Covered by Medicare? Here’s what to know before you go.

In most situations, Medicare won’t pay for health care or supplies outside the United States. The term “outside the United States” means anywhere other than 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands.

Here are some answers to frequently asked questions about Medicare and international travel.

Information is provided by the Department of Health and Human Services/Centers for Medicare and Medicare Services.

When does Medicare cover health care services in a foreign hospital?
There are three circumstances when Medicare may pay for certain types of health care services provided in a foreign hospital:

• You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat your illness or injury.

• You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs. The Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury. Medicare determines what qualifies as “without unreasonable delay” on a case-by-case basis.

• You live in the United States and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it’s an emergency.

In these situations, Medicare will pay only for the Medicare-covered services you get in a foreign hospital.

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What kind of health care services does Medicare pay for in the 3 situations described above?
Medicare covers these services:

• Part A covers inpatient hospital care (care you get when you’ve been formally admitted with a doctor’s order to the foreign hospital as an inpatient). For more information on understanding your hospital status, visit Medicare.gov/publications to view “Are You a Hospital Inpatient or Outpatient?”

• Part B covers emergency ambulance and doctor services provided immediately before and during your covered foreign inpatient hospital stay. However, if Medicare doesn’t cover your hospital stay and/or you get ambulance and doctor services outside the hospital after your covered hospital stay ends, Medicare generally won’t pay. For example, Medicare won’t cover return ambulance trips home, nor cover doctor services you get in a foreign country after your covered foreign hospital stay ends.

• Medicare only pays for its share of Medicare-covered services. If you only have Part A, Medicare only covers inpatient hospital care.

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Does Medicare pay for dialysis treatments when I travel outside the U.S.?
No. Unless it’s one of the three circumstances described above, Medicare doesn’t cover dialysis when you travel outside the United States.

Does Medicare pay for prescription drugs outside the United States?
No. Medicare drug plans can’t cover drugs you buy outside the United States. Contact your drug plan for more information.

Will Medicare pay for medically necessary health care services I get on a cruise ship?
Medicare may cover medically necessary health care services you get on a cruise ship in these situations:

• The doctor is allowed under certain laws to provide medical services on the cruise ship.

• The ship is in a U.S. port or no more than six hours from a U.S. port when you receive the services, regardless of whether it’s an emergency. Medicare doesn’t cover health care services you obtain when the ship is more than six hours from a U.S. port.

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What do I pay if I get Medicare-covered services outside the U.S.?
Except in the limited situations described previously, Medicare doesn’t pay for health care services outside the United States. If your circumstances don’t meet these limited exceptions, you pay the full cost of care to the provider.

If your situation matches one of the exceptions and Medicare covers your care, you would pay the related coinsurance, co-payments, and deductibles.

Although U.S. hospitals must submit claims to Medicare for you, foreign hospitals aren’t required to file Medicare claims. If you’re admitted to a foreign hospital under one of the exceptions, and if that hospital doesn’t submit Medicare claims for you, then you must pay the full cost of care to the provider.

You must also submit an itemized bill to Medicare for your doctor, inpatient and ambulance services. If you received Medicare-covered services on a cruise ship under the circumstances described above, the doctor must submit the Medicare claim. However, you may also file a claim directly to Medicare in these circumstances.

For information on where to send a foreign claim, visit Medicare and download the “Patient’s Request for Medical Payment” form (CMS 1490S). You can also call 1-800-MEDICARE (1-800- 633-4227). TTY users can call 1-877-486-2048.

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What if I have a Medicare Supplement Insurance (Medigap) policy?
Your Medigap policy may offer additional coverage for health care services or supplies outside the United States. Medigap plans C, D, E, F, G, H, I, J, M, and N provide foreign travel emergency health care coverage.

Even though Plans E, H, I, and J are no longer for sale, you can maintain these plans if you purchased them before June 1, 2010.

Medigap plans C, D, E, F, G, H, I, J, M, and N pay 80% of the billed charges for certain medically-necessary emergency care outside the United States (after you meet a $250 annual deductible). These Medigap policies cover foreign travel emergency care if it begins during the first 60 days of your trip and if Medicare doesn’t otherwise cover the care. Foreign travel emergency coverage with Medigap policies has a lifetime cap of $50,000.

Before you travel abroad, 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 Medicare.gov/publications and download “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.” You can also call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call 1-877-486-2048.

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What if I get my health care from another Medicare health plan rather than Original Medicare?
Medicare Advantage Plans and other Medicare health plans must follow rules set by Medicare, including for the three circumstances described here. However, your plan may offer additional coverage for health care services you get outside the United States. Research your plan before traveling to understand what it covers.

As a Medicare customer, can I buy travel insurance to help pay for the cost of health care services?
Yes. Because Medicare has limited coverage of health care services outside the United States, you can buy travel insurance to get more coverage.

Where can I get more  Medicare information?
Visit Medicare.gov/coverage to find out what Medicare covers or call 1-800-MEDICARE.

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