Does Medicare Cover Expenses Outside the US?

Medicare generally provides healthcare coverage within the United States and its territories, which include the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. However, Medicare generally does not cover expenses outside these areas. While this often leads travelers to believe they have no coverage abroad, there are specific and limited situations where Medicare Part A and/or Part B may extend benefits to services received in a foreign country. This article clarifies these rare exceptions and highlights the importance of securing alternative coverage for international travel.

Specific Situations for Medicare Coverage Abroad

Medicare Part A and Part B may cover healthcare services in a foreign hospital under specific circumstances. One situation arises if a medical emergency occurs in the U.S. and the nearest hospital equipped to treat your condition is in a foreign country. Medicare may cover the emergency care received at that foreign facility. Another exception applies if you are traveling through Canada between Alaska and another U.S. state. Should a medical emergency occur during this transit, and a Canadian hospital is closer or more accessible than the nearest U.S. hospital, Medicare may cover the services.

Medicare may also provide coverage if 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, whether or not an emergency exists. In these limited scenarios, Medicare would pay its share for covered inpatient hospital care under Part A, and for related emergency and non-emergency doctor and ambulance services under Part B, provided these services are received immediately before and during your covered inpatient hospital stay.

General Exclusions for Foreign Medical Care

Medicare generally does not cover healthcare services received outside the United States. This means that for most international travel, individuals should anticipate being responsible for any medical expenses incurred.

Routine medical care, such as check-ups, or non-emergency treatments received abroad, are not covered by Medicare. This also extends to elective procedures or planned medical tourism, which fall outside the scope of Medicare’s limited foreign coverage. Medicare Part D does not extend to medications purchased outside the U.S. This general exclusion highlights significant gaps in coverage for individuals traveling or residing outside the U.S., underscoring the need for alternative arrangements.

Alternative Coverage for International Travel

Given Medicare’s limited foreign coverage, exploring alternative insurance options is a practical step for international travelers. Certain Medicare Supplement (Medigap) plans, specifically Plans C, D, F, G, M, and N, offer foreign travel emergency healthcare coverage. These Medigap plans typically cover 80% of billed charges for medically necessary emergency care outside the U.S., after a $250 annual deductible is met. This coverage is generally available if the emergency begins during the first 60 days of your trip. A lifetime maximum of $50,000 for foreign travel emergency coverage applies, which can be exhausted quickly by significant medical events.

Some Medicare Advantage (Part C) plans may also offer limited emergency coverage abroad, though specifics vary by plan. Beneficiaries should review their plan documents or contact their provider to understand any international benefits. Separately, purchasing a comprehensive travel insurance policy is a common strategy, as these plans can include broader medical coverage, emergency medical evacuation, and trip interruption benefits.

Submitting Claims for Covered Foreign Services

For instances where Medicare covers services received in a foreign country, a specific claims process must be followed. Foreign hospitals are typically not required to file claims with Medicare on your behalf, so you must submit the claim yourself using Form CMS-1490S, the Patient’s Request for Medical Payment form.

Gather all necessary documentation, including itemized bills from the foreign healthcare provider. These bills should detail the date of service, the specific services rendered, and the associated costs. Obtaining medical records and ensuring any foreign language documents are translated into English can facilitate the claims process.

Once the form is completed and supporting documents are attached, mail the claim to the appropriate Medicare contractor, which varies by state. Retain copies of all submitted materials for your records. Reimbursement, if approved, will typically be in U.S. dollars, and standard Medicare deductibles and coinsurance will apply. Processing times for these claims can vary, often taking several weeks or months.