For many retirees, traveling is at the top of the list; however, Medicare coverage overseas is a large concern. Requiring medical attention in another country can leave a Medicare beneficiary with a hefty bill for which Medicare provides no reimbursement. When enrolled in Medicare Parts A and B (Original Medicare.), your Medicare benefits will be honored anywhere in the 50 United States that accept Medicare, including Puerto Rico, the Northern Mariana Islands, the District of Columbia, Guam, the Virgin Islands, and American Samoa. However, Original Medicare coverage overseas only covers very specific situations unless you are equipped with a Medigap policy.
Medicare Coverage Outside of the United States
Generally speaking, Medicare will not cover doctor or hospital visits anywhere outside of the United States or its territories. Consequently, there are a few rare cases when Original Medicare benefits would extend outside its borders.
According to Medicare.gov, there are some instances where Medicare will pay for services outside the U.S. and its territories that would fall under the Original Medicare umbrella. These include:
- You’re in the U.S. when a medical emergency occurs that requires immediate medical attention to prevent a disability or death, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
- You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
- You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.
In addition, if you are on a cruise ship that is still in U.S. waters, then Medicare will cover medical services as defined by your Medicare coverage. The cruise ship could also be within six hours of docking at a U.S. port or departing from the port. Be sure that the physician treating you can legally provide the service you are needing.
Costs of Medicare when Traveling Abroad
Unfortunately, you will more than likely have to pay 100% of the costs of the medical service you received while traveling unless your case falls into any of the above mentioned circumstances. In those instances, Original Medicare coverage overseas will pay 80% of the costs. You will be responsible for 20%. Again, Medicare will decide whether or not your case falls into any of the special situations they cover. If your coverage does work for you, then Medicare Part A will cover inpatient hospital visits that were needed. These visits will need to be formally ordered by a doctor. Medicare Part B covers both emergency and non-emergency hospital and ambulance services that were given during the covered inpatient hospital stay in the foreign country.
Options to Cover Medical Costs and Coverage while Traveling
Since Original Medicare coverage overseas is so limited, popular options for retirees wanting to travel abroad is to enroll in a Medicare Supplement (Medigap) plan in addition to Original Medicare. There are several supplement coverage options currently available that provide emergency health care coverage for foreign travel: Plans C, D, F, G, M, and N. In addition, these older plans are no longer available for purchase, but also include foreign travel emergency health care coverage: Plans E, H, I, and J.
Here are a few key considerations on these Medigap plans:
- Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care.
- Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year.
- Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.
There are also some Medicare Advantage plans that include emergency medical coverage for overseas travel, however they vary by carrier.
Each Medigap and Medicare Advantage Plan provides Medicare beneficiaries with varying benefits and costs. Additionally, it’s important to be aware that certain Medigap Plans and Medicare Advantage are only available for enrollment during specific time frames. We highly suggest talking with an independent insurance broker that specializes in Medicare to assess your specific needs and educate on plan options. Dan Griset has 40 years of experience in providing client-centered services and expertly assists clients as they choose well-planned Medicare protections.
Short-term Intermittent Medical Coverage
If you are only looking for one-and-done coverage or not planning to travel outside the United States frequently, then purchasing private health insurance accepted in the country you are traveling to might be a better option.
There are several options and varying benefits on foreign travel health coverage that can supplement Medicare coverage overseas. For these reasons, we are here to answer your questions and put your mind at ease before you embark on any trip you may take.