% of a foreign travel emergency. You first must meet the $250 deductible, then the Medigap plan will pay 80%, and you will be responsible for 20%. Once you reach the $50,000 lifetime limit, the plan will no longer cover you. The medical incident must happen within the first 60 days you are outside of the United States for the Medigap plan to cover you.

A Medicare Advantage plan will only cover worldwide emergency coverage. There will be a copay or coinsurance that you will be responsible for paying.

Another thing to keep in mind is your Part D plan will not cover you outside of the U.S. You will want to make sure you have enough medications to cover you until you return.

Foreign travel exceptions

As stated previously, there are few travel exceptions where Medicare may cover services outside the U.S.

• Medicare Part B may cover services that you get on a cruise ship if you are within U.S. territorial waters.
• If a medical emergency occurs and you are closer to a foreign hospital than a U.S. hospital, Medicare may cover those services.
• If you live in the U.S. and the nearest hospital is a foreign hospital, Medicare may provide coverage.
• When traveling through Canada to get from Alaska to another state or vice versa and a medical emergency happens with a Canadian hospital being closest, Medicare may cover those services.

If you find yourself in the first travel exception, there may be two situations where Medicare covers the services on a cruise ship:

• The doctor must be allowed to provide medical services on the ship under specific laws.
• The ship is docked in a U.S. port or not more than 6 hours away from a U.S. port.

A foreign hospital or office is not required to file the claim with Medicare or your Advantage plan. You will want to submit the bill to Medicare if the foreign provider does not. This means it is crucial to keep all bills and receipts.

Conclusion

Medicare coverage inside the U.S. is different from coverage outside the U.S. There are only a handful of travel exceptions where Original Medicare will provide coverage when you are traveling, such as on a cruise ship traveling in U.S. territorial waters. If you also have a Medigap or Advantage plan, you can have worldwide emergency coverage. However, is it highly recommended to look into traveler insurance options if you plan on traveling outside the U.S.