International Travel and Medicare Coverage
Medicare coverage outside of the United States is limited and, in most situations, Medicare will not pay for health care or supplies a client gets “outside of the United States” (anywhere other than the 50 states of the U.S., District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands).
There are three exceptions in which Medicare may pay for certain types of health care services received in a foreign hospital:
- Client is in the U.S. when a medical emergency happens, and the foreign hospital is closer than the nearest U.S. hospital that your client can be treated at.
- If your client is traveling through Canada without reasonable delay by the most direct route between Alaska and another state, when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your client. Note: Medicare determines on a case-by-case basis what qualifies as “without unreasonable delay”.
- Your client lives in the U.S. and the foreign hospital is closer to their home than the nearest U.S. hospital that your client can be treated at, regardless of if it is a medical emergency.
In addition, Medicare will not pay for any dialysis treatments outside of the U.S. unless it is one of the 3 situations described above. Medicare does not cover over the counter or prescription drugs purchased outside of the U.S.
Medicare may cover medically necessary health care services received on a cruise ship if:
- The doctor is allowed under certain laws to provide medical services on the cruise ship.
- The ship is in a U.S. port no more than 6 hours away from a U.S. port when the services are rendered, regardless of whether it’s an emergency.
Medicare does not cover health care services received when the ship is more than 6 hours away from a U.S. port.
U.S. hospitals are required to submit claims to Medicare for you, however foreign hospitals are not. If your client is admitted to a foreign hospital under one of the situations described above, and the hospital does not submit the claim to Medicare, your client will be responsible for paying the full bill to the provider. Your client will then need to submit an itemized bill to Medicare for the tending doctor, inpatient and ambulance services.
A cruise ship doctor must submit the Medicare claim, or the client can file the claim directly to Medicare in these rare circumstances.
What about Medicare supplement (Medigap) insurance policy?
Most Medigap plans provide some sort of foreign travel emergency health coverage with a lifetime limit of $50,000. These Medigap plans:
- Pay 80% of the billed charges for certain medically necessary emergency care outside the U.S., once the $250 annual deductible is met.
- Cover foreign travel emergencies if it occurs during the first 60 days of your trip and if Medicare doesn’t cover the care.
The above reasons are why it is important to discuss any plans your client has regarding traveling outside of the U.S. A Medigap plan can help cover some of the unexpected expenses that may occur during international travel. Be sure to help your client select the right plan with the correct coverage for potential international travel.