International Medicare and Medigap coverage
Clothing — check. Passport — check. Medical coverage?
If you are enrolled in Medicare and planning a vacation abroad, you should review what international medical services are covered under Medicare and Medigap.
Original Medicare health insurance provides limited international medical coverage. If you need health care coverage outside of the United States, you may want to consider a Medicare Supplement insurance plan (also called Medigap). Some plans provide a foreign travel emergency care benefit.
Original Medicare and international health care coverage
Original Medicare (Medicare Part A and Part B) rarely covers health services provided outside of the United States and its territories.
Original Medicare covers beneficiaries living in the continental United States, and in the unincorporated territories of Puerto Rico, Guam, the U.S. Virgin Islands, the Northern Mariana Islands, and American Samoa.
If you travel outside of these specified areas, you are only covered in very limited situations. There are 3 instances when Medicare may cover certain international medical services:
- You’re in the U.S. when you have a medical emergency and the foreign hospital is closer than the nearest U.S. hospital that can treat your injury or illness.
- You’re traveling through Canada “without unreasonable delay” by a direct route between Alaska and another state, when a medical emergency occurs and the Canadian hospital is closer than a U.S. hospital.
- You live in the U.S. and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of it being an emergency.
In the 3 situations above, Medicare only covers the Medicare-approved service and only pays for its share of services. Medicare will not cover any prescriptions drugs or non-emergency dialysis care. You are still responsible for co-insurance, co-payments, and deductibles. Foreign hospitals are not required to file Medicare claims. You may be required to submit the medical claim directly to Medicare.
Medical care and cruises
If you travel outside of the U.S. on a cruise, you face other specific restrictions. Original Medicare will cover medically necessary health care on a cruise ship in 2 situations:
- The doctor is allowed under certain laws to provide medical care on the ship.
- The cruise ship is in a U.S. port, or less than 6 hours away from a U.S. port, when the medical services are provided, regardless of whether the service is an emergency.
If you do not meet the strict Medicare program requirements for international travel or cruises, you are required to pay the full cost to the health care provider.
Medicare Supplement insurance can cover international care
Several Medicare Supplement insurance plans provide an international coverage benefit. Six plans — Medigap plans C, D, F, G, M, and N — include the benefit. Plans E, H, I, and J, which are no longer available for sale but are still valid for use, also provide this benefit.
The plan will only cover certain care if it begins during the first 60 days of your international trip and Medicare does not cover it. The Medigap plan will pay for 80% of the billed charges for certain medically necessary emergency care received outside of the U.S. You are responsible for the remaining 20% cost.
You must meet a $250 deductible each year when using the benefit. Additionally, there is a $50,000 lifetime limit for international care.
Your Medigap insurance company can provide more specific details about your Medicare and Medigap coverage while abroad.