Medicare Coverage While Out of the Country

Medicare Coverage While Out of the Country

Do beneficiaries have Medicare coverage while out of the country?  To put it simply: medical coverage outside of the United States for Medicare beneficiaries is extremely limited. The definition of “outside of the United States” means outside of the continental United States and its territories. There are only three situations in which coverage under Medicare can be provided to a beneficiary outside of the United States.

1. The beneficiary is in the United States and has a medical emergency, but the closest hospital or facility that can treat them is a foreign one (a foreign one meaning one outside of the country) rather than a local one.

2. The beneficiary is traveling through Canada in order to get to or from Alaska and the closest hospital or facility that can treat a medical emergency is a Canadian one. Medicare determines on a case-by-case basis who qualifies for this, because it is dependent on the travel being considered “without reasonable delay.” Without reasonable delay is an arbitrary definition, and must be determined individually.

3. The beneficiary lives in the United States but the closest hospital that can treat them is a foreign one, regardless of medical emergency. The foreign hospital has to be closer than the closest United States hospital to be considered for Medicare coverage.
   
   

Even in these exceptional situations above, Medicare will only pay for Medicare-approved services. Medicare Part A will cover hospital care when the beneficiary has been formally admitted to a hospital. Medicare Part B will cover emergency ambulance and doctor services that occur before and during the hospital stay. If administered outside of the United States, dialysis services are not covered.  Additionally, prescription drugs outside of the United States are not covered.

Managed Care Plans

For those beneficiaries who have a Medicare Health Plan like Medicare Advantage rather than Original Medicare, the previous three situations are still the exceptions under which they will cover foreign medical services. Medicare Advantage plans, although privately held, still have to follow the guidelines and laws set by the federal government.

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