In most circumstances, Medicare will not cover the cost of treatment or health supplies if you are outside the United States. There are exceptions where Original Medicare and Medicare Advantage plans are required to provide you with coverage when you are out of the country.
Original Medicare Exceptions
Original Medicare plans consist of Medicare Part A and Medicare Part B. Medicare Part A is hospital insurance and Medicare Part B is outpatient/medical insurance.
There are three exceptions where Medicare will cover treatment received from a foreign hospital:
- You are in the United States at the time of the emergency, and the foreign hospital is closer than a hospital in the United States that can treat you.
- You are traveling through Canada “without unreasonable delay” by the most direct path between Alaska and another state when you experience a medical emergency. The Canadian hospital is closer than a U.S. hospital that can treat your illness or injury. Situations considered “without unreasonable delay” are taken on a case-by-case basis through Medicare.
- You reside in the United States but the foreign hospital is closer to your home than the nearest U.S. hospital, regardless if it is an emergency or not.
Don’t forget to note that Medicare will only provide coverage for Medicare-approved services provided in a foreign hospital. Medicare Part A coverage consists of inpatient hospital care within a foreign hospital. Inpatient is defined as “care you receive when you have formally been admitted with a doctor’s order.”
Medicare Part B will cover emergency services provided by ambulances and physician services you receive immediately before and during your covered foreign inpatient hospital stay. Medicare will not cover return ambulance trips home or treatment received by a doctor once your Medicare-approved inpatient hospital stay ends.
Medicare Supplement (Medigap) Coverage Outside The U.S.
Medigap may provide extra coverage for health care services/supplies while outside the U.S. This coverage helps fill in the gaps where Original Medicare does not pay for services. Medigap plans C, D, F, G, J, M, and N provide you with foreign travel emergency health coverage while outside the United States. These Medigap plans provide 80% payment towards your health services. The treatment must be deemed as necessary emergency care as well. Medigap provides coverage if the emergency occurs within the first 60 days of foreign travel and if Medicare will not otherwise provide care.
Medicare Advantage Coverage Outside The U.S.
While some Medicare Advantage plans do offer health coverage during foreign travel, not all of them do. It is important to check with your plan provider to discuss what coverage is available during foreign travel. Some plans will offer coverage, but they have certain criteria that must be met.
If you travel outside the U.S. for six months or longer, then you will be dropped by your Medicare Advantage plan. This type of plan must also follow the rules set in place by Medicare, as well as the three exceptions listed above.
We’re Here To Help
Our team is devoted to helping you navigate your way through the waters of Medicare. If you need help researching your Medicare coverage options and how you will be covered by a specific plan, get in touch with us today.