Many seniors look forward to traveling during their retirement.
However, they also want to have peace of mind that they will be covered if they become sick and need medical attention outside the U.S.
In this article we will outline everything you need to know about Medicare and foreign travel, as well as how to make sure your medical expenses are covered.
The federal Medicare program is health insurance for people 65 or older, certain people under 65 with disabilities and people of any age with End-Stage Renal Disease (ESRD).
To help seniors cover various medical services, Medicare is made up of the following parts:
Part A covers the care and treatment of patients in hospitals and other medical facilities (for example, hospice and nursing facility care).
Part B covers outpatient care and services. This includes vaccines, specialist consultations and medical equipment.
Part D helps cover the costs of prescription drugs and is run by private insurance companies.
To find out more about how Medicare works, what it covers and how much you can expect to pay, read our 2021 guide to Medicare.
In general, Original Medicare will not cover your health care expenses or medical supplies when you are outside the United States.
This term refers to anywhere other than:
If you travel outside of these areas, you will have to pay for all of your medical expenses in a foreign hospital.
It’s important to note that the doctors in the above areas have to accept Original Medicare for your medical expenses to be covered.
There are scenarios when Medicare will pay for medical services you receive in a foreign hospital. These are:
You are within the U.S. when you have a medical emergency, but a foreign hospital is closer than the nearest U.S. facility that can treat the injury or illness.
You are travelling through Canada without reasonable delay via the most direct route between Alaska and another U.S. state when a medical emergency occurs.
The Canadian hospital must be closer than the nearest U.S. hospital that can treat the injury or illness.
This term means that you are simply passing through the area and not stopping to sightsee, for example.
You live in the U.S. and the foreign hospital is closer to where you are than the nearest U.S. hospital, regardless of whether it’s a medical emergency or not.
For example, this applies to seniors who live on the borders of Canada and Mexico.
If your medical circumstances__ do not__ fit into these three scenarios, Medicare will not cover any emergency services in a foreign hospital. This means that you will have to cover 100% of the costs.
Let’s take a closer look at what Medicare will cover if you fit into the three scenarios described above.
Medicare Part A will cover inpatient hospital care once you have been admitted to a foreign hospital.
Medicare Part B will cover emergency ambulance and doctor consultations before being admitted as a patient to a hospital outside the US.
Although Medicare Parts A and B will cover 80% of these expenses, you will still be responsible for paying the remaining 20%.
You will also need to cover any copayments, coinsurance or deductibles when you receive medical treatment outside the US.
Deductible: This refers to the set amount you pay for health care services before your insurance begins to pay. For example, if you have a $1,000 deductible you have to pay $1,000 before your insurance kicks in.
Coinsurance: The percentage of costs you pay after your deductible has been met.
Copayment: A set rate you must pay for doctor visits, hospital stays and prescriptions.
Out-of-pocket costs: This term refers to expenses that are not covered by Medicare and that you must pay for yourself. For example, a fee for a visit to the chiropractor.
For seniors on chronic medication, it’s important to note that Medicare will not cover prescription drugs outside the United States.
If you are planning on travelling and want emergency medical coverage outside of the U.S., you will need one of the three health insurance plans listed below:
A Medicare Supplement Plan
Trip-specific travel health insurance
Let’s take a look at each of these policies in more detail.
Also known as Medigap coverage, a Medicare Supplement Plan is health insurance that you can buy from private companies.
Many seniors buy Medicare Supplement Plans to help pay for the remaining out-of-pocket costs that Medicare Parts A and B don’t cover.
There are several standardized Medicare Supplement Plans that seniors can join. Each one can be identified by a letter: A, B, C, D, E, F, G, H, I, J, K, L, M and N.
Depending on the plan you choose, it could cover:
Part of the expense that Original Medicare doesn’t cover, known as the deductible.
20% of the amount you’re responsible for paying, this is called coinsurance.
Any other additional medical costs
Medicare Supplement Plans C, D, E, F, G, H, I, J, M, and N offer foreign travel emergency benefits when you travel outside the U.S.
Although Plans E, H I and J are no longer for sale for new Medicare enrollees, you can keep them if you bought them before June 1 2010.
The Medicare Supplement Plans that offer foreign travel benefits will cover 80% of the cost of medically necessary emergency care outside of the U.S.
This means you will have to pay the remaining 20% of the costs if you need treatment in a hospital outside the U.S.
This term refers to health care services or supplies that are needed to diagnose or treat an illness, injury, condition, disease or its symptoms.
For your foreign travel emergency benefits to kick in, you will need to meet or pay a $250 deductible.
Once this amount has been met, the Medicare Supplement Plan will begin covering your expenses.
Foreign travel emergency benefits also have a lifetime limit of $50,000. This amount cannot be increased or renewed if you use the full amount.
For your Medicare Supplement Plans to cover foreign travel emergencies, the treatment you receive must begin within the first 60 days of your trip.
When you receive treatment in hospitals in the U.S., the claims are submitted to Medicare for you. However, foreign hospitals are not required to do the same.
If you are admitted to a hospital outside the U.S. and do not submit a claim to Medicare, you will have to pay the full medical bill at the foreign health care facility.
To avoid an expensive medical bill, you will have to submit an itemized bill to Medicare for any doctor, inpatient and ambulance services you received.
Medicare Advantage Plans (also known as Medicare Part C) are government-approved alternatives to Medicare. These plans are also sold by private insurance companies.
These plans are often “bundled” which means they provide Part A and B benefits, as well as Part D prescription drug coverage.
If you’d like to learn more about Medicare Advantage Plans, take a look at this article.
Medicare Advantage Plans must provide the same foreign travel emergency benefits as Original Medicare.
This means that your Medicare Advantage Plan will also only cover medical services if they fall into the three scenarios mentioned above.
Similar to Original Medicare, some Medicare Advantage Plans will cover 80% of medically necessary care in a foreign hospital. You will then have to cover the remaining 20% of the medical costs.
Medicare will begin covering your expenses once you have paid a $250 deductible. The treatment must also begin during the first 60 days of your trip.
The extent of the foreign emergency benefits will also depend on:
The Medicare Advantage Plan
Where you travel
How long you plan on being away for
The care needed during the trip
Before you book your next overseas holiday, make sure you contact a Medicare Advantage Plan insurance agent first.
This is the best way to find out what your foreign travel emergency benefits are if you need medical care while you are outside the U.S.
If you don’t want to pay monthly premiums for Supplement Plans or Medicare Advantage but want coverage while travelling outside the U.S., consider travel medical insurance.
Travel medical insurance can be used with a Medicare Supplement Plan or a Medicare Advantage Plan.
This is great for seniors who want additional peace of mind that they will be covered if they need medical care in a foreign country.
Although travel medical insurance is widely available from private companies, seniors may have limited coverage due to their age.
For example, medical benefits are often limited to $50,000 or less for people over 70 years old. Once this amount is reached, seniors will no longer be able to claim foreign travel emergency benefits.
Trying to make sense of Medicare coverage and foreign travel often feels like navigating a maze.
At Policy Scout, we know that you want to find the right coverage for your needs so that you can enjoy your travels stress-free.
If you have any questions about Medicare or health coverage outside the U.S., contact one of our friendly consultants.