Does Medicare Cover Healthcare in Canada?

Medicare provides essential healthcare coverage within the United States. When planning international travel, particularly to Canada, understanding Medicare’s specific rules and limitations for healthcare received abroad is important to avoid unexpected financial burdens. This article clarifies Medicare’s coverage for medical services obtained in Canada and explores alternative options for securing coverage during international trips.

Medicare’s General Stance on International Coverage

Medicare, a federal health insurance program for individuals aged 65 or older and certain younger people with disabilities, primarily covers healthcare services within the United States and its territories. This includes the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Original Medicare, consisting of Part A (Hospital Insurance) and Part B (Medical Insurance), generally does not cover healthcare services received outside these areas.

If you receive routine medical care or emergency treatment in Canada, Medicare will not pay for those services. Beneficiaries are responsible for 100% of the costs incurred for medical care outside the U.S., unless specific exceptions apply. This applies to both planned medical visits and unexpected health issues that may arise during a trip.

Limited Circumstances for Coverage Outside the US

While Medicare generally does not cover healthcare in Canada, there are limited situations where it may provide payment. One circumstance is when you are in the U.S. and experience a medical emergency, but the closest hospital equipped to treat your condition is located in Canada. In this scenario, Medicare Part A covers inpatient hospital care if you are formally admitted, and Part B covers emergency ambulance and doctor services immediately before and during your inpatient stay.

Another exception is if you are traveling through Canada via the most direct route between Alaska and another U.S. state, and a medical emergency occurs where the Canadian hospital is closer than the nearest U.S. hospital. Medicare may also cover non-emergency inpatient services in a foreign hospital if that hospital is closer to your U.S. home than the nearest U.S. hospital that can treat your medical condition. Even in these instances, standard deductibles, coinsurance, and copayments apply.

Alternative Solutions for Healthcare While Traveling

Given Medicare’s limited international coverage, travelers to Canada should consider alternative solutions to ensure financial protection for potential healthcare needs. Travel medical insurance is a primary option, covering emergency medical expenses, medical evacuation, and other health-related incidents while abroad. This insurance is highly recommended as Canadian healthcare is not free for visitors, and out-of-pocket costs can be substantial. Policies often include benefits for hospitalization, doctor visits, prescription medications, and emergency medical evacuation back to the U.S.

Another option for Medicare beneficiaries is a Medigap policy, also known as Medicare Supplement Insurance. Several Medigap plans (C, D, F, G, M, and N) offer a foreign travel emergency benefit. This benefit covers 80% of billed charges for medically necessary emergency care received outside the U.S., after you meet a $250 annual deductible. This coverage applies during the first 60 days of each trip and has a lifetime limit of $50,000.

Employer-sponsored or retiree health plans may also offer international coverage. Contact the plan administrator before your trip to understand the specifics of any international benefits, including coverage limits, deductibles, and any network restrictions that may apply.