Does Kaiser Medicare Advantage Cover Out of Country Travel?

According to Kaiser Permanente, Medicare Advantage members are covered for emergency and urgent care anywhere in the world. This means if you have an unexpected medical issue while traveling internationally, your Kaiser Medicare Advantage plan does provide some coverage. However, this coverage is limited to emergencies and urgent care and does not include routine medical services.

Quick Summary

Kaiser Medicare Advantage plans cover emergency and urgent care worldwide for enrolled members. Routine care and prescriptions are typically not covered internationally, and members must often pay upfront for services and seek reimbursement later. Pre-trip planning, understanding reimbursement claims, and considering supplemental travel insurance are essential.

Key Points

• Emergency Coverage: Kaiser Medicare Advantage plans provide coverage for urgent and emergency care anywhere in the world, not just within the U.S..

• Exclusions: Routine care, such as checkups, preventive screenings, and non-emergency doctor visits, are typically not covered while traveling internationally.

• Reimbursement Process: Members usually need to pay for international medical services upfront and submit a claim to Kaiser for reimbursement upon their return.

• Travel Line Support: In case of an emergency, members can call the Kaiser Away from Home Travel Line for assistance with coordinating care and payment.

• Documentation is Key: To ensure successful reimbursement, it is essential to collect detailed medical records and itemized receipts from any foreign healthcare provider.

• Supplemental Insurance: For more comprehensive international coverage or longer trips, considering supplemental travel medical insurance is often recommended.

• Medigap Comparison: Unlike Kaiser's HMO, Medigap policies that cover foreign travel often have specific limits, like a $50,000 lifetime maximum and coverage for only the first 60 days of a trip.

Your Kaiser Medicare Advantage covers international emergencies, but with limitations

When traveling abroad, a medical emergency can be a significant source of stress. The good news is that if you are a Kaiser Permanente Medicare Advantage member, you have some protection. Your plan covers urgent and emergency medical care received anywhere in the world, including outside the U.S.. This coverage is specifically for unexpected conditions that need immediate attention, not for planned, routine check-ups or appointments.

How Kaiser handles international medical claims

Receiving care internationally and seeking reimbursement from Kaiser is a multi-step process that differs significantly from getting care within the U.S.. In most cases, you will be required to pay for the medical services and prescriptions upfront and in full. After your trip, you must submit a claim to Kaiser Permanente for reimbursement. The amount you are reimbursed will depend on your plan's specific copayments, coinsurance, and deductibles, consistent with the terms of your Evidence of Coverage. Documenting all medical encounters, including obtaining detailed, itemized bills with doctor's signatures, is crucial for a successful claim.

What to do if you need care overseas

If you experience an urgent or emergency medical situation while outside the country, follow these steps:

• Seek immediate care. Go to the nearest hospital or medical facility capable of treating your condition. You do not need to call Kaiser for prior approval for emergency or urgent care.
• Pay upfront. Be prepared to pay for the services and any prescriptions at the time of your visit. Some foreign healthcare providers may not accept any form of insurance billing directly.
• Notify Kaiser. After your condition has been stabilized, call the Kaiser Away from Home Travel Line at 951-268-3900 to let them know you have received treatment.
• Obtain documentation. Collect all medical records, itemized bills, and receipts related to your care. Detailed information is critical for submitting a reimbursement claim.
• Submit a claim. Once you return home, submit your claim to Kaiser for reimbursement. The necessary forms and instructions can be found on their website.

Limitations and exclusions of international coverage

While Kaiser Medicare Advantage offers excellent international travel benefits compared to some other plans, it is not without limitations. Here are some key coverage restrictions to be aware of:

• Routine care: Your plan will not cover routine visits, preventive screenings, or checkups while you are abroad.
• Prescription medications: While you are covered for refills of acute-care medications prescribed during an urgent visit, ongoing prescriptions (maintenance drugs) may not be included, and you may need to pay upfront.
• Medicaid/Medi-Cal: If you also have Medicaid or Medi-Cal, your international coverage is severely limited or non-existent, especially outside Canada and Mexico.
• Post-stabilization care: Coverage for follow-up care after an emergency has stabilized, such as follow-up appointments or tests, may require pre-approval from Kaiser.
• Extended travel: Spending more than six months outside your service area can lead to disenrollment from your Medicare Advantage plan.

Comparing international coverage: Kaiser Medicare Advantage vs. Medigap

Choosing the right coverage for international travel involves understanding how different plan types work. The following table compares the typical coverage provided by Kaiser Medicare Advantage with a standard Medigap policy that includes foreign travel benefits.

Feature	Kaiser Medicare Advantage (HMO)	Medigap (Plans C, D, F, G, M, N)
Coverage Type	Worldwide coverage for emergency and urgent care only.	Emergency care abroad covered for the first 60 days of a trip.
Routine Care	No coverage for routine or non-emergency care outside the U.S..	No coverage for routine or non-emergency care abroad.
Claim Process	Member pays upfront and files a claim for reimbursement upon return.	Member pays upfront and submits a claim; plan covers 80% of costs after deductible.
Deductible	Plan-specific copayments, coinsurance, and deductibles apply.	$250 annual deductible for foreign travel emergencies.
Coverage Limit	No specific international lifetime maximum limit; based on plan benefits.	Lifetime maximum limit of $50,000 for emergency care.
Pre-approval	Not needed for emergencies, but may be required for post-stabilization care.	Not required for initial emergency treatment.
Prescription Drugs	Prescriptions filled during an urgent or emergency visit are typically covered, but maintenance drugs may be excluded.	No coverage for prescriptions filled abroad under Part D.

Conclusion

While Kaiser Medicare Advantage does cover out-of-country emergency and urgent medical services, it is not a comprehensive international travel health plan. Members must be prepared to pay for services out-of-pocket and manage the reimbursement process after returning home. For those who travel frequently or take extended trips, purchasing a separate travel medical insurance policy may be a wise decision to supplement Kaiser's limited international benefits. Checking your specific plan's Evidence of Coverage before any trip is always the most reliable way to understand your benefits and potential costs.

Frequently Asked Questions

Is routine care covered by Kaiser Medicare Advantage when traveling abroad?

No, your Kaiser Medicare Advantage plan does not cover routine medical care, such as checkups, screenings, and planned doctor visits, when you are traveling outside of the country. Coverage is limited to urgent and emergency medical needs.

Do I have to pay upfront for international care with Kaiser Medicare Advantage?

Yes, in most cases, you will need to pay for medical services and prescriptions upfront when traveling internationally. Kaiser Permanente generally does not pay foreign providers directly. You will then need to file a claim for reimbursement after you return home.

How do I file a claim for international medical expenses?

To file a claim, you must collect all itemized bills and receipts from the foreign healthcare provider. After your return, you will submit these documents, along with a completed claim form, to Kaiser for reimbursement.

What is the Kaiser travel line number for international emergencies?

For assistance with coordinating care or payment during international travel, you can call the Kaiser Away from Home Travel Line. The phone number is 951-268-3900. International calling codes may apply.

Will Kaiser cover me if I travel internationally for more than six months?

Kaiser Medicare Advantage plans have limitations on how long you can be outside your service area. If you are abroad for an extended period, such as more than six consecutive months, you may be disenrolled from your plan and enrolled in Original Medicare.

Are international prescription drugs covered by Kaiser?

Coverage for prescription drugs overseas is limited. While medications prescribed during an urgent or emergency visit may be covered, maintenance medications are often excluded. You will likely need to pay upfront for any international prescription drug purchase.

Should I get travel insurance in addition to Kaiser Medicare Advantage?

Given the limitations of Kaiser's international coverage, especially regarding paying upfront and filing for reimbursement, many members choose to purchase supplemental travel medical insurance for more comprehensive protection.