Medicare Coverage Outside of the United States Explained

In most situations, Medicare doesn't pay for health care or supplies you receive outside the United States. You may have to pay the full cost of medical care outside the U.S. (with limited exceptions). This includes anywhere other than the 50 states, Washington, DC, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

Medicare Prescription Drug Plans don't cover prescription drugs you buy outside of the U.S., even in the situations listed below. Call your prescription drug plan provider for more information.

Medicare may pay for certain types of health care services outside the U.S., in these situations:

• You're in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat you.

• You're 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 you. Medicare determines what qualifies as without unreasonable delay on a case-by-case basis.

• You live in the U.S., and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition regardless of whether it's an emergency.

In the above situations, Medicare only pays for Medicare-covered services:

• Part A covers care you receive when you've been formally admitted, with a doctor's order, to the foreign hospital as an inpatient.

• Part B covers emergency ambulance, non-emergency ambulance, and doctor services you receive immediately before and during your covered foreign inpatient hospital stay. However, if Medicare doesn't cover your hospital stay, or you receive ambulance and doctor services outside the hospital after your covered hospital stay ends, Medicare generally doesn't pay for these services.

Medicare Coverage While on a Cruise

Medicare may cover medically necessary health care services you receive on a cruise ship when:

• The doctor is allowed, under certain laws, to provide medical services on the cruise ship.

• The ship is in a U.S. port or no more than six hours away from a U.S. port when you receive the services regardless of whether it's an emergency.

Please note: Medicare only pays for its share of services covered by Original Medicare. If you only have Part A, Medicare only covers inpatient hospital care. Additionally, you still pay the coinsurance or copayments and deductibles you would normally pay if you got these same services or supplies inside the U.S.

Coverage Under a Medicare Supplement Insurance (Medigap) Policy

• A Medigap policy may offer additional coverage for health care services or supplies outside the U.S. (verify in the plan benefits).

• Some Medigap policies cover foreign travel emergency care if it begins during the first 60 days of the trip.

• Medigap policies typically pay 80% for certain medically necessary emergency care outside of the U.S., after the yearly deductible is met.

• Medigap policies offer foreign travel coverage with a lifetime limit of $50,000.

Coverage Under a Medicare Advantage Plan

Your Medicare Advantage plan, such as an HMO or PPO, may offer additional coverage for health care services outside the U.S.

Speak with your insurance carrier, before you travel outside the U.S., for more information about coverage while traveling outside the U.S.

Please note: Foreign hospitals aren't required to file Medicare claims. If a hospital doesn't submit Medicare claims for you, 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, the doctor must, ordinarily, submit the Medicare claim. However, you may also file a claim directly with Medicare.

Travel insurance policies may be available to obtain additional coverage. An insurance or travel agent can give you more information about buying travel insurance. Travel insurance doesn't necessarily include health insurance, so it's important to carefully read the conditions or restrictions.

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