How Medigap and Medicare Advantage Plans Cover Out-of-Area Services: Domestic and International Insights
For Medicare beneficiaries who travel frequently or live part-time in different locations, understanding how their coverage works outside their local area is essential. Whether exploring another state or venturing abroad, the differences between Medigap (Medicare Supplement Insurance) and Medicare Advantage plans can significantly impact access to healthcare and out-of-pocket costs. Here’s what you need to know about how each type of plan handles care away from home.
Medicare Advantage Plans and Out-of-Area Coverage
Medicare Advantage (Part C) plans are offered by private insurers approved by Medicare. These plans bundle Original Medicare (Part A and Part B), and often include additional benefits like prescription drug coverage, vision, and dental. But they come with a trade-off—network restrictions.
Domestic Coverage
Most Medicare Advantage plans are either HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations), and the rules for out-of-area coverage vary depending on the type:
- HMO Plans: These generally require members to get care within a specific network of providers and typically only cover emergency or urgent care outside of that provider network. Routine or non-emergency care received while traveling domestically may not be covered unless it’s pre-approved.
- PPO Plans: These offer more flexibility. While staying in-network is more cost-effective, PPOs generally allow beneficiaries to seek care outside the plan’s network—though at a higher cost. PPOs are a better fit for snowbirds or frequent travelers within the U.S.
Some Medicare Advantage plans also offer visitor/travel benefits, where members can stay in another service area for a defined period (e.g., 6 months) and still access some in-network care.
International Coverage
Medicare Advantage plans are not required to offer international coverage, but some do include limited emergency care abroad. These benefits vary widely and are not standardized, so it’s important to check each plan’s Evidence of Coverage (EOC) for details. Some plans may cover emergency hospitalization or urgent treatment, but routine international care is almost never included.
MEDIGAP PLANS AND OUT-OF-AREA COVERAGE
Medigap plans, sold by private companies, supplement Original Medicare by covering many of the out-of-pocket costs such as copayments, coinsurance, and deductibles. They work with any provider nationwide that accepts Medicare, offering broad access and flexibility.
Domestic Coverage
One of the biggest advantages of Medigap is nationwide portability. There are no provider networks, so beneficiaries can receive care from any doctor or hospital in the U.S. that accepts Medicare. This makes Medigap particularly appealing to those who travel often, split time between multiple residences, or simply want freedom in choosing providers.
Because Medigap policies are standardized across most states, benefits don’t change depending on where you’re located domestically. For example, if you have Plan G in Florida, you’ll receive the same coverage if you get treated in California, as long as the provider accepts Medicare.
International Coverage
Certain Medigap plans—specifically Plans C, D, F, G, M, and N—include foreign travel emergency coverage. This benefit is generally structured as follows:
- It covers 80% of the cost for medically necessary emergency care outside the U.S.
- There is a $250 annual deductible.
- The coverage kicks in only during the first 60 days of a trip.
- There is a $50,000 lifetime limit on foreign travel emergency benefits.
It’s worth noting that Plans C and F are no longer available to new Medicare enrollees as of 2020, but those who already have them may retain them.
Key Takeaways
| Feature | Medicare Advantage | Medigap |
| Domestic Flexibility | Limited to plan network; varies by HMO/PPO | Nationwide, any provider accepting Medicare |
| Routine Care Away from Home | May not be covered (HMO); partial out-of-network coverage (PPO) | Fully covered across the U.S. (Unless a “select” plan is chosen) |
| Emergency Care in U.S. | Always covered | Always covered |
| International Emergency Coverage | Sometimes offered, varies by plan | Included in select plans (80% coverage, $50k lifetime cap) |
| Ideal For | Local or regional residents, cost-conscious | Frequent travelers, snowbirds, multi-state living |
In conclusion, your travel habits and lifestyle should guide your Medicare plan choice. Those who prioritize flexibility and nationwide provider access may prefer a Medigap plan. Conversely, if staying mostly local and managing costs are top priorities, a Medicare Advantage plan might be a better fit.
If you need additional help understanding how Medicare coverage works while you are traveling, or if you have any other questions about Medicare, please connect with one of our Member Agents. There are never any fees for their educational or enrollment services!
