11037 Outside The Us.qxp
CENTERS FOR MEDICARE & MEDICAID SERVICES
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Medicare Coverage Outside the United States
This fact sheet explains coverage under Original Medicare.
Medicare coverage outside the United States is limited.
In most situations, Medicare won’t pay for health care or supplies you get outside
the United States (U.S.). The term “outside the U.S.” means anywhere other than
the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin
Islands, Guam, American Samoa, and the Northern Mariana Islands. This fact
sheet explains some of the exceptions that would allow you to get coverage outside
the U.S. under Original Medicare Part A (Hospital Insurance) and/or Medicare
Part B (Medical Insurance).
When does Medicare cover health care services in a
foreign hospital?
There are three situations when Medicare may pay for certain types of health care
services you get in a foreign hospital (a hospital outside the U.S.):
1. You’re in the U.S. when you have a medical emergency, and the foreign hospital
is closer than the nearest U.S. hospital that can treat your illness or injury.
2. You’re traveling through Canada without unreasonable delay by the most direct
route between Alaska and another state when a medical emergency occurs, and
the Canadian hospital is closer than the nearest U.S. hospital that can treat your
illness or injury. Medicare determines what qualifies as “without unreasonable
delay” on a case-by-case basis.
3. You live in the U.S. and the foreign hospital is closer to your home than the
nearest U.S. hospital that can treat your medical condition, regardless of
whether it’s an emergency.
Remember, the services you get in a foreign hospital still have to be services
Medicare covers for Medicare to pay.
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What kind of health care services does Medicare pay
for in the three situations described on page 1?
Original Medicare covers the following services:
• Part A covers inpatient hospital care (care you get when you’ve been
admitted to the foreign hospital as an inpatient).
• Part B covers emergency ambulance and doctor services you get immediately
before and during your covered foreign inpatient hospital stay. However, if
Medicare doesn’t cover your hospital stay, and/or you get ambulance and
doctor services outside the hospital after your covered hospital stay ends,
Medicare generally won’t pay for these services. For example, Medicare won’t
cover return ambulance trips home.
• Part B covers non-emergency doctor and ambulance services that you get
immediately before and during your covered foreign inpatient hospital stay.
However, if Medicare doesn’t cover your hospital stay and/or you get doctor
services outside the hospital, Medicare generally won’t pay for these services.
For example, Medicare won’t cover doctor services you get in Canada after
your covered Canadian hospital stay ends.
Remember, Medicare only pays for its share of services covered by Original
Medicare. If you only have Part A, Medicare only covers inpatient hospital care.
Does Medicare pay for dialysis treatments when
I travel outside the U.S.?
Unless it’s an emergency in which you get dialysis at a hospital, Medicare
doesn’t cover dialysis when you travel outside the U.S.
Does Medicare pay for prescription drugs outside
the U.S.?
Medicare drug plans can’t cover prescription drugs you buy outside the U.S.
Call your drug plan for more information.
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Will Medicare pay for medically-necessary health care
services I get on a cruise ship?
Medicare may cover medically-necessary health care services you get on a cruise ship
in these circumstances:
• The doctor is allowed under certain laws to provide medical services on the cruise
ship.
• The ship is in a U.S. port or no more than 6 hours away from a U.S. port when
you get the services, regardless of whether it’s an emergency.
Medicare doesn’t cover health care services you get when the ship is more than 6
hours away from a U.S. port.
For more information on Medicare-covered emergency stays in foreign hospitals, see
“When does Medicare cover health care services in a foreign hospital?” on page 1 and
“What kind of health care services does Medicare pay for in the three situations
described on page 1?” on page 2.
What do I pay if I get Medicare-covered services
outside the U.S.?
Except in the limited situations described in this fact sheet, Medicare doesn’t pay for
health care services you get outside the U.S. If your circumstances don’t meet these
limited exceptions, you pay the full cost to the health care provider.
If your situation matches one of the exceptions in this fact sheet, and Medicare covers the
items or services you get, you still pay the coinsurance or copayments and deductibles
you would normally pay if you got these same services or supplies inside the U.S.
Although U.S. hospitals must submit claims to Medicare for you, foreign hospitals
aren’t required to file Medicare claims. If you are admitted to a foreign hospital and
that hospital doesn’t submit Medicare claims for you, then you must submit an
itemized bill to Medicare for your doctor, inpatient, and ambulance services.
If you got Medicare-covered services on a cruise ship under the circumstances
described in the previous question, the doctor must submit the Medicare claim if he
or she has an office in the U.S.
For information on where to send a foreign claim, please visit
www.medicare.gov/MedicareOnlineForms/ and select the form “Patient’s Request for
Medicare Payment” (CMS 1490S). You should print out the form and instructions
that apply to your situation (such as for services you got on a cruise ship or during
other foreign travel). You can also call 1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048.
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What if I have a Medigap (Medicare Supplement
Insurance) policy?
Your Medigap policy may offer additional coverage for health care services or
supplies that you get outside the U.S. A Medigap policy is supplemental health
insurance sold by private insurance companies to fill “gaps” in Original Medicare
coverage. A Medigap policy must be standardized in all states, except
Massachusetts, Minnesota, and Wisconsin. Most states identify the policies as
lettered plans, so you can compare them easily. Standard Medigap Plans C, D, E, F,
G, H, I, and J provide foreign travel emergency health care coverage when you
travel outside the U.S.
Note: Starting June 1, 2010, the types of Medigap Plans that you can buy will
change:
• Two new Medigap Plans will be offered: Plans M and N.
• Plans E, H, I, and J will no longer be available to buy.
• If you already have or you buy Plan E, H, I, or J before June 1, 2010, you can
keep that plan. Contact your plan for more information.
Medigap Plans C, D, E, F, G, H, I, and J pay 80% of the billed charges for certain
medically-necessary emergency care outside the U.S. after you meet a $250
deductible for the year. The deductible for the high-deductible option for Plans F
and J is $2,000 for 2009. These Medigap policies cover foreign travel emergency
care if it begins during the first 60 days of your trip, and if Medicare doesn’t
otherwise cover the care. Foreign travel emergency coverage with Medigap policies
has a lifetime limit of $50,000.
Before you travel outside the U.S., talk with your Medigap company or insurance
agent to get more information about your Medigap coverage while traveling. To
learn more about Medigap policies, visit
www.medicare.gov/Publications/Pubs/pdf/02110.pdf to view the booklet,
“Choosing a Medigap Policy: A Guide to Health Insurance for People with
Medicare.” You can also call 1-800-MEDICARE (1-800-633-4227) for more
information. TTY users should call 1-877-486-2048.
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What if I get my health care from another Medicare
health plan rather than Original Medicare?
If you have a Medicare Advantage Plan (like an HMO or PPO) or another
Medicare health plan, your plan may offer additional coverage for health care
services you get outside the U.S. Check with your plan before traveling to see
what’s covered.
Can I buy travel insurance to help pay for the cost of
health care services?
Yes. Because Medicare has limited coverage of health care services outside the U.S.,
you can choose to buy a travel insurance policy to get more coverage. An insurance
agent or travel agent can give you more information about buying travel insurance.
Travel insurance doesn’t necessarily include health insurance, so it’s important to
read the conditions or restrictions carefully.
Where can I get more information?
• Visit www.medicare.gov, and select “Find out What Medicare Covers.”
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048.
CMS Product No. 11037
Revised September 2009
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