If you have Medicare as your primary insurance and get hit with a health-related emergency while traveling in another country or on a cruise ship, will your treatment be covered? That’s the question many of our readers are asking.
Read on to understand what your Medicare coverage will and won’t do if you face a medical problem during an international trip. And, of course, I’ll also tell you how to make sure you are protected.
Medicare is not likely to cover you outside of the United States
Let’s cut right to the chase. In most cases, Medicare will not provide the protection you need on an international trip. But there are some exceptions.
The clearest explanation for when you might have Medicare coverage outside of the country can be found on the Center for Medicare and Medicaid Services (CMS) website in the instructions on form “CMS-1490s Patient’s Request for Medical Payment.”
Here’s what that form says:
In most situations, Medicare will not pay for health care outside the United States (U.S.) and its territories. The term “outside the U.S.” means anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
Medicare may pay for inpatient hospital, doctor, or ambulance services you get in a foreign hospital (a hospital outside the U.S.) in the following situations:
The Center for Medicare and Medicaid Services
- If an emergency arose within the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
- If you are traveling through Canada without 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.
- If 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.
Coverage when you’re on a cruise
That same form also includes an explanation of when Medicare might cover your treatment on a cruise ship:
Medicare may pay for medically necessary services furnished on a ship in a U.S. port or within 6 hours of when the ship arrived at or departed from a U.S. port only if all of the following requirements are met:
- You have Part B benefits
- The physician is legally authorized to practice in the U.S.
If the ship is more than 6 hours away from a U.S. port, Medicare can pay for medically necessary services only if all of the following requirements are met:
- You have a medical emergency within 6 hours of departing or arriving at a U.S. port that requires inpatient hospital services.
- The nearest or most accessible hospital that can treat you is a foreign hospital rather than a U.S. hospital.
- The services are to treat the emergency illness or injury.
- You have Part B benefits.
- The physician is legally authorized to practice where he or she furnished the services.
Note that the document says “may pay” and “can pay.” It does not say “will pay.”
The paperwork requirements to get reimbursed for treatment under those exceptions are very detailed. If you don’t follow them exactly and submit all the information requested, you likely won’t collect. Not understanding those rules was a factor in the tragedy faced by this Holland America passenger.
But that doesn’t mean Medicare is useless during international travel. There are some Medigap and Medicare Advantage plans that actually provide some coverage.
Medicare supplement plans can provide some healthcare protection
Medicare supplement (Medigap) plans are sold by private insurance companies and are used to help with the Part A and Part B deductibles and co-pays. These are standardized Medigap plan categories with letter names. Plans C, D, E, F, G, H, I, J, M, and N provide limited foreign travel medical emergency benefits if the emergency begins during the first 60 days of your trip.
I say limited because these plans only cover 80 percent of the cost of emergency care after a $250 deductible, and the currently available plans have a $ 50,000 lifetime limit. It’s better than nothing, but the coverage does not include transportation back home. Also, you likely will have to pay the bills first and then seek reimbursement.
Many Medicare Advantage plans provide coverage outside of the U.S.
Medicare Advantage (MA), also known as Part C, is the privatized alternative to original Medicare. These are plans sold by insurance companies that receive a fixed monthly fee from Medicare to provide your health coverage. They have the flexibility, if they choose, to use some of that money to provide extra benefits not covered by Medicare. Many, but not all, of those plans offer some degree of health emergency coverage when you are traveling in other countries.
The coverage and rules vary by plan. Some have no specified dollar limit, some have an annual limit, and others have a lifetime limit. Many insurance companies sell several different MA plans under their names and some of their plans have international medical emergency coverage while others do not. You can’t go just by the plan or insurance company name.
If you’re considering relying on your MA plan to cover your international trip, contact the plan before you travel. The plan representative should give you accurate information, but that depends on the quality of training of the person who answers your phone call.
The most reliable way to know for sure is to read your plan’s Evidence of Coverage document.
These are typically 200 or more pages long. Most likely, you don’t have a hard copy. But you can find it online. Do an internet search that combines the exact name of your Medicare Advantage plan (you can find that on your plan member card) and the words “Evidence of Coverage” in quotes.
Many insurance companies sell multiple plans, so be sure you’re looking at the right one. Then, within the document, use your search function to find the term “outside of the United States.” If your search finds multiple occurrences of that term, be sure to read all of them so that you understand what is and is not covered.
Pay careful attention to the details
Having a medical emergency is stressful enough, even without international complications. But since Medicare, Medigap, and MA plans all have detailed requirements you have to meet for them to pay, it’s important that you or someone you’re traveling with stays calm and remembers the following:
- Generally, you are expected to pay in full for your care and then seek reimbursement.
- Before you leave the provider, make sure you get a written, detailed, itemized bill or receipt showing all of the specific services that were provided.
- Most plans will require that you send them copies of all of that paperwork.
- They may also require you to send your medical records.
- It’s in your best interest to fully cooperate with the plan and help them obtain all of the information necessary to properly process your request for reimbursement.
FYI: Medicare prescription drug plans are not allowed to cover any prescriptions you get in those circumstances.
If you have questions about what Medicare does or does not cover, a source of free, unbiased advice is your state’s office of the federally-funded State Health Insurance Assistance Program (SHIP).
Consider buying travel insurance with medical coverage
Years ago, there was a television advertising campaign for a credit card that included the slogan, “Don’t leave home without it.” If you’re traveling outside the U.S., that should apply to travel medical insurance.
Consumer Rescue’s publisher, Michelle Couch-Friedman, offered detailed pointers on buying travel insurance in this story and explained what can go wrong when health problems arise while in another country. In another column, she gave a warning about what can happen if you purchase a quasi-travel insurance policy from your tour operator. (Hint: It can go spectacularly awful.)
I recommend getting travel insurance with medical coverage in addition to what your Medicare plan might provide
You should buy your travel insurance from a licensed and bonded travel insurance company. Use a site like InsureMyTrip to compare a variety of travel insurance policies and get a free quote before you buy.
To focus specifically on medical coverage, keep the following in mind:
- Make sure that your policy covers the full cost of any potential medical treatment or evacuation you might need for the entire length of your trip. Some policies have limits on how much they will pay per incident or per day, or how long they will cover you after you leave the U.S.
- For any plan you consider, be sure you understand exclusions and limitations. These are the situations or conditions that your policy does not cover or covers only partially. For example, some policies may not cover pre-existing medical conditions, high-risk activities (such as scuba diving), or travel to certain countries or regions. Carefully read the policy’s fine print and make sure you understand what is and is not covered. You should also check if your policy requires prior authorization or notification for certain services or procedures, and how to contact your insurer in case of a claim.
- You should look for a policy that provides the benefits and features that are important to you and that enhance your travel experience.
I have friends who say “travel safe.” To that I’m adding “travel medically covered.”
If you have general Medicare questions, write to me here at Consumer Rescue, and I’ll be happy to answer them in an upcoming column. (Abe Wischinia reporting for Consumer Rescue)