Does Medicare Cover International Medical Care?

Medicare is a federal health insurance program for individuals aged 65 or older and certain younger people with disabilities. It helps manage healthcare costs within the United States. Many beneficiaries may wonder about their coverage when considering travel outside the country. Understanding how Medicare operates internationally is important for preparing for potential medical needs abroad.

Medicare’s International Coverage Stance

Medicare, including Part A (Hospital Insurance) and Part B (Medical Insurance), generally does not cover healthcare services or supplies received outside the United States. “Outside the United States” for Medicare purposes refers to any location other than the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

This means that if a Medicare beneficiary travels to a foreign country, traditional Medicare will not pay for medical care. Prescription drugs purchased outside the U.S. are also generally not covered by Medicare Part D plans. Individuals are responsible for the full cost of medical care incurred while traveling internationally.

Limited Circumstances for Coverage Abroad

Despite the general rule, Medicare might provide some coverage for services received in a foreign hospital in specific, limited situations. These exceptions are narrow and involve emergency care or proximity to the U.S. border. Medicare Part A may cover inpatient hospital care, while Part B might cover emergency and non-emergency ambulance and doctor services received immediately before and during a covered foreign inpatient hospital stay.

One scenario occurs if a medical emergency arises while in the U.S., and the nearest hospital capable of treating the condition is a foreign hospital. Another exception applies when traveling through Canada on the most direct route between Alaska and another U.S. state. If a medical emergency happens, and a Canadian hospital is closer than the nearest U.S. hospital, Medicare may cover the care.

Medicare may also cover certain healthcare services in a foreign hospital, even if not an emergency, if an individual lives in the U.S. and the foreign hospital is closer to their home than the nearest U.S. hospital that can treat their medical condition. For services on a cruise ship, Medicare may cover medically necessary care if the ship is in a U.S. port or within six hours of arrival or departure from a U.S. port.

Alternative Coverage for Travel

Individuals planning foreign travel often consider additional insurance options due to Medicare’s limited international coverage. Medicare Supplement Insurance (Medigap) plans can offer foreign travel emergency care. Some Medigap policies (Plans C, D, F, G, M, and N) provide coverage for medically necessary emergency care outside the U.S. This coverage typically pays 80% of billed charges after a $250 annual deductible is met.

This Medigap foreign travel emergency benefit generally applies if the emergency begins within the first 60 days of a trip, and Medicare would not otherwise cover the care. There is a lifetime limit of $50,000 for this coverage. Medigap plans do not cover routine care, non-emergency treatments, or elective procedures outside the U.S.

Medicare Advantage (Part C) plans, offered by private insurance companies, must provide at least the same level of coverage as Original Medicare. Some Medicare Advantage plans may offer additional benefits for emergency or urgent care outside the U.S., but the extent of this coverage can vary by plan. Beneficiaries should contact their specific Medicare Advantage plan provider to understand what is covered before traveling.

Travel insurance is a comprehensive option for international medical coverage. These policies can include benefits for emergency medical expenses, medical evacuations, and sometimes pre-existing conditions with specific riders. Travel medical insurance provides primary emergency coverage for unexpected illnesses or injuries while abroad, and some policies also offer coverage for trip cancellations or interruptions.

Pre-Travel Medical Planning

Individuals should plan for potential medical needs before international travel. Contact all health insurance providers, including Medicare, any Medigap plan, or Medicare Advantage plan, to confirm specific international coverage details. Understanding the terms and limitations of existing policies is important for avoiding unexpected costs.

Carrying essential documentation is prudent. This includes insurance cards, policy numbers, and emergency contact information. Researching how to access medical care in the destination country, such as local emergency numbers or the locations of clinics and hospitals, can be beneficial.

For individuals with ongoing medical needs, pack sufficient supplies of prescription medications for the entire trip, plus a few extra days in case of unforeseen delays. Bringing a copy of prescriptions and a letter from a healthcare provider explaining the need for certain medications can also be helpful, as some countries have regulations on controlled substances. Checking immunization requirements for the destination and getting any necessary vaccinations well in advance is a wise preparatory step.