Medicare benefits outside the country
There are a few things you need to tell your clients about their Medicare benefits outside the country. In most cases, Medicare does not cover health care services or supplies if you travel outside the U.S.. When this is the case, your client will have to pay the total cost of all medical services and supplies.
Remember: The U.S. includes; the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.
There are certain situations where Medicare will pay for necessary medical treatment.
- When the client is in the U.S. and a medical emergency occurs and the closest hospital for treatment is outside the U.S.
- If they travel through Canada and experience a medical emergency, and the Canadian hospital is closer than the nearest U.S. hospital.
- They live in the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition. This is true weather it is an emergency or not.
In some cases, when you are on board a ship within the territorial waters that join land areas of the U.S., Medicare may cover medically necessary health care services. Medicare won’t pay for health care services if the ship is over 6 hours away from a U.S. port.
When the above circumstances apply, the client will be responsible for 20% of the cost of Medicare approved treatments and supplies after they meet the part B deductible.
Medicare drug plans do not cover prescription drugs (Medicare PDP plans) your clients purchase outside of the U.S.
All that being said, you can still find coverage options for yourself when you decide to travel abroad.
Below we have listed a few ways clients can receive Medicare benefits outside the country:
- They can apply for a Medicare Supplement (Medigap) policy. Medicare Supplement (Medigap) policies include Plans: C, D, E, F, G, H, I, J, M or N. In general these plans will:
- Cover your client for foreign travel emergency care. If the emergency occurs during the first 60 days of their trip, and if Medicare doesn’t otherwise cover the care.
- After the beneficiary meets the $250 deductible, these plans pay 80% of the cost for medically necessary emergency care clients receive while outside the U.S..
- Medicare supplements C,G,F,M and N are currently available to new applicants in most states.
Please note: Foreign travel emergency coverage has a lifetime limit of $50,000 with Medicare Supplement (Medigap) policies.
Your client should either talk to you (their agent) or their insurance company before they travel outside the U.S.. They can check their policy to understand what amount of health coverage they have when they travel.
Another option your client has is to purchase a travel insurance policy that includes health coverage.
All travel insurance policies do not include this option. Be sure your client is aware of this before they go out and purchase a plan.
Medicare Advantage plans MA and MAPD will provide coverage outside of the country. Benefits should be reviewed specific to the MA or MAPD plan.