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Medicare Coverage While Traveling Abroad

by | Aug 3, 2022

For many seniors, retirement means the opportunity to travel more. Original Medicare, Medigap and Medicare Advantage plans all offer different coverage and limitations. If you plan to travel outside the U.S., you need to know how you are covered before you go.

What Original Medicare Covers While Traveling

Original Medicare doesn’t cover treatment outside the U.S. and it’s foreign territories except for a few rare circumstances. This includes prescription drugs. Medicare plans do not cover outpatient medications purchased outside the U.S.

Coverage outside of the United States is limited to these specific circumstances:

  • You’re in the US when you have a medical emergency, but a foreign hospital is closer than the nearest US hospital that is able to treat your illness or injury.
  • You are traveling in Canada with unreasonable delay by most direct route between Alaska and another state when a medical emergency happens. If a Canadian hospital is closer than a U.S. hospital, that hospital can treat your illness or injury. Medicare will determine what “unreasonable delay” means on a case-by-case basis.
  • You live in the U.S., but a foreign hospital is closer to your home than the nearest US hospital and can treat your medical condition, regardless of whether it is an emergency.

If you don’t meet these circumstances, you pay the full cost to the health care provider. If your situation matches one of the circumstances above, and Medicare covers the items or services you get, you will pay the related coinsurance or copayments, and deductibles. Foreign hospitals aren’t required to file Medicare claims. If you’re admitted to a foreign hospital under one of the situations described and if that hospital doesn’t submit Medicare claims for you, then you pay the full cost to the health care provider. You must submit an itemized bill to Medicare for reimbursement.

What Medigap Covers While Traveling

If you plan to travel outside the U.S frequently, it might be worthwhile to look at adding a Medigap plan to Original Medicare. Most Medigap plans provide some coverage for foreign travel (80% of the cost of emergency care received in the first two months of a trip, limited to a $50,000 lifetime cap, and with a $250 annual deductible).

In most states, Medigap plans are only available with no medical underwriting during your initial enrollment period and during a very limited special enrollment period. Medical underwriting is used to determine whether the insurer should offer you coverage, and if so, at what price. It’s wise to plan ahead to avoid this process if possible.

What Medicare Advantage Covers While Traveling

If you get a Medicare Advantage plan, then your plan doesn’t always cover medical services while traveling outside of the United States. It depends on what kind of plan you signed up and how long you travel for. It also depends on where you travel and the kind of care that you need while you are traveling. It’s important to know the details of the plan you select to ensure you have the right coverage so there are no surprises.

What is Covered While on a Cruise Ship?

Original Medicare (Part A and B) may provide coverage for care that is received on a cruise ship if each of the following conditions apply:

  • The care is medically necessary
  • The cruise ship that you are on when you receive the care is in U.S. waters (within six hours of a U.S. port)
  • The doctor rendering the care is legally allowed to provide medical services aboard a cruise ship

If you got Medicare-covered services on a cruise ship under a situation described above, the doctor must submit the Medicare claim. However, you may also file a claim directly to Medicare in these rare circumstances. If you have a Medicare Advantage plan, you need to see if your particular plan offers any coverage in this situation.

What if You Plan to be Abroad for an Extended Period of Time?

If you travel outside of a Medicare Advantage plan’s service are for more than six months, you will likely be disenrolled and placed back into Original Medicare. When this happens, you will receive a notification, and you will continue to pay the Part B premium. If you drop Part B and do not pay for your Medicare, then you will have to pay an enrollment penalty when you come back to the United States. Premiums increase each year by 10 percent when not enrolled in Part B. It’s important that you continue to maintain your health insurance even if you decide to travel for longer periods of time outside of the United States.

Other Coverage Options While Traveling

You may want to consider buying a travel health insurance policy to supplement what Medicare covers. If you want coverage for transportation back to the U.S for medically necessary treatment, you want to make sure medical repatriation and evacuation is included. You should review the policy carefully to know what is covered and what is not.

If you need help finding a plan that offers the right coverage for you when you travel, contact us. Our knowledgeable and experienced team is here to help