Medicare Usually Doesn’t Cover You Outside the US. Here’s What Older Travelers Use Instead

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If you are on Original Medicare and you get sick or hurt in another country, Medicare usually will not pay. That is the core problem with Medicare outside the US. According to Medicare.gov, Medicare usually does not cover health care while you are traveling outside the United States, with only a few narrow exceptions. Older travelers fill that gap with Medigap plans that include foreign travel emergency coverage, Medicare Advantage plans with worldwide benefits, separate travel medical insurance, or medical evacuation coverage.

The gap matters. A hospital stay abroad can cost thousands or tens of thousands of dollars, and an emergency medical evacuation flight back to the United States can cost far more. In most cases, Medicare.gov says, you pay all of the costs for care you get outside the United States.

Here is what Medicare does and does not cover abroad, and the options older travelers use to protect themselves.

What Medicare covers outside the US

Medicare’s coverage outside the United States is limited to a few specific situations. According to Medicare.gov, Medicare may pay for inpatient hospital, doctor, and ambulance services in a foreign country in rare cases, including when:

• You are in the United States when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your condition.
• You are traveling through Canada without unreasonable delay by the most direct route between Alaska and another U.S. state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
• You live in the United States and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your condition, whether or not an emergency exists.

Medicare Part B may also pay for medically necessary services you get on a cruise ship in some cases, if the doctor is legally allowed to provide medical services on the ship and the ship is in a U.S. port or no more than six hours away from a U.S. port when you get the services.

Outside those situations, Original Medicare generally does not cover care abroad.

What older travelers use instead of Medicare outside the US

Because of these limits, many older travelers use one or more of the following options.

Medigap foreign travel emergency coverage

Medicare Supplement Insurance, also called Medigap, can help. According to Medicare.gov’s publication on coverage outside the United States, most Medigap plans, including Plans C, D, F, G, M, and N, as well as older plans E, H, I, and J that are no longer sold, provide foreign travel emergency health care coverage. Those plans:

• Pay 80% of the billed charges for certain medically necessary emergency care outside the United States after you meet a $250 deductible for the year.
• Have a lifetime limit of $50,000.
• Cover foreign travel emergency care if it begins during the first 60 days of your trip and Medicare does not otherwise cover the care.

That is helpful, but it has gaps. You pay 20% of the charges plus the deductible, coverage is capped at $50,000 for your lifetime, and it applies only to emergency care in the first 60 days of a trip. It also generally does not cover medical evacuation back to the United States.

Before you travel, ask your Medigap company for details about how it handles foreign claims.

Medicare Advantage plans with worldwide coverage

Medicare Advantage plans, offered by private insurers, may include some coverage for emergency or urgent care outside the United States. Benefits vary widely by plan. Some plans include worldwide emergency coverage with limits, while others offer little or none.

If you have a Medicare Advantage plan, check your plan’s evidence of coverage or call the insurer to ask what is covered abroad, what limits apply, and how to file a claim.

Travel medical insurance

Travel medical insurance is a separate policy that covers medical care during a trip abroad. Policies can cover doctor visits, hospital stays, prescription drugs, and emergency care. Many also include emergency medical evacuation and repatriation.

For older travelers, travel medical insurance can fill the gaps left by Medicare and Medigap. When shopping, consider:

• Coverage limits. Look for limits high enough to cover a serious hospital stay.
• Medical evacuation. Check whether evacuation is included and the coverage limit.
• Pre-existing conditions. Many policies have specific rules about pre-existing conditions. Read them carefully.
• Age limits. Some policies have age restrictions or higher premiums for older travelers.
• Primary versus secondary. Primary coverage pays first, while secondary coverage pays after other insurance.

Some travel insurance packages include medical coverage along with trip cancellation and other benefits.

Medical evacuation coverage

An emergency medical evacuation, such as an air ambulance flight from a remote area or another country back to the United States, can be extremely expensive. Medicare generally does not cover it, and many Medigap plans do not either.

Some travelers buy separate medical evacuation coverage, either as part of a travel insurance policy or through a membership program that arranges and pays for evacuation. Read the terms closely: some programs only transport you to the nearest adequate hospital, while others will bring you home.

What about prescription drugs abroad?

Medicare Part D drug plans generally do not cover prescriptions you buy outside the United States. Before traveling, talk to your doctor and pharmacy about getting enough medication for your trip. Keep medications in their original containers and carry a copy of your prescriptions.

Cruises and Medicare

Cruises are a common situation where older travelers are surprised. Medicare’s cruise ship coverage is narrow: it may apply only when the ship is in a U.S. port or within six hours of one, and only under certain conditions. Once a ship is farther away or in a foreign port, Medicare generally does not cover care.

Cruise ship medical centers often charge high fees, and serious emergencies may require evacuation to a hospital on land. Travel medical insurance with evacuation coverage is worth considering for cruises, especially those visiting foreign ports.

Living abroad versus traveling

If you are retiring or spending long periods outside the United States, Medicare’s limits matter even more. Medicare generally will not cover your care abroad, but you may still need to pay Part B premiums to avoid late enrollment penalties if you return later. Some people keep Medicare for care when they return to the United States and buy local or international health insurance for their time abroad.

This is a complex decision. Talk with a Medicare counselor through your State Health Insurance Assistance Program, known as SHIP, or a licensed insurance professional.

Questions to ask before you buy travel medical insurance

Older travelers often have more complex health needs, so it pays to ask specific questions before buying a policy:

• Does the policy cover pre-existing conditions, and if so, what are the conditions for coverage?
• What is the maximum medical benefit, and is it per trip or per person?
• Is medical evacuation included, and will it bring me home or only to the nearest adequate hospital?
• Does the insurer pay hospitals directly, or will I have to pay upfront and file for reimbursement?
• Is there a 24-hour assistance line that can help find doctors and hospitals?
• Are there age limits or higher rates for travelers over a certain age?

Write down the answers and keep a copy of the policy and the assistance phone number with your passport.

A simple checklist before you travel

• Confirm what your Medicare plan covers outside the United States.
• If you have Medigap, ask about foreign travel emergency coverage and how to file claims.
• If you have Medicare Advantage, ask about worldwide coverage and limits.
• Consider travel medical insurance for international trips.
• Consider medical evacuation coverage, especially for remote destinations and cruises.
• Pack enough medication and carry copies of prescriptions.
• Carry your insurance information and emergency contacts.

Keep records for claims

Whatever coverage you use, claims will go more smoothly with good records. Ask foreign hospitals and doctors for itemized bills and medical reports, ideally in English, and keep receipts for every payment. Note the dates of your trip and when treatment began, since Medigap foreign travel coverage depends on care starting within the first 60 days.

A quick example

Imagine a 70-year-old traveler on Original Medicare with a Medigap Plan G falls and breaks a hip in Italy, requiring surgery and a hospital stay costing $30,000. Medicare would generally pay nothing. The Medigap foreign travel emergency benefit could pay 80% of the billed charges after a $250 deductible, or about $23,800, leaving the traveler with about $6,200 to pay, plus any costs for getting home.

If the traveler also had travel medical insurance with sufficient coverage, it could help pay the remaining costs and the trip home, depending on the policy terms.

The bottom line

Medicare outside the US usually pays nothing, with only a few narrow exceptions. Medigap plans with foreign travel emergency coverage pay 80% after a $250 deductible up to a $50,000 lifetime limit for emergencies early in a trip, some Medicare Advantage plans offer worldwide emergency benefits, and travel medical and evacuation insurance can fill the rest. Check your coverage before you go, and you will not find out about the gap in a foreign emergency room.