Planning to travel abroad this summer? Before you go, keep in mind that Medicare usually does not cover health care services or supplies while you’re traveling outside the United States.
That doesn’t mean you have to travel abroad without health coverage. There are three ways you can get health coverage outside the U.S.:
• If you have a Medicare Supplement Insurance (Medigap) policy, check your policy to see if it includes coverage when traveling outside the U.S.
• If you have Medicare Advantage or another Medicare health plan (instead of Original Medicare), check with your plan to see if it offers coverage outside the U.S.
• Consider buying a travel insurance policy that includes health coverage.
In some cases, Medicare may cover medically necessary health care services you get on board a ship within the territorial waters adjoining land areas of the U.S. Medicare won’t pay for health care services you get when a ship is more than six hours away from a U.S. port.
Medicare also may pay for inpatient hospital, doctor, ambulance services or dialysis in a foreign country in these rare cases:
• You’re in the U.S. when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
• You’re traveling through Canada without unreasonable 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 the emergency.
• You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.
Medicare drug plans (Part D) don’t cover prescription drugs you buy outside the U.S.
If you get sick or injured while abroad, in most cases you’ll pay 100% of the costs. In the situations described above, you pay 20% of the Medicare-approved amount, and the Part B deductible applies.
In the situations above, Medicare pays only for services covered under Original Medicare:
• Medicare Part A (Hospital Insurance) covers hospital care (care you get when you’ve been formally admitted with a doctor’s order to the foreign hospital as an inpatient).
• Part B covers emergency and non-emergency ambulance and doctor services you get immediately before and during your covered foreign inpatient hospital stay.
Medicare generally won’t pay for services (like return ambulance trips home) in either of these cases:
• Medicare didn’t cover your hospital stay.
• You got ambulance and doctor services outside the hospital after your covered hospital stay ended.
• You pay the part of the charge you would normally pay for covered services. This includes any medically necessary doctor and ambulance services you get in a foreign country as part of a covered inpatient hospital stay. You also pay the coinsurance , copayments, and deductibles you’d normally pay if you got these same services or supplies inside the U.S.
The 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands and American Samoa are considered part of the United States.
Foreign hospitals aren’t required to file Medicare claims for your medical costs. You need to submit an itemized bill to Medicare for your doctor, inpatient and ambulance services if both of these apply:
• You’re admitted to a foreign hospital under one of the situations above.
• The foreign hospital doesn’t submit Medicare claims for you.
Safe travels! JN
Greg Dill is Medicare’s regional administrator for Arizona, California, Nevada, Hawaii and the Pacific Territories. You can get answers to Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).