Understanding Medicare Coverage Limitations on International Travel
Embarking on global adventures in retirement is a dream for many retirees, but navigating health care coverage abroad can be a daunting task, especially when it comes to Medicare. While Medicare is a reliable companion within the United States, its support dwindles beyond its borders. Understanding what Medicare covers and the options available for international travel health care is crucial for seniors looking to explore the world while ensuring their health needs are met.
So what does Medicare cover outside of the US? While many older adults look forward to fulfilling their travel bucket list during retirement, Medicare may not be along for the ride. Here’s a comprehensive guide to Medicare coverage limitations outside the United States.
Table of Contents
Medicare Coverage Outside the U.S.
Medicare generally does not cover health care services received outside the United States or its territories. However, there are exceptions for specific circumstances
If you experience a medical emergency while traveling between Alaska and another state, and a Canadian hospital is closest to your location.
In a medical emergency within the U.S. or its territories, if the nearest hospital is across the border in Canada or Mexico.
If you need hospital care in a foreign country and the nearest hospital is closer than the nearest U.S. facility.
Emergency medical attention needed on a ship within six hours of a U.S. port.
Though not nearly comprehensive for all places abroad, these provisions ensure that Medicare beneficiaries can receive crucial care when faced with unforeseen medical emergencies in proximity to U.S. borders or territories.
Coverage Details Medicare Parts A & B
Medicare Part A and Part B provide limited coverage outside the U.S. under certain conditions:
Medicare Part A
Covers inpatient hospitalization in foreign countries when medically necessary, following a deductible (deductible size may vary between Supplement plans) and applicable coinsurance.
Medicare Part B
Covers emergency and non-emergency ambulance services and doctor visits immediately before and during a covered inpatient hospital stay abroad. Deductibles, copayments, and coinsurance apply similarly to services in the U.S. After hospitalization, Medicare generally does not cover services like return ambulance trips or subsequent outpatient care in the foreign country.
Submitting Claims
- Foreign hospitals may not be required to file Medicare claims. You may need to submit an itemized bill to Medicare for reimbursement. You will need this form and to submit the following items:
- A completed claim form (blank pdf linked above)
- The itemized bill from your doctor, supplier, or other health care provider
- A letter explaining in detail your reason for submitting the claim, like your provider or supplier isn’t able to file the claim, your provider or supplier refuses to file the claim, and/or your provider or supplier isn’t enrolled in Medicare
- Any supporting documents related to your claim
To find where to submit the documents look underneath the instruction area in the pdf document linked above.
Coverage Options for Foreign Travel
For those seeking additional coverage while traveling abroad, certain Medigap plans offer emergency health care coverage:
Medigap Coverage
Some Medicare Supplements cover emergency health care expenses outside the U.S. If coverage abroad is provided by your supplement plan it will cover 80% (meaning you will be responsible for 20%) of billed charges after a $250 deductible, with a lifetime limit of $50,000.
There are alternative options to supplement Medicare’s limited international coverage:
Medicare Advantage
Some Medicare Advantage plans may offer limited coverage for foreign travel emergencies. Coverage specifics vary so you will need to check with individual plans specific policies. Though plans differ in what they will cover and the steps they require insureds to take to file a claim they will typically require an itemized bill so it is good to keep in contact with any foreign hospitals or clinic you receive treatment at when getting ready to file a claim.
Travel Insurance
Consider purchasing travel health insurance, which covers emergency medical care abroad, including medical evacuation. Also, be sure to review travel insurance policies for exclusions, coverage limits, and handling of pre-existing conditions.
Medicare Drug Coverage (Part D)
Part D covers all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including those necessary for international travel have no copayment or deductible for ACIP-recommended vaccines under Part D. For a complete list of ACIP recommended vaccines you can search their list at the link here.
Conclusion
Summary
It is good to think about how your insurance will work in an emergency while outside of the United States just in case. Medicare provides limited coverage for health care services outside the United States and its territories, primarily focusing on emergencies and specific situations.
Coverage includes medical emergencies while traveling between Alaska and another state, emergencies within the U.S. where the nearest hospital is across the border in Canada or Mexico, and situations where a foreign hospital is closer than the nearest U.S. facility. Medicare Part A covers necessary inpatient hospitalization abroad, subject to deductibles and coinsurance, while Part B includes emergency and non-emergency ambulance services and doctor visits during covered hospital stays. Submitting claims for reimbursement may require submitting an itemized bill and supporting documents directly to Medicare.
Supplemental Medigap plans can provide additional coverage for emergency health care abroad, covering 80% of expenses after a deductible. Alternatively, Medicare Advantage plans and travel health insurance may include emergency medical care and evacuation abroad. Part D of Medicare covers all recommended vaccines for international travel with no copayment or deductible. Understanding these coverage options is essential for retirees and travelers planning trips outside the U.S.
