Does Medicare Provide Coverage Out of the Country?

Medicare is a federal health insurance program primarily designed for individuals aged 65 or older, certain younger people with disabilities, and individuals with End-Stage Renal Disease. This program serves a vast population within the United States and its territories. This article clarifies how Medicare applies to medical services received when traveling outside of the United States, helping beneficiaries understand their coverage when planning international travel.

Understanding Original Medicare Coverage Abroad

Original Medicare, comprising Part A (Hospital Insurance) and Part B (Medical Insurance), generally provides limited coverage for healthcare services obtained outside the U.S. and its territories. In most scenarios, if you receive medical care in a foreign country, Medicare will not cover the costs, and you will typically be responsible for the full cost.

Despite this general rule, there are specific exceptions where Original Medicare might provide coverage for services received in a foreign hospital. One exception occurs if you are in the U.S. and experience a medical emergency, and a foreign hospital is closer or more accessible than the nearest U.S. hospital. Another exception applies if you are traveling through Canada using the most direct route between Alaska and another U.S. state, and a medical emergency necessitates care at a Canadian hospital that is closer than the nearest U.S. hospital.

Medicare may also cover certain medically necessary services received on a ship. This coverage typically applies if the ship is within the territorial waters of the U.S. or during a continuous journey between U.S. ports. In these limited circumstances, beneficiaries are still responsible for their usual deductibles, coinsurance, and copayments that would apply if they received the same services within the U.S. These exceptions do not extend to routine care, non-emergency situations, or prescription drugs purchased outside the U.S.

How Supplemental Plans Address Foreign Travel

Many individuals with Original Medicare choose to enroll in supplemental plans to help cover out-of-pocket costs and address gaps in coverage. These supplemental options, Medigap policies and Medicare Advantage Plans, offer varying degrees of foreign travel coverage. Understanding their specific benefits is important for international travelers.

Medigap, also known as Medicare Supplement Insurance, offers additional benefits, including foreign travel emergencies for some plans. Specifically, Medigap Plans C, D, F, G, M, and N include a foreign travel emergency benefit. This benefit typically covers 80% of the billed charges for certain medically necessary emergency care received outside the U.S., after a $250 annual deductible is met. There is a lifetime limit of $50,000 for this foreign travel emergency coverage. For this coverage to apply, the emergency care must begin during the first 60 days of the trip, and it does not cover routine services.

Medicare Advantage (Part C) Plans are offered by private insurance companies approved by Medicare. These plans often have their own rules regarding foreign travel coverage, which can vary significantly from one plan to another. Some Medicare Advantage plans may offer limited emergency or urgent care coverage for services received outside the U.S., while others may not provide any international coverage. Individuals enrolled in a Medicare Advantage Plan should review their plan’s Evidence of Coverage (EOC) document or contact their plan provider directly before traveling internationally to understand the specifics of their coverage, including how claims and reimbursements are handled.

Considering Travel Insurance for International Trips

For most international travel, particularly for situations not covered by Original Medicare or supplemental plans, travel insurance can serve as a primary solution for medical expenses. Travel medical insurance is a separate policy designed to cover unexpected illnesses or injuries that occur when traveling outside one’s home country. This type of insurance typically covers emergency medical treatment, medical evacuation to a suitable facility, and sometimes repatriation of remains.

Travel insurance policies vary, with options such as single-trip coverage for a specific journey or multi-trip plans for frequent travelers. Comprehensive travel plans may also include benefits beyond medical care, such as trip cancellation, interruption, or lost baggage coverage. It is important to carefully review the policy details, including any deductibles, coverage limits, and exclusions, such as pre-existing conditions. Understanding the process for seeking care or filing claims while abroad is also a crucial aspect of selecting an appropriate travel insurance policy.

Navigating Medical Care and Claims While Abroad

When receiving medical care outside the U.S., it is highly probable that you will need to pay for services upfront, even if your Medicare or supplemental plan might offer some coverage. Foreign hospitals and providers are typically not obligated to file claims directly with Medicare. Therefore, you should be prepared to handle payments out-of-pocket at the time of service.

Upon receiving care, it is important to obtain detailed documentation. This includes itemized receipts, medical records, and any other relevant information such as doctor’s notes or diagnosis codes. If possible, these documents should be in English or accompanied by certified translations to facilitate the claims process upon your return. Maintaining copies of all submitted documents for your records is also a good practice.

For those with Original Medicare or a Medigap policy, claims for reimbursement must typically be submitted after returning to the U.S. You will need to complete a Patient’s Request for Medical Payment form, specifically Form CMS-1490S. This form, along with the itemized bills and supporting medical documentation, should be sent to the appropriate Medicare administrative contractor.

If you have a Medigap policy, you would then submit the Medicare Explanation of Benefits (EOB) and the foreign itemized bill to your Medigap insurer for their portion of the coverage. Medicare Advantage enrollees should contact their specific plan directly for instructions on submitting claims for care received abroad, as their procedures will differ from Original Medicare. It is also advisable to have emergency contact information readily available, including details for family, your insurance provider, and potentially the nearest U.S. embassy or consulate.