While original Medicare offers coverage across the United States, navigating healthcare in an unfamiliar area can be challenging. Finding care quickly, especially in urgent situations, can be complicated.
If you’re trying to avoid the emergency room, locating an urgent care center that accepts Medicare can be tricky. Additionally, if you need to fill a prescription while away, finding a preferred pharmacy can save you money. This becomes even more crucial with Medicare Advantage plans, which often have specific provider networks. Seeing an out-of-network doctor could result in high out-of-pocket costs or require you to cover the bill entirely. Coverage details differ by plan.
Medicare Advantage plans are required to cover emergency and urgent care services nationwide as in-network services, even if the facility isn’t part of the plan’s network. However, the copayments can vary from those under original Medicare. For instance, one plan might charge a $135 copay for emergency visits and $50 for urgent care, regardless of the provider’s network status.
Once your condition is stabilized, you or your treating physician should contact your plan to discuss follow-up care. Chrissie Cooper, senior vice president of government programs at Kaiser Permanente, advises that additional services may need plan approval. Some Medicare Advantage plans include convenience care and walk-in clinics within their networks. Ali Khan, M.D., Medicare chief medical officer for Aetna, notes that members of Aetna’s Medicare Advantage PPO and HMO plans, which don’t require a primary care provider referral, can visit nationally contracted retail health clinics and pay the same copay as a regular primary care visit. This includes MinuteClinics, which are contracted with most Medicare Advantage plans.
When traveling, some Medicare Advantage plans have extensive national or regional networks that allow you to find participating providers more easily. For example, 73 percent of UnitedHealthcare’s standard Medicare Advantage members have access to over 1 million providers nationwide. However, not all contracted providers are available everywhere.
UnitedHealthcare offers tools on their member website and mobile app to help locate network providers by zip code. Amanda Weigel, senior product director of UnitedHealthcare Medicare and retirement, recommends downloading the plan’s mobile app and keeping your member ID and customer service phone number handy while traveling.
Many Humana Medicare Advantage PPO plan members also have access to a national provider network. Some Humana HMO plans offer a visitor/traveler benefit, allowing members to receive in-network services while traveling that would be covered at home. It’s important to contact your plan to verify benefits and locate providers.
Additionally, some plans, like Kaiser Permanente, provide 24/7 access to virtual care while you’re traveling, ensuring you can get medical advice and support anytime, anywhere.
