Medicare Coverage Outside the United States

Traveling Abroad in the Medicare World

Retirement affords many seniors the opportunity to travel, which often includes trips abroad. These activities create certain challenges with regard to health insurance coverage for medical issues that may arise while these Medicare members are outside of our borders.

Coverage under Original Medicare outside of the United States is limited. In most situations, Medicare won’t pay for the health care or supplies that you receive in a foreign country. Outside of the U.S. refers to anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

There are three situations when Medicare may pay for certain types of health care services that you receive in a foreign hospital (outside of the U.S.):

• You have a medical emergency while you are in the United States, and the foreign hospital is closer than the nearest U.S. hospital that can treat your illness or injury,
• You are traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury. Medicare determines on a case-by-case basis what qualifies as “without unreasonable delay”, or
• You live in the United States and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether or not it is an emergency.

In these unique cases, Original Medicare will only pay for the Medicare-covered services that you receive in a foreign hospital. These services are:

• Inpatient Hospital care (covered under Part A), which is the care that you receive when you have been formally admitted as an inpatient under a doctor’s order to the foreign hospital,
• Emergency Ambulance and Doctor services (covered under Part B) that you receive immediately before and during your covered foreign inpatient hospital stay. However, if Medicare doesn’t cover your hospital stay, and/or you receive ambulance and doctor services outside of the hospital after your covered hospital stay ends, Medicare generally won’t pay for these services. For example, Medicare won’t cover a return ambulance trip home, and
• Non-Emergency Ambulance and Doctor services (covered under Part B) provided to you immediately before and during your covered foreign inpatient hospital stay. However, if Medicare doesn’t cover your hospital stay and/or you receive ambulance and doctor services outside of the hospital, Medicare generally won’t pay for these services. For example, Medicare won’t cover doctor services you get in Canada after your covered hospital stay ends. Medicare only pays for its share of services covered by Original Medicare. In addition, If you only have Part A, Medicare will only cover Inpatient Hospital care.

Unless it is an emergency in which you get dialysis at a foreign hospital, Original Medicare also doesn’t cover dialysis when you travel outside of the U.S.

Medicare may cover medically necessary health care services you get on a cruise ship in these situations:

• The doctor is allowed under certain laws to provide medical services on the cruise ship, or
• The ship is in a U.S. port or no more than 6 hours away from a U.S. port when you get the services, regardless of whether or not it is an emergency.

Except in the limited circumstances already described, Original Medicare doesn’t pay for health care services you get outside of the U.S. Therefore, you would pay the full cost to the health care provider. If your situation matches one of the exceptions, and Original Medicare covers the items or services, you will still pay the coinsurance or copayments and deductibles that you would normally pay if you had received these same services or supplies while in the U.S. Also, U.S. hospitals are required to submit claims to Medicare for you, but foreign hospitals are not. You must submit an itemized bill to Medicare for your doctor, inpatient, and ambulance services. If you received Medicare-covered services on a cruise ship as described, the doctor would ordinarily submit the Medicare claims, but you may also file a claim directly to Medicare, as well.

Your Medigap policy may offer additional coverage for health care services or supplies that you get outside the U.S. A Medigap policy is supplemental health insurance sold by private insurance companies to fill the “gaps” in Original Medicare coverage. Standard Medigap policies provide foreign travel emergency health care coverage when you travel outside of the U.S. at 80% of the billed charges for certain medically necessary emergency care. Foreign travel emergency coverage under Medigap policies is typically limited to $50,000. Before you travel outside the U.S., consult with your Medigap company or broker about the travel coverage.

If you have a Medicare Advantage Plan or a Medicare Cost plan, your plan may offer additional coverage and benefits for health care services that you receive outside of the U.S that can reduce your out-of-pocket costs. Check with your plan before traveling to see what’s covered. Also, under any Medicare Prescription Drug plan, medications that are purchased outside of the United States are never covered.

Because Original Medicare has limited coverage for health care services obtained outside of the U.S., you may choose to buy a travel insurance policy for additional coverage. Travel insurance does not necessarily include health insurance, so it is important to read the conditions or restrictions carefully. For more information, please contact the Medicare experts at Minnesota Health Insurance Network.