Your Medicare Coverage
Is my test, item, or service covered?
Travel (when you need health care outside the U.S.)
How often is it covered?
In general, health care you get while traveling outside the U.S. isn't covered. The 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa are considered part of the U.S.
- You're in the U.S. when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
- 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 the emergency.
- 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 an emergency exists.
- In some cases, Medicare Part B (Medical Insurance) may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won't pay for health care services you get when a ship is more than 6 hours away from a U.S. port.
Medicare drug plans don't cover prescription drugs you buy outside the U.S.
Medicare doesn't cover dialysis you get when you travel outside the U.S. unless it's an emergency in which you get dialysis at a hospital.
Your costs in Original Medicare
You pay 100% of the costs, in most cases. In the situations described above, you pay 20% of the approved amount, and the Part B deductible applies.
In the situations above, Medicare pays only for services covered under Original Medicare:
- Part A covers hospital care (care you get when you've been formally admitted with a doctor's order to the foreign hospital as an inpatient).
- Part B covers emergency and non-emergency ambulance and doctor services you get immediately before and during your covered foreign inpatient hospital stay. Medicare generally won't pay for services (like return ambulance trips home) if Medicare didn't cover your hospital stay, or you got ambulance and doctor services outside the hospital after your covered hospital stay ended.
- You pay the part of the charge you would normally pay for covered services. This includes any medically necessary doctor and ambulance services you get in a foreign country as part of a covered inpatient hospital stay. You also pay the coinsurance, copayments, and deductibles you'd normally pay if you got these same services or supplies inside the U.S.
Foreign hospitals aren’t required to file Medicare claims. If you’re admitted to a foreign hospital under one of the situations above, and if that hospital doesn’t submit Medicare claims for you, you need to submit an itemized bill to Medicare for your doctor, inpatient, and ambulance services.
To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.