Does Medicare Cover Health Care During International Travel?

The General Rule: Medicare Stops at the U.S. Border

For most trips abroad, Medicare simply won't pay. In the great majority of situations, Original Medicare does not cover health care or supplies you receive outside the United States. If you get treatment overseas and none of the limited exceptions apply, you generally pay the full cost yourself.

It helps to know exactly what Medicare counts as "the United States." For coverage purposes, the U.S. means the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Care you get in any of these places is treated as care inside the U.S. "Outside the U.S." means everywhere else — so a trip to Canada, Mexico, Europe, or anywhere overseas usually falls outside Medicare's reach.

• Inside the U.S. (covered normally): the 50 states, Washington D.C., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, Northern Mariana Islands.
• Outside the U.S. (generally NOT covered): all foreign countries, including Canada and Mexico, except in three narrow situations described below.

The 3 Exceptions Where Medicare May Pay a Foreign Hospital

There are only three situations where Original Medicare may pay for care at a foreign hospital. In each one, the key idea is that a foreign hospital is closer to you than the nearest U.S. hospital that can treat your condition.

• Exception 1 — Emergency while you are in the U.S. You have a medical emergency while in the United States, and a foreign hospital is closer than the nearest U.S. hospital that can treat you.
• Exception 2 — Traveling through Canada to or from Alaska. You have a medical emergency while traveling the most direct route between Alaska and another state, without unreasonable delay, and a Canadian hospital is closer than the nearest U.S. hospital. Medicare decides "without unreasonable delay" on a case-by-case basis.
• Exception 3 — You live near the border. You live in the U.S. and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat you — here it does not even have to be an emergency.

What Part A and Part B Cover in a Qualifying Situation

When one of the three exceptions applies, your regular Medicare parts kick in for the foreign care — but only in tightly limited ways.

Even in a covered situation, you still pay your usual Medicare cost-sharing. That means the Part A hospital deductible of $1,736 per benefit period, and for Part B the $283 annual deductible and then 20% coinsurance. If your situation does not meet one of the three exceptions, none of this applies — you simply pay the full cost to the provider.

• Part A covers inpatient hospital care — but only if you are formally admitted with a doctor's order as an inpatient to the foreign hospital.
• Part B covers emergency and non-emergency ambulance and doctor services you get immediately before and during a covered foreign inpatient stay.
• Medicare generally will NOT pay for a return ambulance trip home, or for doctor services you get in a foreign country after your covered hospital stay ends.
• If the hospital stay itself is not covered, no related ambulance or doctor services are covered either.

Dialysis, Drugs, Cruises, and Other Common Questions

A few specific services trip people up the most. Here is how Medicare treats them when you travel internationally.

• Dialysis: Medicare does NOT cover dialysis when you travel outside the U.S., unless you receive it during a covered inpatient hospital stay under one of the three exceptions.
• Prescription drugs: Medicare plans can't cover prescription drugs you buy outside the U.S.
• Cruise ships: Medicare may cover medically necessary care if the ship is in a U.S. port or no more than 6 hours away from a U.S. port (and the doctor is legally allowed to provide services on the ship). Medicare does NOT cover care when the ship is more than 6 hours from a U.S. port.
• Medical evacuation / flight home: a return ambulance trip home is generally not covered, and there is no separate Medicare benefit for medical evacuation from abroad — this is a major reason travelers buy private travel insurance.
• Travel vaccines: Part D covers all ACIP-recommended vaccines, including certain travel vaccines like yellow fever, chikungunya, and Japanese encephalitis, with no copayment and no deductible.

How Medigap and Medicare Advantage Can Help

Because Original Medicare's foreign coverage is so limited, your supplemental coverage is what often makes the difference when you travel.

Most Medigap (Medicare Supplement) plans — Plans C, D, E, F, G, H, I, J, M, and N — include foreign travel emergency health care. These plans pay 80% of billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year, up to a $50,000 lifetime limit. There are two important catches: the care must begin during the first 60 days of your trip, and the benefit only applies when Medicare doesn't otherwise cover the care. Plans E, H, I, and J are no longer sold, but if you bought one before June 1, 2010, it still includes this benefit.

Medicare Advantage Plans and other Medicare health plans must follow Medicare's rules, including the rules for care outside the U.S. However, many plans choose to offer some additional coverage abroad — this varies widely by plan, so confirm the details in your plan documents (your Evidence of Coverage) and call your plan before you travel. Never assume a benefit is included.

Plan Ahead: Travel Insurance and Filing Claims

Given the gaps above, it is wise to plan for the cost of care abroad before you go. Because Medicare's coverage overseas is limited, you can buy a separate travel insurance policy for more protection. Read the policy carefully — travel insurance does not necessarily include health coverage, and you'll want to confirm it covers medical care and, ideally, emergency medical evacuation.

If you do receive covered care abroad, be ready to handle the paperwork yourself. Foreign hospitals aren't required to file Medicare claims. If a hospital doesn't file for you, you pay the full cost up front and then submit your own claim to Medicare for reimbursement using the "Patient's Request for Medical Payment" form (CMS-1490S).

Finally, if you live or travel outside the U.S. for long stretches, think carefully before dropping Part B to save the $202.90 monthly premium. If you drop Part B and want it back later, you may face a lifelong late-enrollment penalty of 10% for each full 12 months you were eligible but not enrolled. Weigh that risk against your situation, and consider speaking with a licensed advisor or your State Health Insurance Assistance Program (SHIP).