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.
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:
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:
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.
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.
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:
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?"
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.
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.
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.
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.
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.
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.
QuoteWizard.com LLC has made every effort to ensure that the information on this site is correct, but we cannot guarantee that it is free of inaccuracies, errors, or omissions. All content and services provided on or through this site are provided "as is" and "as available" for use. QuoteWizard.com LLC makes no representations or warranties of any kind, express or implied, as to the operation of this site or to the information, content, materials, or products included on this site. You expressly agree that your use of this site is at your sole risk.