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Information for Medicare holders to getting travel insurance coverage when travelling outside of the US

If you are planning a trip abroad, you may be wondering whether your Medicare insurance will cover your medical expenses overseas.

Medicare is the US federal government program which provides health insurance coverage for US nationals over the age of 65, or those under 65 years who receive Social Security Disability Insurance (SSDI) or are diagnosed with End-Stage Renal Disease (ESRD).

It is a health insurance plan for US citizens to provide them with medical coverage in the USA. As such, there is no (or very limited) coverage for international travel. Instead, US citizens travelling abroad can choose to purchase comprehensive travel insurance.

What Countries Accept US Medicare?

You can only use Medicare in the USA and its territories. This includes the 50 US States as well as its territories: Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

Do I Have Medicare Coverage Abroad?

No, in most cases, Medicare does not offer coverage for medical treatment outside the US or its territories. Medicare does not cover international travel. The instances where you could potentially be covered abroad are very limited, as follows:

  • You’re within the US when you have a medical emergency, but a foreign hospital is closer to your location than the closest US hospital than can treat your emergency.
  • You are within Canada, on your way back from Alaska. If you have a medical emergency as you are travelling across Canada without “unreasonable delay”* directly between Alaska and another US state and a Canadian hospital is closer than a US hospital.
  • Non-emergencies: Only if you live in the US but the hospital that can treat your medical condition closest to you is a foreign hospital rather than a US hospital.

*To be determined by Medicare on a case-by-case basis.

If you fit into one of the situations described above, then you can be reimbursed for medical expenses (part A and B) as follows:

  • Inpatient hospital care, when you have been admitted in a foreign hospital with a doctor’s order
  • Emergency services (ambulance and doctor care). This includes the services you receive immediately prior to and during your hospital stay.

Basically, in the instances described above and only those, you will be covered in the same manner as you would in the US, including all coinsurance/copayments and deductibles.

To be covered for medical emergencies abroad, you have to purchase a travel health insurance plan from a reputable insurance company. In some cases, the so-called Medigap policies will also offer health insurance for foreign medical care, but it is usually more limited than that received from an actual travel insurance plan.

Medicare Travel Insurance: What Options Do You Have?

If you are travelling internationally, you can purchase a travel insurance plan which will cover your medical expenses abroad.

Travel insurance policies, unlike Medicare, offer more than simply health insurance. The best travel insurance policy should have at least the following coverage:

  • Medical treatment. If you fall ill or get into an accident during your trip, your travel insurance will cover for medical treatment, doctor consultations, emergency services, hospitalization, surgery, prescription drugs and medicine, etc.
  • Trip cancellation, interruption, or curtailment. If you have to cut your trip short or cancel it for some reason, you will be partially reimbursed for any lost travel and or accommodation costs.
  • Lost, stolen, or damaged possessions. As long as it is due to recklessness, travel insurers can reimburse you for a part of the cost of your lost or damaged luggage.
  • Repatriation and evacuation, in case of an emergency.

Medicare Travel Insurance Plans

Some travel insurance plans which offer coverage for US citizens over the age of 65 travelling abroad are:

Atlas International

  • No Co-Insurance; 100% of medical costs covered after the deductible is paid
  • Available coverage: $50,000 to $2 million
    • For ages 70-79: maximum coverage is limited to $50,000, $250,000
    • For ages over 80: maximum coverage is limited to $10,000.
  • Up to $10,000 in trip disruption

Patriot International

  • Available Coverage: from $50,000to $1 million
    • Ages 70+: Limited to $50,000
    • Ages 80+: Limited to $10,000
  • After deductible, the plan pays 100% up to the policy maximum.

Liaison Travel Basic

  • No Co-insurance. For trips outside the US, the plan will pay 100% up to policy maximum, after the deductible is paid.
  • Available coverage:  $50,000 to $1 million
    • Ages 80 and over: Limited to $10,000

Liaison Travel Choice

  • No Co-insurance. For trips outside the US, the plan will pay 100% up to policy maximum, after the deductible is paid.
  • Available coverage:  $50,000 to $1 million
    • Ages 80 and over: Limited to $10,000

If you have a pre-existing condition, you can look at travel insurance plans which offer coverage for the acute onset of a pre-existing condition.

What If I Have a Medigap? Medicare Supplement Policy for Foreign Travel

Since Medicare does not cover 100% of your medical needs, a Medigap is a supplement policy which is purchased to fill in the “gaps” leftover from Medicare. Your Medigap policy will cover you for medical emergencies abroad if you have purchased a policy which includes travel health insurance.

These are known as plans C, D, E, F, G, H, I, J, M, and N, and can cover up to 80% of your medical bills abroad after you pay a $250 deductible. They also have a lifetime limit of $50,000.

However, to make sure, you have to contact your Medigap policy provider and ask them where you stand on medical travel insurance abroad and just how much coverage you need.

Remember that Medigap policies are not as comprehensive as actual travel insurance policies, which include higher limits, evacuation coverage, as well as coverage for trip cancellation or disruption.

If you do not have a Medigap policy, you can find plans on the official US website for Medicare after you enter your ZIP code (here).

Does Medicare Cover Prescription Drugs Abroad?

No, Medicare does not offer reimbursement for any prescription drugs you purchase abroad. You will have to purchase a travel health insurance policy with adequate coverage for prescription drugs and treatment. See above.

Can I Use Medicare for Medical Treatment on a Cruise?

Just as with trips to a foreign country, Medicare will not cover your medical expenses that occur during a cruise. But there is a very small window, starting from when the cruise starts, during which you have Medicare protection:

  • The present doctor is authorized to provide medical care to you
  • The ship is still in US waters, not international waters, and
  • The ship is within 6 hours away from a US port, regardless of whether it is an emergency or not. If you are more than six hours away from the port, then Medicare will not cover your medical expenses.

Does Medicare Cover Dialysis Abroad?

No, Medicare cannot be used to get any medical treatment as you’re travelling internationally, including dialysis. The only time when Medicare could potentially cover dialysis is if t is an emergency and:

  • You are in the US, but the nearest hospital that could offer you dialysis is a foreign hospital; or
  • You are in Canada, on your way back from Alaska, and the nearest hospital that could offer you dialysis is in Canada

What If I Become Eligible for Medicare When I Am Abroad?

If you are a US national living abroad, and you become eligible for Medicare (you turn 65), then you can request Medicare enrollment forms from the United States Embassy or Consulate in the country where you currently live. You don’t necessarily need to return to the US just so you can enroll.

You will also receive a letter from the Social Security Administration (SSA), informing you that you’ve reached your Initial Enrollment Period (IEP) and a form which you can use to request the enrollment pack. You may have to send the forms and required paperwork via certified mail.

If you are not eligible for premium-free Medicare Part A, then you may actually have to go to the US to enroll. Additionally, if you do not enroll during the Initial Enrollment Period (IEP), you may have to wait for the General Enrollment Period, which starts from January to March.

Can I Use Medicare If I Retire Abroad?

No, if you choose to spend your retirement outside the US, Medicare will not reimburse you for any medical expenses that you have abroad. Medicare only covers medical treatment within US states and territories (see above).

If you are retiring abroad, then you will likely have to obtain private expat health insurance within the country you are in or (if available) enroll in a government health insurance plan. This, of course, changes depending on which country you’re retiring to.

But you can still keep Medicare, which will cover your expenses if you return to the US.

Can I Still Keep Medicare in the US If I Am Living Abroad?

If you are currently living abroad, you can continue to keep your Medicare coverage in the US with no additional costs, if you are eligible for the premium-free Part A (i.e. if you do not have to pay a monthly fee for Medicare). Part A is free in most cases, but the same is not for Part B, which covers outpatient care and other healthcare providers’ services. Since Part B coverage does require you to pay a premium, then in order to keep the plan, you will have to continue paying the monthly installments.

But remember that despite keeping your enrollment in Medicare active, you won’t be able to actually use Medicare to pay for medical expenses if you are outside the US or its territories.

So, if you do not intend to return, you have medical insurance in the country you are living, or you are volunteering in a non-profit organization which is tax-exempt, you can re-consider keeping the enrollment active.

Also remember that if you stop your Part A enrollment, you may be required to pay back all the benefits you have received to the Social Security Administration (SSA).

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