Traveling in the U.S.?
Posted 07/01/26
Understand your out-of-network coverage before you go.
Many trips within the country may take you places where in-network care is not available. Before heading out, it’s important to understand how your health plan’s out-of-network coverage works.
Overview.
Urgent care and emergency services are covered at in-network copays anywhere within the US. For other health care services, out-of-network coverage and cost shares vary by plan. In most cases, you will need to pay the full costs up-front and submit records/receipts to the plan for any applicable reimbursement.
Urgent/Emergency Services.
All Generations Advantage plans cover these services at in-network copays when received out-of-network.
- Ambulance Services (each way)
- Emergency Care for life-threatening or severe injury/illness
- Urgent Care for less severe illness/injury requiring prompt attention
Member Copays (In-country).
| Prime (HMO-POS) |
Essential (HMO-POS) |
Select (LPPO) |
Alliance (HMO) |
|
|---|---|---|---|---|
| Ambulance | $325 Copay | $325 Copay | $325 Copay | $325 Copay |
| Emergency Care | $115 Copay | $115 Copay | $115 Copay | $125 Copay |
| Urgent Care | $30 Copay | $40 Copay | $40/$30 Copay (Varies by county) |
$0 Copay |
Other Common Health Care Services (Non-emergency/non-urgent).
Below is a partial list. For details on your plan’s out-of-network coverage/cost shares, please see your Evidence of Coverage.
| Prime (HMO-POS) |
Essential (HMO-POS) |
Select (LPPO) |
Alliance (HMO) |
|
|---|---|---|---|---|
| Primary Care Visits | $65 Copay (out of area) |
$75 Copay (out of area) |
$50 Copay | Not covered |
| Specialty Care Visits | $65 Copay | $75 Copay | $50 Copay | Not covered |
| Outpatient X-rays | $50 Copay | $50 Copay | 15% of Cost | Not covered |
| Inpatient Hospital | 40% of Cost | 40% of Cost | 40% of Cost | Not covered |
How to Use Your Benefit.
Follow these steps when receiving in-country, out-of-network care. Remember these steps only apply when the situation is covered—see charts shown and your Evidence of Coverage for details.
1. You may try presenting your Generations Advantage member ID card as many out-of-network urgent care and emergency care providers will bill this insurance. Do not present your red, white, and blue Medicare card.
2. If the provider will not bill Generations Advantage, you will need to pay full costs directly to the providers/facilities that delivered the care. Obtain copies of medical records showing services provided and itemized receipts showing the amount you paid.
3. Complete a Medical Services Reimbursement form available at MartinsPoint.org/GAMedicalReimbursementForm. Submit it with a copy of receipts and records to the plan. (Keep a copy for your records.) The plan will reimburse 100% of the Medicare-allowable costs minus applicable copays/cost shares.
If you have questions about your coverage, don’t hesitate to call Member Services.
Smart Traveler Tip.
Once you arrive—find local care resources. Look up the locations of local urgent/emergency care facilities and keep their phone numbers handy.
