Do Medicare, Medicare Advantage, or Medigap plans pay for medical treatments in foreign countries?
Here's when and how these insurance policies for older Americans do and don't cover getting health care outside the U.S.
There's a lot to think about when you're preparing for a trip to a foreign country.
Do you have your tickets? Where's your passport--and is it up to date? How about your luggage--will it hold up to international travel? And, of course, who's going to get your mail and water your plants while you're away?
No one wants to add "what will I do if I get sick or injured over there?" to their pile of pre-travel worries. It's a must, though, if you don't want to be hit with an expensive surprise should either of those things happen when abroad.
What kinds of expensive surprises are we talking about here? One of the biggest is related to health insurance. If you have an employer-sponsored plan, it may cover medical care you receive outside the U.S. The same is true if you have some other form of private health insurance.
If you're on Medicare, though, don't expect reimbursement if you see a physician, visit a hospital, or need a drug refill while on foreign soil.
Keep reading to find out why and to learn how Medicare Advantage and Medigap or MedSup policies handle this situation.
More on Medicare and Medical Services Abroad
The good news is Medicare does pay for some international doctor visits, hospital stays, ambulance calls, and even dialysis treatments. Now for the bad news: it only pays for them in a limited number of circumstances.
Here's what has to happen for Medicare to pick up even part of your foreign medical bill:
- You're in the U.S. when a medical emergency occurs. A foreign hospital is closer than the nearest U.S. hospital that can treat your condition.
- You're in Canada while traveling between Alaska and another U.S. state when a medical emergency occurs. A Canadian hospital is closer than the nearest U.S. hospital that can treat your condition.
- You live in the U.S. and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat your condition. (In this instance, your situation doesn't need to be a medical emergency.)
By the way, as far as Medicare is concerned, a "medical emergency" is an injury or illness that requires immediate medical attention to prevent disability or death.
Medicare also sometimes covers medical services received on a ship. The catch here, though, is the services must be "medically necessary." Also, the ship has to be within the territorial waters of the U.S. If it's more than six hours away from a U.S. port, Medicare won't reimburse you for any portion of the resulting bill or bills.
Here's a Medicare refresher for anyone who needs it:
- Many people call Medicare Part A "hospital coverage." That's probably because its main benefit is it covers inpatient hospital care. It also covers care provided in skilled nursing facilities and in hospice settings, although neither applies here.
- Medicare Part B, on the other hand, covers preventative and medically necessary treatments. That includes most doctor appointments, outpatient hospital visits, lab tests, x-rays, mental health care, as well as some home health and ambulance services.
- As for Medicare Parts C and D, Part C refers to Medicare Advantage plans and Part D refers to Medicare prescription drug plans. Private insurers contract with Medicare to offer the former, which provide all Part A and B benefits along with drug coverage, too.
So, if your medical needs meet the requirements described earlier, look for Medicare Part A to pay for some of the care you receive after you're formally admitted to a foreign hospital.
How about Medicare Part B? It pays for ambulance and doctor services that happen just before as well as during an inpatient hospital stay in a foreign country. If Medicare refuses to cover your hospital stay, though, it also won't cover these ambulance or doctor services.
Finally, Medicare drug plans never cover prescription medications bought outside the U.S.
Although the general rule of thumb is you have to pay 100 percent of the cost of medical services received abroad if you're on Medicare, that's not true when it comes to the Part A and B examples mentioned above. In those situations, you pay just 20 percent of the approved amount, according to medicare.gov.
One more thing to keep in mind regarding Medicare and overseas medical services: foreign hospitals likely won't file Medicare claims for you. That's your responsibility. Specifically, once you're back home, you'll need to submit an itemized bill to Medicare for any covered doctor, inpatient hospital, and ambulance services.
Medicare Advantage Plans and Overseas Medical Services
As you may already know, Medicare Advantage plans provide all the benefits included in Original Medicare. So why would someone get Medicare Advantage over Medicare Parts A and B?
One reason is most Medicare Advantage policies, which are sold by private insurers that contract with Medicare, also offer prescription drug coverage. Many offer vision, hearing, and dental coverage, too.
That's not where Medicare Advantage's benefits end. A relevant case in point: they also often pay for at least a portion of medical care performed overseas.
As is true of job-based and other private health insurance policies, though, whether your Medicare Advantage policy covers you in this way depends on the provider and the plan.
To find out if that's true of a Medicare Advantage plan you already have or you're considering enrolling in, read through its "Summary of Benefits and Coverage." If that doesn't make things clear, contact your insurer and ask if the plan includes this kind of coverage. If it does, ask for specifics--when does and when doesn't it cover you when you're outside the U.S. and you need medical attention?
Read more about Medicare Advantage policies.
Medigap or MedSup Plans and Foreign Medical Care
You might think Medicare Advantage and Medigap or Medicare Supplement (also called MedSup) policies are one and the same.
Although private insurance companies sell both types of policies, they're otherwise pretty different. Medicare Advantage policies basically provide Americans an alternate way to obtain Medicare benefits. As for Medigap and MedSup policies, they pay some of the costs Original Medicare doesn't cover.
Medigap policies also tend to provide coverage that's above and beyond what Medicare Parts A and B offer. One example: many cover health care or supplies policyholders get while traveling internationally.
In particular, Medigap plans C, D, F, G, M, and N cover emergency medical services and treatments performed in a foreign country.
The same is true of Medigap plans E, H, I, and J. Insurers no longer sell these policies, but if you bought one before June 1, 2010, you can keep it and continue to benefit from this coverage.
All of these policies pay 80 percent of the billed charges for certain forms of "medically necessary emergency care" received outside the U.S.
They won't just reimburse you for any overseas medical care, however. Some of the requirements tied to this coverage:
- You must first meet a $250 deductible for the year.
- The emergency care has to begin during the initial 60 days of your trip.
- Medicare can't otherwise cover the services or treatments.
- You haven't yet reached the lifetime limit of $50,000 placed on this type of care.
If you have any questions or concerns about how your Medigap or MedSup policy does or doesn't cover foreign health care, contact your insurance agent or company.
Also, check out our Medigap and MedSup FAQ for more information about those plans. Or read this article: "When Does it Make Sense to Get a Medicare Supplement Plan?"
Frequently Asked Questions
Q: Does Medicare pay for medical care I receive outside the U.S.?
A: In general, no, it doesn't. It does cover certain emergencies (explained earlier), but most people are unlikely to find themselves in those situations. More importantly, your Medicare plan won't reimburse you for routine doctor or hospital visits when you're abroad. Only some Medicare Advantage and Medigap or MedSup plans do that.
Q: Will Medicare cover dialysis treatments when I'm in a foreign country?
A: Your Medicare coverage only pays for these treatments if you find yourself in one of the situations described earlier in this article. Otherwise, it won't pay for dialysis treatments done outside the U.S.
Q: If I need medical attention while on a cruise ship, will Medicare cover it?
A: Only in certain circumstances. One is the care must be "medically necessary." Another is the ship has to be in a U.S. port when you receive the care. Or it must be no more than six hours away from a U.S. port. In pretty much any other situation, Medicare won't pay any bills tied to medical services performed on a cruise ship.
Q: If I need to refill a prescription while traveling abroad, will Medicare pay for it?
A: No. Medicare drug plans never pay for medications bought outside the U.S. Medicare Advantage and MedSup or Medigap plans may help with this.
Q: Do Medicare Advantage plans pay for medical services and treatments performed overseas?
A: Some do, some don't. Medicare Advantage plans often provide coverage that's above and beyond what Original Medicare offers. Many cover international health care. To see if that's true of yours, read through the policy. If you still aren't sure after that, contact your insurance company.
Q: Will my MedSup plan reimburse me if I need to see a doctor or visit a hospital while outside the U.S.?
A: It depends on the type of MedSup or Medigap plan you have. Certain plans do cover emergency medical care performed in a foreign country. If you're not sure if your plan provides such coverage, call or email your insurer and ask.
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