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Medicare Coverage Outside the U.S.: What to Know Before You Travel

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Medicare Coverage Outside the U.S.: What to Know Before You Travel

When you’re preparing to travel abroad, it’s important to know your Medicare coverage does not typically apply outside the U.S. In most cases, you will be fully responsible for healthcare costs you incur while traveling internationally.

Additionally, Medicare drug plans do not cover any prescription drugs you purchase while traveling internationally.

However...

Original Medicare does offer coverage outside the U.S. in some rare cases


There are some specific circumstances in which Original Medicare plans are required to pay for your inpatient hospital bills, doctor bills, ambulance charges, or dialysis expenses abroad, according to Medicare.gov.

These situations include:

  • You experience a medical emergency or need treatment for a medical condition while in the U.S. and a foreign hospital is the nearest hospital qualified to treat your condition.

  • You experience a medical emergency in Canada while traveling the most direct route between Alaska and another U.S. state. A Canadian hospital is the nearest hospital that’s qualified to treat your ailment or illness.

  • You receive medically necessary healthcare services onboard a ship while it’s located* in the territorial waters that adjoin the land areas of the United States.

*Note that Medicare will not pay for any medical care you receive while the ship is over 6 hours away from the nearest U.S. port.

Reminder! The United States includes...

 

  • The 50 States
  • The District of Columbia
  • Puerto Rico
  • Guam
  • The U.S. Virgin Islands
  • The American Samoa
  • The Northern Mariana Islands

Here’s how much you’ll pay for covered medical expenses outside the U.S.


Remember, in most cases, you will pay 100% of the medical costs you incur while traveling internationally.

However, if you’re covered under Original Medicare due to one of the circumstances listed above, you will pay only 20% of the expenses approved under Medicare.

Note that you must pay your Part B deductible before your Original Medicare plan will begin to cover the approved charges. You must also pay any copayments you would normally owe if you received the same health services or supplies inside the U.S.

Don’t have Original Medicare? Click here to learn about your international Medigap coverage or click here to learn about your international Medicare Advantage coverage.

Original Medicare will pay its share of the following expenses in covered situations:

  • Hospital care you receive after your doctor formally orders you to be admitted to a foreign hospital as an inpatient (covered under Medicare Part A)

  • Emergency and non-emergency ambulance services you receive before you are formally admitted to a foreign hospital as an inpatient for a covered stay (covered under Medicare Part B)

  • Emergency and non-emergency doctor services you receive before and during your covered stay as an inpatient at a foreign hospital (covered under Medicare Part B)

Original Medicare will not cover:

  • Any medical expenses stemming from an uncovered hospital stay
  • Healthcare services you receive outside the hospital once you are no longer an inpatient


The amount you owe typically depends on:

  • The type of medical facility
  • How much your healthcare provider charges
  • Whether or not your doctor accepts Medicare assignment
  • Any other insurance you have

PRO TIP: Talk to your doctor or healthcare provider to determine how much any necessary tests, services, or supplies will cost.


Medigap may cover certain healthcare costs as you travel abroad


According to Medicare.gov,
standard Medicare supplement insurance (Medigap) plans C, D, E, F, G, H, I, J, M, and N provide coverage for some emergency healthcare expenses incurred overseas if both the following are true:

  • You receive emergency medical care during the first 60 days of your trip
  • Medicare would not otherwise cover the care you receive

(Note that Medigap plans E, H, I, and J are no longer for sale. However, you may keep your E, H, I, or J plan if you purchased it before June 1, 2010.)

Here’s how much you’ll pay for covered medical expenses outside the U.S.


Medigap plans C, D, E, F, G, H, I, J, M, and N will pay 80% of your billed medical expenses for certain “medically necessary” treatments abroad. This means you will pay 20% of covered costs. However, your Medigap policy will only begin to pay its share after you have met your $250 deductible for the year.

 

"Medically necessary" healthcare:


Refers to healthcare services, treatments, or supplies required to diagnose or treat an illness, ailment, condition, or disease.

Medigap policies have an overall lifetime maximum of $50,000 for eligible healthcare costs abroad. This means $50,000 is the maximum dollar amount your Medigap policy will pay toward your covered expenses during your lifetime.

PRO TIP: Contact your Medigap provider to learn more about your foreign healthcare coverage before you travel outside the United States.


Medicare Advantage plans cover the same unique travel situations as Original Medicare


Medicare Advantage plans are required to provide at least the same level of coverage as Original Medicare for eligible expenses incurred while traveling internationally. This means you’ll have equal coverage—or possibly more coverage—in the same limited scenarios highlighted above.

Some Medicare Advantage plans provide additional benefits beyond what Original Medicare covers abroad. Check with your Medicare Advantage provider to determine your benefits as you travel outside the United States.


How to file a Medicare claim for your covered expenses


U.S. laws require doctors to file Medicare claims for the covered services you receive inside the U.S. However, foreign hospitals are not required to file your Medicare claims for you.

If you’re admitted to a foreign hospital as an inpatient under one of the covered situations listed above, you’ll need to file your own Medicare claim. You must file your claim within the 12 months following the date you received treatment to be eligible for reimbursement.

Generally, you’ll need to submit the following with your claim:

  • A complete claim form titled “Patient Request for Medical Payment (CMS-1490S)”
  • An itemized bill that lists the ambulance, doctor, and hospital services you received
  • A letter explaining your reason for submitting the claim yourself
  • Any additional documents that support your claim

Follow the instructions included within the claim form to submit your claim to Medicare.

Learn more about how to submit a Medicare claim.


Don’t have adequate overseas health coverage? Consider travel medical insurance for unexpected healthcare costs


Travel medical insurance (also referred to as travel health insurance) is temporary health coverage designed to pay for emergency medical expenses stemming from an unanticipated illness or injury abroad.

Say you’re golfing at Ballybunion Golf Club in Ireland when you fall and break your ankle. Depending on the circumstances and the plan you choose, you may be covered for:

  • The cost of a local ambulance to transport you to the hospital
  • Your emergency room co-payment
  • The bill for your hospital room and board
  • All other eligible medical expenses

Travel health insurance does not cover pre-existing conditions, regular prescriptions, or preventive care. But it does offer more than just emergency medical coverage.

 

For example, a plan like Tokio Marine HCC – MIS Group’s Atlas Travel can cover you for situations like:

 

  • You’re taken to the nearest emergency medical facility following a severe injury in a fairly remote location. Unfortunately, the facility lacks sufficient equipment and the medical specialists required to treat you. You need to be transported by helicopter to a hospital better suited to your needs—a cost that can exceed $100,000. Under Atlas Travel, you’re covered for an emergency medical evacuation of up to $1,000,000.

  • You’re relaxing on the beach in the Bahamas when you receive the devastating news that your sibling has passed away. You decide to return home immediately to help your family make funeral arrangements. Thankfully, Atlas Travel’s Trip Interruption benefit pays for your one-way ticket to return home.

  • You’re hospitalized due to a medical emergency while traveling solo through Italy. Fortunately, Atlas Travel pays to fly a family member from your home country to your bedside.

  • You’re injured in a terrorist attack in London. Atlas Travel pays for your covered injuries up to the $50,000 maximum lifetime limit allowed under the Terrorism benefit.

  • Your husband and travel companion contracts an illness in the Caribbean and dies. Your joint Atlas Travel policy pays to transport his body back to your home country.

Atlas Travel also includes high coverage limits for seniors. Overall maximum coverage limits are as follows:

  • Up to Age 69: $2,000,000
  • Age 70-79: $250,000
  • Age 80+: $10,000

Learn More About Atlas Travel Insurance

 

Be sure to explore our helpful travel medical insurance resources:

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Tokio Marine HCC - MIS Group international insurance products are underwritten by Lloyd’s. Tokio Marine HCC - Medical Insurance Services Group (MIS Group) is a service company and a member of the Tokio Marine HCC group of companies. Tokio Marine HCC - MIS Group has authority to enter into contracts of insurance on behalf of the Lloyd’s underwriting members of Lloyd’s Syndicate 4141, which is managed by HCC Underwriting Agency Ltd.