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Medicare Coverage Outside the U.S.
In most situations, Medicare won't pay for health care or supplies that you get outside the United States (U.S.). This booklet explains some basic rules for coverage outside the U.S. under the Original Medicare Plan (Part A and/or Part B).
What does "outside the U.S." mean?
"Outside the U.S." means anywhere other than these places: the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
A: In general, there are two conditions under which Medicare may cover the medically necessary health care services that you get from a ship's doctor. These conditions are
The doctor is allowed under certain laws to provide medical services on the cruise ship, and
The ship is in a U.S. port or no more than six hours away from a U.S. port when you get the services.
Medicare also may pay for health care services that you get from a ship's doctor if you are admitted to a U.S. or foreign hospital for a Medicare-covered emergency stay. To be covered in this situation, the ship's doctor must give you emergency services while the ship is in waters outside the U.S. and on that same day you are admitted to a U.S. or foreign hospital.
The service of the ship's doctor must be for the same condition for which you are admitted to the hospital. Medicare doesn't cover health care services you get in other situations on a cruise ship.
A: There are three situations when Medicare may pay for certain types of health care services if you are in a foreign hospital. This happens only if the foreign hospital is closer or easier to get to than any hospital in the U.S.
You live in the U.S. near a foreign hospital, and you need emergency or non-emergency medical treatment. If a foreign hospital is closer or easier to get to from your home than the nearest U.S. hospital that can treat your condition, Medicare may pay for the services.
You're in the U.S. when you have a medical emergency. If a foreign hospital is closer or easier to get to than the nearest U.S. hospital that can treat your emergency, Medicare may pay for the services.
You're crossing through Canada without delay between Alaska and another state, and you have a medical emergency. If a Canadian hospital is closer or easier to get to than the nearest U.S. hospital that can treat your emergency, Medicare may pay for the services.
Normal or other Medicare coverage criteria also applies to the services you get in foreign settings.
A: If you have Part A (Hospital) and Part B (Medical) in the Original Medicare Plan, Medicare covers the following services:
Inpatient hospital care (care you get when you have been admitted to the hospital as an inpatient).
Doctors' services that you get during your covered inpatient hospital stay. However, if you aren't admitted to a hospital and/or you get doctors' services outside the hospital, Medicare generally won't pay for these services.
Ambulance services to get you to the hospital in an emergency situation. Medicare will only cover ambulance services for the trip to the hospital if you're admitted as an inpatient. Return trips aren't covered.
Medicare only pays for its share of the costs for services covered in the Original Medicare Plan. If you only have Part A, Medicare only covers inpatient hospital care.
A: Unless it is an emergency situation where the dialysis is furnished at a hospital, Medicare doesn't cover dialysis when you travel outside the U.S.
A: A Medicare drug plan can't cover prescription drugs purchased outside the U.S. Call your drug plan for more information.
A: Except in the limited situations described above, Medicare doesn't pay for health care services you can get outside the U.S. If your circumstances don't meet these limited exceptions, you're responsible for full payment to the health care provider.
If you meet one of the exceptions described above, and the items or services you get meet Medicare coverage criteria, you pay the part of the charge you would normally pay when you get these same services or supplies inside the U.S. Even in these situations, you still pay the deductibles.
Although hospitals in the U.S. must submit claims to Medicare on your behalf, foreign hospitals aren't required to file Medicare claims. If you're admitted to a foreign hospital and that hospital chooses not to submit claims to Medicare on your behalf, then you must submit an itemized bill to Medicare for your doctor, inpatient, and ambulance services. For information on where to send a foreign claim, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
A: Your Medigap policy may offer some additional coverage for health care services or supplies that you get outside the U.S.
A Medigap policy is health insurance sold by private insurance companies to fill "gaps" in the Original Medicare Plan coverage. In all states, except Massachusetts, Minnesota, and Wisconsin, a Medigap policy must be one of 12 standardized policies so you can compare them easily. Medigap Plans C, D, E, F, G, H, I, and J provide Foreign Travel Emergency health care coverage when you travel outside the U.S. These policies pay for 80% of the billed charges of medically necessary emergency care that must be the type that would have been covered by Medicare in the U.S. This care must begin during the first 60 days of each trip, after you meet a $250 deductible each year. Foreign Travel Emergency coverage with Medigap policies has a lifetime limit of $50,000.
Before you travel outside the U.S., talk with your Medigap company or insurance agent to get more information about your Medigap coverage while traveling. To learn more about Medigap policies, visit www.medicare.gov on the web and view a copy of "Choosing a Medigap Policy: Guide to Health Insurance for People with Medicare", or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call 1-877-486-2048.
A: If you have a Medicare Advantage Plan, such as an HMO or PPO, or another Medicare plan your plan may offer some additional coverage for health care services you get outside the U.S. Check with your Medicare plan before traveling outside the U.S. to see what's covered.
A: Because Medicare has limited coverage of health care services outside the U.S., you may choose to buy a travel insurance policy to get more coverage when you travel. An insurance agent or travel agent can give you more information about buying travel insurance. Please be advised that travel insurance doesn't necessarily include health insurance. So it's important to read the conditions or restrictions carefully.
Comments from Insubuy®, Inc.:
Insubuy®, Inc. is a leading brokerage firm where you can purchase travel medical insurance while you are traveling abroad. We provide several international health insurance products to choose from. You can get instant quotes, compare various products side by side, and make an instant purchase online. Insurance can be effective as early as the next day or any future date that you specify.
Look at our guide for international travel medical insurance for further details.
- Visit www.medicare.gov on the web.
- Call 1-800-MEDICARE (1-800-633-4227) before traveling outside the U.S. TTY users should call 1-877-486-2048.
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