Retirement’s advantages include the freedom and time to travel. However, as we age, we’re also concerned about unexpected medical events — whether a sprained ankle or chest pains — and their costs.
Unfortunately, Original Medicare does not cover you outside the U.S. and specific U.S. territories, but you might be able to buy a plan that offers the coverage you need while trotting the globe.
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Does Medicare Cover Care Outside the U.S.?
While Original Medicare does not cover care when you’re outside the U.S., it may pay for foreign-hospital bills if you’re in the U.S., but a foreign hospital is closer than a U.S. hospital. For example, if you’re in the U.S. and near the Canadian or Mexican borders and a Canadian or Mexican hospital is closer to you than a U.S.-based hospital in an emergency.
Another exception is for people covered by Medicare traveling “without unreasonable delay” through Canada between Alaska and another U.S. state. So, Medicare could cover car accident treatment for those driving directly from Alaska to Washington State. But Medicare may not pay for emergency services for those tooling around British Columbia for a month in an RV.
Alternatively, if you’re traveling in a U.S. territory such as Washington, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands, Original Medicare will cover you as long as the doctor and facility accept Medicare Part B.
It’s important to note you may be able to acquire some international coverage for specific situations through Medicare Advantage or by buying a Medigap plan.
Medicare Part A Coverage Overseas
Medicare Part A helps cover costs associated with inpatient hospital care, including a semi-private room, meals, and nursing.
Medicare Part A does not generally cover inpatient foreign hospital stay outside the U.S. and territories, although it’s possible in rare circumstances. For example, suppose you shattered bones while in a car accident en route between Alaska and Montana. In that case, Medicare Part A might pay for a brief Canadian inpatient hospital stay until you can get back on the road.
Medicare Part B Coverage Overseas
Medicare Part B covers medically necessary services, which include ambulance services, medical equipment, emergency room treatment, and outpatient care.
Similar to Part A, Part B does not include international coverage except in the circumstances described above. For example, Part B might cover the Canadian ambulance trip, surgical materials used to repair your leg, crutches, and other services to help you in the Canadian hospital.
As the Canadian hospital is not contracted with Medicare, you may need to submit an itemized bill to get coverage, as foreign hospitals aren’t required nor should be expected to submit claims for you.
Medicare Part D Coverage Overseas
Medicare Part D is also known as prescription drug coverage and, as you might expect, helps pay costs associated with prescription drugs. Part D does not cover prescription drugs bought outside the U.S., so you’ll pay out of pocket.
Bring plenty of medication for your entire trip and perhaps several extra days’ worth in case you run into delays or issues traveling home. If you worry about theft or loss, bring a letter from your physician describing your prescription medication (including the generic name) and your medical condition.
What Counts As a Medical Emergency Overseas?
Public health experts describe a medical emergency as involving acute symptoms and significant pain that seriously jeopardizes your health, could impair bodily functions, or cause serious dysfunction of any bodily organ or part.
Typically, Medicare covers emergency services if you have the following:
- Sudden illness
- Illness that quickly worsens
In these cases, you’ll want to go to a facility with an emergency department or seek emergency services. A medical emergency differs significantly from a routine medical need. More routine care might include:
- An annual check-up
- Care for chronic conditions
- Prescribing your regular medication
- Undergoing a procedure like a mammogram
How to Get Medicare Coverage Abroad
As discussed, if you’re traveling and break an arm, catch pneumonia, or otherwise become injured and ill, Medicare does not pay the costs for emergency treatment care and overseas hospital care. To address Medicare gaps, consider these options.
Medicare Advantage Coverage Overseas
Medicare Advantage (MA) is also known as Medicare Part C. These plans are all-in-one bundled plans sold by private companies combining Medicare Parts A, B, and, usually, D.
You’ll need to pay any Medicare Advantage deductibles and copays for emergency visits, diagnostic tests, ambulance trips, and other costs. You might also need to get approvals and referrals—check your plan’s fine print or call the insurance provider for details. The insurer determines the international benefits, reimbursement approach, maximum payout amounts, and your portion of worldwide emergency coverage costs.
Medicare Advantage plan service areas are determined by individual providers. If you live outside the service areas for a certain amount of time, the Medicare Advantage plan provider may remove you from their plan. However, some offer the ability to stay on for an additional period, typically another six months. Always review your emergency insurance options with the private company offering Medicare Advantage before departing on a trip.
Medigap Coverage Overseas
If you want Medicare international coverage when traveling outside the U.S., the standard Medigap Plans C, D, F, G, M, and N sold today provide this emergency coverage. Older plans (E, H, I, and J) bought before 2010 offer overseas Medicare emergency coverage but are unavailable for sale today.
You must buy these plans in combination with Original Medicare as Medigap acts to cover gaps in coverage. Medigap cannot be purchased as a standalone plan or in conjunction with Medicare Advantage.
Specifically, Medigap plans generally:
- Pay 80% of the charges for medically necessary emergency care or supplies in a foreign country.
- Expect you to pay a co-insurance amount of 20% for emergency care or supplies.
- Have a lifetime limit of $50,000—you can’t spend more than $50,000 altogether.
- Require first meeting an annual $250 deductible
- Only pay for care if needed during your trip’s first 60 days.
- Only pay if Medicare doesn’t cover the care already under one of the exceptions (border hospital; transit through Canada) described earlier.
- May vary, so check with your Medigap provider for details.
For example, if you buy a Medigap coverage plan and have a $1000 foreign hospital bill after an emergency, you could be reimbursed for $800 of the qualifying expenses.
How to Get Medicare Coverage On a Cruise Ship
Medicare Part B could pay up to 80% for emergency medical services while on board a cruise ship within the “territorial waters” or domestic waters adjoining U.S. land areas. You could also qualify for emergency medicare coverage if the boat is at a U.S.-baed dock.
Your boat must be less than 6 hours away from a U.S. port to qualify for coverage. You can call the cruise line to ask if you’re unsure whether your boat will remain in domestic waters.
If you have Medigap or Medicare Advantage plans, you can call the plan administrator to ask whether it covers cruise ship emergency services. However, if you’re concerned, consider getting additional medical insurance.
Alternative Options for Medical Coverage Outside the U.S.
If you have Original Medicare, consider getting travel medical insurance to cover medical care costs while traveling abroad or on a cruise ship sailing in international waters. You can buy travel medical insurance online or through a travel or insurance agent.
Travel medical insurance is generally available for trips outside the U.S. for up to six months. This insurance covers emergency and pre-existing conditions for medical services, emergency transportation, and medical evacuation, which you would need if that country’s doctors can’t help you or require advanced care. Medical evacuations can run more than $50,000, depending on where you are and your medical situation.
Depending on the plan, it may also cover emergency dental treatment and prescription drugs up to 100%. Maximum limits vary but can reach up to $1 million; deductibles vary but can be as inexpensive as $0.
The catches—you might be required to have a primary, U.S.-based health plan and must purchase the insurance before departure. Travel medical insurance costs increase with age. The price for a $1 million travel medical insurance plan could be around $4/day for someone aged 50-59 and $12/day for a traveler aged 70-74.
It may feel silly to buy coverage you might not use. But medical travel insurance allows you to spend time doing what you want versus worrying over Medicare coverage outside the USA.