Original Medicare plans provide coverage throughout the United States, the District of Columbia, and in five major U.S. territories. The same rules may not apply to other Medicare plan types.
Whether a person is traveling or temporarily residing in another state, they may be wondering if they can use their Medicare benefits while away from home.
In this article, we look at where Medicare can be used and provide information on Medicare coverage when a member is traveling or living in another country.
If a person has original Medicare parts A and B, they will have Medicare coverage anywhere within the 50 U.S. states, the District of Columbia, or in five major U.S. territories including:
- Puerto Rico
- the Virgin Islands
- Guam
- American Samoa
- the Northern Mariana Islands
Most U.S. health care providers accept original Medicare.
If a person travels outside of the U.S. or its territories and requires health care, Medicare may not provide coverage.
There are a few exceptions, however, and services that could be eligible for coverage include:
- inpatient hospital care
- doctor visits
- ambulance services
- dialysis
Onboard a ship
Medicare Part B will cover health services provided while a person is on board a ship currently in U.S. territorial waters and adjoining U.S. land areas.
If a ship is over 6 hours away from a U.S. port, Medicare may not pay for medical services.
Medical emergency
If a medical emergency requires immediate attention while a person is in the U.S., but a foreign hospital is closer than a U.S. hospital to treat the medical condition, coverage is usually available.
Medical emergency when traveling from Alaska
Services are typically covered if a person is traveling between Alaska and another U.S. state when a medical emergency occurs, and a Canadian hospital is closer than the nearest U.S. hospital.
Non-U.S. hospital closer to residence
When residing in the U.S. and the nearest U.S. hospital is further from a person’s home than the closest non-U.S. hospital, coverage may be approved regardless of whether a medical emergency takes place.
If a member purchases prescription drugs outside the U.S., Medicare usually will not cover the cost.
Medigap plans may offer coverage for medical services or supplies a person receives outside the U.S or when traveling.
If a person has a Medigap plan, their coverage may include emergency non-U.S. medical care when traveling, applicable if the medical incident occurs during the first 60 days of the trip, and if original Medicare does not cover the care.
It may also include 80 percent of costs, after a person has met the yearly deductible. The 80 percent coverage relates to some kinds of necessary emergency care provided outside the U.S.
It may be important for an individual to note that currently, Medigap non-U.S. emergency coverage has a lifetime limit of $50,000.
People that are eligible for Medicare may be able to receive Medicare coverage while living outside the U.S.
If they qualify for Part A coverage, they can contact their nearest U.S. Social Security office, U.S. Consulate, or U.S. Embassy to enroll.
If an eligible person lives outside the U.S. and wants to enroll in Medicare Part B, they can only do so the month they return to the U.S., and they may pay higher premiums depending on their situation.
Late enrollment penalties may apply if an individual does not enroll in Part B within 3 months of returning to the U.S.
If a person decides to move to another state, they should report their change of address to Medicare online, call the Social Security Administration at 1-800-772-1213, or by visiting a local SSA office.
Plans with private insurance companies
Private insurance companies administer:
- Medigap plans
- Medicare Advantage (Part C) plans
- prescription drug plans (PDPs)
If a private insurance company administers a person’s Medicare plan, they will need to directly contact the plan provider to change their address.
Most companies provide an option for contacting them online, by phone, or by mail.
Not all plans are available by all insurers in all states or counties. Upon moving, it may be necessary for an individual to change their insurance provider, plan, or both. This could bring different benefits and rules.
Original Medicare members are covered while they reside and travel within one of the 50 U.S. states, the District of Columbia, or one of the five principal U.S. territories.
If a Medicare recipient travels outside the U.S. or its territories and requires care, Medicare may not cover services. There are exceptions to this rule.
If a Medicare-eligible person resides outside the U.S., they may be able to receive Medicare coverage.
If a Medicare member moves to another state, they should report their change of address to their local Social Security office.