On the road? Medicare options for travelers in the U.S.

Editor’s Note: Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in “Ask Phil, the Medicare Maven.” Send your questions to Phil.

The Ask Phil (e)mailbox has been overflowing of late. I will get to as many questions as I can here, but please accept my apologies that I am not able to answer everyone’s questions.

Susan – S.D.: My husband and I are both on Medicare with a Medicare Advantage plan. However, this spring we are embarking on a two-year, full-time RV retirement holiday with no fixed base. Our domicile for legal, voting and tax purposes will be either South Dakota or Texas. Are there any Medicare Advantage plans or options to supplement Medicare for those of us who live “on the road”?

Phil Moeller: Geez, I wonder if Jack Kerouac ever worried about health insurance? It doesn’t really go with his image, does it? In any event, even Kerouac might want to vent about the cost of health care today. Your first step should be to call your Medicare Advantage insurer or insurers (if your husband’s policy is with a different company). Find out whether they provide any coverage outside your current service area. Many plans offer emergency coverage, and some also provide coverage for out-of-network health expenses. Also, will they send prescription medications to you while you’re on the road? If you can live with your plan’s options, fine. This also might require periodic swings to your plan’s home territory for care not covered by your plan when you’re away. If this doesn’t work for you, a common approach here is to switch to Original Medicare and get a stand-alone Part D drug plan and also perhaps a Medigap plan to plug coverage holes in basic Medicare. These policies are good anywhere in the country. Before dropping your current plan, make sure you qualify for a special enrollment period that will permit you to change coverage right away. Otherwise, you would have to wait until this year’s open enrollment period, and your switch wouldn’t be effective until next Jan. 1.

READ MORE: Am I still covered by Medicare when I travel out of state?

Ingrid – Wash.: I recently moved from Florida to Washington state. When am I able to switch to a supplemental insurance plan here, and how do I find an evaluation of services? Since most of the services I use are alternative and not covered, and I take only one prescription, I choose plans that have no cost to me. I live on Social Security disability payments, so every cent counts!

Phil Moeller: You ask about supplemental insurance. This is another name for Medicare supplement policies or Medigap, but your reference to zero-cost plans leads me to believe you are talking about a Medicare Advantage plan. Because you have moved, you are entitled to sign up for new coverage right away. You can find available plans where you now live by using Medicare’s Plan Finder. Follow the prompts to find zero-premium plans that include Part D drug coverage. Use Plan Finder to review general coverage options and payment terms for things such as office visit copays and other variable charges. Also check out the plans’ quality star ratings from Medicare. Once you’ve narrowed your choices, you can get in touch with individual plans and get any remaining questions answered.

If you are actually talking about Medigap coverage, here’s a list from the Washington State Office of the Insurance Commissioner of approved Medigap plans and their premiums. Every different kind of Medigap policy — known as letter plans — must provide identical coverage, but premiums for the same coverage often vary greatly. You also should check out whether you’d face any adverse underwriting requirements. When first eligible for Medicare at 65, most people have guaranteed issue rights to a Medigap policy and can’t be refused coverage or charged more because of pre-existing health conditions. However, these rights may not be available to disabled Medicare beneficiaries younger than 65 or to people who seek to buy or switch Medigap policies after they’ve been on Medicare for some time.

READ MORE: Which Medigap plan should you get?

John – Germany: I am a U.S. citizen, retired from the company Lockheed Martin and living in Germany. My wife and I are covered by Cigna international health insurance through Lockheed. I will be turning 65 next year. Do I need to sign up for Medicare?

Phil Moeller: We chatted with Cigna about this. The insurer suggested that you talk with Lockheed about how it treats Medicare-age retirees in Germany. The representative also said you could use the secure email service at the Cigna Envoy site and ask to speak with someone. In general terms, however, the company said, “If a couple is planning on retiring in Germany, it is important for them to understand that generally Medicare does not pay for claims incurred outside the U.S., except in some very limited circumstances. They would need to secure local German coverage or an individual global plan, which can be used in Germany and elsewhere.” Cigna sells such coverage, or you could buy it from a German insurer. If you plan on returning regularly to the U.S., you and your wife (when she turns 65) might still want to sign up for Medicare for care while you’re in the states. You can enroll in Medicare while in Germany at the nearest embassy or consulate office.

READ MORE: Can expats take their Medicare abroad?

Marguerite – Calif.: My Medicare supplemental insurance premium just went up. Usually this happens in December around my birthday. This is the first time in 10 years they just raised it mid-year. Is this due to Obama’s health plan? I have a fixed income, and I am sick of this.

Phil Moeller: The Affordable Care Act gets blamed for nearly everything we dislike about health care and lots more too. But I know of no connection between this law and your Medigap premiums. I’d call your insurer or perhaps the state insurance department where you live. Good luck!

Wendall – Hawaii: If a husband and younger wife have healthcare.gov insurance with tax credits, what happens when the husband turns 65 and must get Medicare? Can the younger spouse continue with healthcare.gov, and if so, what is the timeline she should be looking at?

Phil Moeller: Family insurance plans are available on state insurance exchanges set up under the Affordable Care Act. But there are no family plans under Medicare. Each individual must obtain separate Medicare coverage. In this case, the younger spouse can continue getting individual health insurance from the exchange, including applicable tax credits, until she must also switch to Medicare at age 65.

READ MORE: If I’m covered by the Affordable Care Act, do I have to switch to Medicare?

Judy – Wash.: I live in Stevens County in Washington state. My county borders Spokane County. Here is my problem: There are no Medicare health plans in my county. I have spoken with the Medicare office, and they informed me that they are sorry, but there is nothing they can do. Any suggestions on how I can get coverage? Do I need to call all of the Spokane providers and convince them to cover my county too?

Phil Moeller: I’m assuming that what you mean is that there are no Medicare Advantage health plans offered in your county. Lobbying plans to begin offering coverage is a noble and public-spirited idea. But it probably will do no good for this program year — if ever. The only real option here, according to Medicare experts at the State Health Insurance Assistance Program, is to use Original Medicare (Parts A and B) with a stand-alone Part D drug plan and possibly a Medigap plan to fill coverage gaps in Original Medicare. I’d suggest you call your local State Health Insurance Assistance Program office and work through this process with them. I’d pay careful attention to making sure you don’t face enrollment-period delays in getting coverage or get nailed with late-enrollment penalties. You can check past Ask Phil columns for tips on getting Part D and Medigap plans.