Planning to travel abroad soon? Before you go, remember to look into how your Medicare coverage works outside the United States.
If you have Medicare Part A (Hospital Insurance) and Part B (Medical Insurance), your health care services and supplies are covered when you’re in the U.S. The 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa are considered part of the U.S. In general however, health care you get while traveling outside the U.S. isn’t covered.
Medicare may pay for inpatient hospital, doctor, ambulance services, or dialysis services that you get in a foreign country in the following rare cases:
- You’re in the U.S. when a medical emergency occurs, and a foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
- You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and a Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
- You live in the U.S. and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.
In some cases, Medicare may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. However, Medicare will not pay for health care services you get when a ship is more than 6 hours away from a U.S. port.
Medicare drug plans do not cover prescription drugs you buy outside the U.S.
So, what is your out-of-pocket exposure for health care when travelling outside the U.S. if you have Original Medicare only?
You pay 100% of the costs, in most cases. In the rare situations described above, you pay 20% of the approved amount, and the Part B deductible applies.
- Medicare Part A (Hospital Insurance)covers hospital care (care you get when you’ve been formally admitted with a doctor’s order to a foreign hospital as an inpatient).
- Part B covers emergency and non-emergency ambulance and doctor services you get immediately before and during your covered foreign inpatient hospital stay.
- You pay the part of the charge you would normally pay for covered services. This includes any medically necessary doctor and ambulance services you get in a foreign country as part of a covered inpatient hospital stay. You also pay the coinsurance, copayments, and deductibles you’d normally pay if you got these same services or supplies inside the U.S.
- Medicare generally will not pay for services, like ambulance trips to return home, in either of these cases:
- Medicare didn’t cover your hospital stay.
- You got ambulance and doctor services outside the hospital after your covered hospital stay ended.
What if, in addition to Original Medicare, you have a Medicare supplement (Medigap) plan?
If you have a Medicare supplement (Medigap) policy, you may have some additional coverage, beyond what Original Medicare provides, for health care services or supplies that you get outside the U.S. Standard Medigap Plans C, D, F, G, M, and N provide foreign travel emergency health care coverage when you travel outside the U.S. Plans E, H, I, and J are no longer for sale, but if you bought one before June 1, 2010 you may keep it. All of these plans also provide foreign travel emergency health care coverage when you travel outside the U.S.
If you have a Medigap Plan C, D, E, F, G, H, I, J, M or N, your plan:
- Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care.
- Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year.
- Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.
Before you travel outside the U.S., talk with your Medigap plan or insurance agent to get more information about your Medigap coverage while traveling.
Who files Medicare claims when you receive health care services outside the U.S.?
Foreign hospitals are not required to file Medicare claims. You may need to submit an itemized bill to Medicare for your doctor, inpatient, and ambulance services if both of the following apply:
- You are admitted to a foreign hospital under one of the situations noted previously.
- The foreign hospital doesn’t submit a Medicare claim for you.
How can you minimize your out-of-pocket exposure to health care costs when travelling outside of the U.S.?
Because Medicare has limited coverage of health care services received outside the U.S., you may want to consider purchasing a travel insurance policy. An insurance agent or travel agent can give you more information about travel insurance. Remember that travel insurance does not necessarily include health care coverage, so it’s important to read the conditions and restrictions of the policy carefully.
Some Medicare Advantage plans include limited health care coverage while travelling out of the U.S. If you have such a plan, check with the company or with your agent for the extent of the coverage as each company’s provisions can be quite different.
The following link will take you to a useful CMS-produced video on the subject of this newsletter: https://www.youtube.com/watch?v=yq2WbpPK-9c