As folks travel, it's a natural concern
to know what's my coverage going to look like.
How's it going to work if I'm outside of my home area?
And so that's what we're going to dress today.
And the answer to that question really depends upon
what kind of coverage you have
Welcome to Medicare School Daily,
where we help you understand Medicare, save money,
avoid making Medicare
mistakes, and above all else, get the most
out of your Medicare benefits.
Now, today's topic is a question
that we get often, and that's this
Can I use my Medicare plan anywhere in the USA?
As people go on Medicare,
they only have two options for using their Medicare
benefits, and you can only use one of these at a time.
So one option is, to use an advantage plan.
These are private health insurance companies
that put together a network of doctors
and a series of co-pays a max out of pocket.
And what they're doing
is actually replacing original Medicare for you.
The second option is to do a supplemental plan
This means that somebody has chosen
to stay in original Medicare
A and B, that pays
first and get a supplemental plan
to fill in the gaps that Medicare did not cover.
So those are our two options and so the answer
this question, do I have that coverage
anywhere in the U.S.?
Really depends
upon the kind of plan that you're using
for your Medicare.
So what we're going to do
is we're going to compare these two plans
and then show you what that coverage is going
to look like anywhere in the country.
First off, let's look at Advantage plans.
Now, if a person finds himself
that's on an advantage plan
in an emergency or an urgent care situation,
they absolutely have coverage.
In fact, anywhere in the world,
if you need an emergency room or an urgent care,
you can get that care you'll be covered.
And the only thing you'll be responsible for
is actually a very reasonable,
very small co-pay. All right.
So that's emergency care on an Advantage
Plan you are covered
But if it's a non-emergency situation,
you're outside of your home area.
Well, you may or may not be able to have coverage,
and it just depends upon the network.
So if you're in an HMO plan
and you're outside of your area,
that provider must be inside of your network
for you to have coverage
because HMO plans
do not give you
out-of-network benefit again unless it's emergency
or urgent care.
So if you want to go to a provider
outside the network, you can go there.
But that HMO plan is not going to pay
any of the expenses.
You would be 100% out of pocket
if that providers out of network
in a non-emergency situation.
Now, if you're on
an advantage plan that is actually a PPO network,
then that changes
And so we do have the ability to go out of network
on a PPO plan.
Now, if I stay in my network, my co-pays, my co-insurance
and my max out-of-pocket is going to be less
than out-of-network, but I still can go out of network,
which means it's going to cost me extra
to go out of network,
but at least I can do so if I choose.
So If I'm in a non-emergency situation
and I see a provider that's not on my network.
I do have the right to go there.
It's just going to cost me a little bit more.
And so here's the whole point.
If someone's in an in-network provider on a PPO plan
right now,
those max out of pockets for the whole year
are somewhere between about 3500 to $5,000.
If they go out-of-network that's going to change from
about seven to $10,000 max out of pocket for that year.
So as you can see,
it's just going to cost you
a little bit more, but you can certainly do that.
So that's the way it works with Advantage plans.
Now let's compare that to Supplemental plans.
So someone has A and B and they have a
Supplemental plan to fill in the gaps.
So if they find themselves anywhere in the country,
in an emergency situation or urgent care,
just go wherever you want that takes Medicare.
So, yes,
you are covered
by that supplemental plan and original Medicare.
Now, when it comes to non-emergency care, well,
we also have coverage anywhere in the country
you can go as long as they take Medicare, you see.
So that's one of the beauties of supplemental plans
that A and B and that supplemental plan
you have,
you have the same coverage anywhere in the country,
whether it's emergency or non-emergency.
And the reason for that is this.
When it comes to Medigap plans, these Medicare
supplemental plans, there are no networks.
You don't have
HMOs and PPO's with supplemental plans.
So when someone has an HMO or PPO,
that's always an advantage plan
because Medigap policies do not have networks.
Medicare is your network, which means any provider
that takes Medicare
will also take your supplemental plan.
And we tell our clients all the time,
when you're on original Medicare
with a supplemental plan, you only have to ask
two questions you asked the provider.
First off, do you take Medicare?
And then secondly, if that provider's
recommending any service,
let's say lab work or a test or a procedure or a surgery,
you just simply have to ask,
is Medicare
going to cover this So if they take Medicare,
Medicare is going to cover it.
If we get yes to both
those questions, you absolutely have coverage.
All right.
So that's the way it's going to work
if you have a supplemental plan.
So back to our original question.
Do you have coverage anywhere in the U.S.?
Yes. If it's emergency situation or urgent care on
any plan that you have.
But if it's not
emergency, just depends on if you have an advantage
plan HMO,
you don't have coverage,
PPO, you do have just pay a little bit more
if you have a supplemental plan, certainly.
Yes for emergency and yes for non-emergency care
Hey, thanks so much for watching the video,
and I do hope that it was helpful.
Now if you feel like
you need to learn more about Medicare
to make sure you're making the right Medicare decision,
really the best way and the easiest way to do
that is to go to MedicareSchool.com.
That's MedicareSchool.com,
and you'll be given the opportunity to be able
to click on Get the Free Workshop.
We call that the essentials workshop
and I do all the teaching.
And there you'll learn all the ins and outs of Medicare
to make sure that you have an accurate
and thorough understanding of how Medicare works.
The second thing you can do
is click where it says, talk to a Medicare guide,
and there
you can actually set up a time
where you can discuss your situation
with a Medicare guide.
They'll explain all your options
and actually even walk you
through the enrollment process as well,
if that's what you need to do.
And so go to MedicareSchool.com,
watch the workshop or talk to a Medicare guide.
It would be our privilege to assist you further.