Medicare will not pay for healthcare outside the U.S., except under specific rare circumstances. That means in most cases, you are not covered anywhere other than the 50 states, the District of Columbia, the U.S. Virgin Islands, Puerto Rico, American Samoa, the Northern Mariana Island, and Guam.
Under What Circumstances Will Medicare Pay for Healthcare Outside the U.S.?
There are only three situations in which Medicare may cover certain types of healthcare in a hospital outside the U.S. Otherwise, you are responsible for the full cost of your care out of pocket.
Traveling Through Canada
If you are traveling, without unreasonable delay and by the most direct route, between Alaska and another state when a medical emergency arises, if a hospital in Canada is closer than the nearest U.S. hospital that can treat your injury or illness, your healthcare costs may be covered. Medicare determines on a case-by-case basis what “without unreasonable delay” entails.
Foreign Hospital Is Closer to Your Home
If you live in the U.S., but a foreign hospital is closer to where you live than the nearest U.S. hospital that can treat your condition, Medicare will cover your costs if you go to the foreign hospital. This applies whether or not it is a medical emergency.
Foreign Hospital Is Closer for Emergency Treatment
If you have a medical emergency while you are in the U.S., and a foreign hospital is closer than the nearest U.S. hospital that can treat your injury or illness, Medicare will cover the costs. In all three of these exceptional situations, Medicare will only pay for the services you receive in a foreign hospital covered by Medicare.
What Does Medicare Cover Outside the U.S. Under These Special Circumstances?
In any of the three situations described above, original Medicare covers the following:
Part A: Medicare Part A covers inpatient hospital care.
Part B: In an emergency situation, Part B covers ambulance and doctor services received immediately before and during your foreign hospital stay. It also covers non-emergency ambulance and doctor services received immediately before and during a covered stay in a foreign hospital.
Will a Medigap Policy Cover Me Outside the U.S.?
Standard Medigap plans C, D, F, G, M, and N, provide coverage for emergency healthcare during foreign travel. Although plans E, H, I, and J are no longer sold, they also offer emergency healthcare coverage outside the U.S. Individuals who purchased these plans before June 1, 2010, may keep and continue using them.
After you meet a $250 yearly deductible, Medigap plans C, D, E, F, G, H, I, J, and M will cover 80% of the costs of medically necessary emergency care outside the U.S. However, to be covered under a Medigap plan, the emergency care must begin during the first 60 days of your trip and must not be covered by Medicare.
If you have plans to travel outside the U.S., it might be wise to consider a Medigap plan to supplement original Medicare. You need to purchase such a plan within the six-month Medigap Open Enrollment period that begins when you turn 65 and enroll in Medicare Part B. Speak with our experienced agent for further assistance.