When people retire, the “to do list” usually starts and the travel bug starts to bite. They hit the road, plane or boat thinking that their new health insurance plan acts just like their group policy. This is usually not the case. Best to know before you go. Are you covered when traveling?

Most people switch from group health insurance policies to Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans. HMO plans are usually hospital-based with a lower cost associated with them. They need a primary care physician and referrals to specialists. The PPO, on the other side of the scale, has in-network and out-of-network coverage and does not require a primary care physician or referrals. For this, PPOs can also have a higher price.

1. HMOs vs. PPO

Both plan structures are generally offered at the group level. Most large company policies (over 200) with group policies are usually PPOs. They allow you to go to any doctor, anywhere, while having some level of coverage. Using in-network physicians with a PPO will save more, and you will generally pay more for using out-of-network physicians. The HMO is full coverage in your local hospital system only because doctors and hospitals have contracted directly with local plans. Both plans will cover emergency services in the United States, but the PPO will far eclipse HMO coverage if you decide to continue your physical therapy while on your beach vacation in Hawaii.

2. How does this all work with Medicare?

The good news is that it’s not as complicated as you might think. Health insurance plans fall into two categories. You have your Medigap policies and your Medicare Advantage plans. If you have health insurance, you will have already discussed this with your agent. Medicare Advantage plans have both HMOs and PPOs available with a variety of carriers in all 50 states. These plans will be more like the group policy you might be used to and will apply the same in-network, out-of-network, and referral rules stated above.

3. I’m on a boat

Some people don’t realize where they are and what they ride can affect their level of coverage. Medicare may pay for coverage while you are on a ship if:

• The boat is in US territorial waters
• The vessel is no more than 6 hours from a US port
• The doctor consulted must be licensed to practice medicine on a cruise ship

If these criteria are not met, you may not be covered.

4. Benefit Plans

Benefit plans have emergency coverage in all 50 states and internationally. So the benefit plans will cover you while you are traveling abroad. In many benefit plans, providers offer something called Synergy. Synergy is when a provider offers all the benefits of the plan, as if you were at home, in other states if the plan or provider is available in the state. Be sure to check with your plan provider if you have these options when traveling.

5. Medigap or supplements

The other option when switching to Medicare is a supplement, commonly known as Medigap. Supplements work with Original Medicare Parts A and B to cover Medicare gaps. These plans have a higher monthly premium but generally lower costs when seeking treatment. Supplements can be used anywhere in the country without a referral from a doctor or hospital that accepts Medicare. This is ideal for interstate travel; however, most supplements have Nope coverage when traveling abroad. Be sure to check your supplement’s “Explanation of Benefits” to see if you are covered. Medigap Plans C, D, E, F, G, H, I, J, M, and N pay 80% of your emergency coverage until lifetime limit $50,000 with a $250 deductible. As you may know, $50,000 doesn’t go as far as it used to. You may want to make sure you are covered by a travel health insurance policy.

6. What about my medication?

Well, your prescription may not even be available in different countries due to laws, restrictions or even supply. For example, if you find yourself in Australia, opiate prescriptions are illegal and cannot be filled. Make sure all your medications are in their original packaging and that you have a list of prescribing doctors and their phone numbers. Also, bring enough for your trip and more. If you have 30-day restrictions and are going to be staying abroad longer, be sure to contact your provider for an exception. Travel health insurance can provide prescription assistance. Just check your policy with an agent.

7. Who needs travel insurance?

If you have a Medigap supplement or an Advantage plan and want to move abroad, this is a very good idea to take out travel insurance. Travel health insurance policies cover you against accidents and illnesses while you are outside the United States. The great part is that they usually only cost around $50 to $100 for even a month of coverage, depending on how much coverage you’ll need. You can check out options like websites like IMG Global for free quotes (without 100 people calling you). Your plan may cover you for these emergency visits, but they are missing on a day-to-day basis. If you end up with a fever in Barbados, you don’t want to have to use your emergency benefits. Travel health insurance will allow you simple visits to the doctor abroad.

Pro Tip: When purchasing a policy, be sure to check the verbiage of pre-existing conditions. Some policies have very little or even no coverage for pre-existing conditions. If you have a pre-existing condition, be sure to let your agent know as they may be able to find a plan with additional coverage.

Even though your plan may have foreign health coverage, it’s always best to be as protected as possible with as much coverage as possible. Keep in mind that US hospitals are required by law to submit claims to Medicare, but foreign hospitals and physicians are not required to submit such claims. You may have to pay 100% of your bills while you are abroad, so be sure to keep any bills you may receive. Without these, you may not be able to be reimbursed for your treatment. Adding travel health insurance to any adventure could add a lot of peace of mind and potential savings to your trip. It’s always a good idea to be safe rather than sorry.