Medicare Advantage plans do not usually cover medical treatment needed when traveling internationally, but sometimes, plans may include coverage for emergency care.
Private insurance companies administer Medicare Advantage plans. Also known as Medicare Part C, the plans are required to include all of the benefits of original Medicare Part A and Part B but are also able to offer extra benefits.
Extra coverage may include vision and hearing care or routine dental treatment. Usually, treatment received internationally is not eligible for coverage unless it is an emergency. Specific rules also apply.
This article looks at what coverage may be available for international travel, rules, extra costs, and options a person may need to consider.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
In most instances, Medicare will not pay for health services received while outside the United States.
When it comes to Medicare, coverage is usually available in the following places, as they are not considered international:
- any of the 50 U.S. states
- the District of Columbia
- Puerto Rico
- the U.S. Virgin Islands
- Guam
- American Samoa
- the Northern Mariana Islands
There are three instances in which Medicare may pay for some emergency medical services a person receives in a non-U.S. hospital.
Medicare may provide coverage if a person is in the U.S. when they become ill, but the nearest hospital able to provide adequate care is in a non-U.S. location.
It may also offer coverage to a person traveling from a U.S. state to Alaska, through Canada, without unreasonable delay, when a medical emergency occurs. In this circumstance, a Canadian hospital should be adequately equipped to treat the illness or injury and be closer than a U.S. hospital. Medicare determines the definition of “without unreasonable delay” on a situational basis.
Lastly, when a person resides in the U.S. and a non-U.S. hospital that can treat the health condition is closer to the place of residence than the nearest U.S. hospital, Medicare may provide coverage. This applies in both emergency and non-emergency situations.
In all cases, Medicare will only pay for Medicare-covered and eligible services that a person receives.
If eligible treatment is received while a person is abroad, they are required to pay the same coinsurance, copayment, or deductible that would apply to treatment received in the U.S.
A person eligible for Medicare may be able to get Medicare coverage while they live outside the U.S.
If a person lives outside the U.S. and qualifies for Part A coverage, they can contact their nearest U.S. Social Security office, U.S. Consulate, or U.S. Embassy to enroll.
If a Medicare-eligible individual resides outside the U.S. and wants to enroll in Medicare Part B, they may pay a higher premium depending on their circumstances.
An individual must be resident in the U.S. to enroll for Part B coverage if all of the following conditions apply:
- they are a U.S. citizen
- they are over age 65
- they are not eligible for Social Security benefits
- they resided in a foreign country when they turned 65 years of age
If a person is returning to the U.S., they will first be eligible to enroll in Part B the month they return and establish residence. They may not have to pay a late enrollment penalty if enrollment takes place for Part B within 3 months of returning to the U.S.
There are other options that may give a person medical coverage while traveling abroad.
Travel insurance
As Medicare provides limited health coverage outside the U.S., a person may choose to purchase travel insurance that includes medical care before they leave on a trip.
Travel insurance that includes medical care protects an individual in the event of an illness or injury when they travel outside of their country of residence. It may also provide key emergency care benefits.
An individual may contact an insurance agent or travel agent for more information about this type of insurance plan.
Medigap (Medicare supplement insurance)
Medigap plans may offer health coverage for medical services a person receives while outside the U.S.
If a person has Medigap Plan C, D, E, F, G, H, I, J, M, or N, their policy may cover foreign travel emergency medical care if the illness or injury occurred during the first 60 days of travel, and if original Medicare does not cover the healthcare.
Medigap may also pay 80% of the charges, after a person has paid an annual deductible.
Medigap’s overseas emergency coverage has a lifetime maximum limit of $50,000.
Private insurance companies administer Medigap plans, and a person may contact a plan provider directly to learn about coverage while traveling overseas. Medicare’s helpful web tool can help an individual to compare available policies.
Usually, Medicare will not pay for medical services a person receives while they are outside the U.S., except for in some emergencies.
A person will pay the same coinsurance, copayment, and deductible as they usually would, had they received the services while in the U.S.
Individuals eligible for Medicare may be able to enroll for Medicare coverage while they live outside the U.S., but some rules apply.
Because Medicare provides limited coverage outside the U.S., a person may wish to purchase a Medigap policy or travel insurance that includes medical coverage before they leave the U.S.