If you plan to travel outside the country, you need to know one big rule about Medicare. Original Medicare does not cover you outside the United States in most cases. There are a few narrow exceptions and a few good workarounds. Here is what you need to know before you book the flight.
The general rule
Original Medicare (Part A and Part B) is designed to cover care inside the United States and its territories (Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands). If you get sick or injured outside those places, Original Medicare usually does not pay.
That means if you have a heart attack in Italy, or break your hip in Costa Rica, or need stitches in Mexico, Medicare will not cover the hospital bill. You are on the hook for it unless you have other coverage.
The three narrow exceptions
Medicare has only three situations where it might pay for care outside the U.S.
1. You are in the U.S. when an emergency happens, but the closest hospital is in another country
If you are inside the United States and you have a medical emergency, and the nearest hospital that can treat you is across the border in Canada or Mexico, Medicare may pay. This is a tiny exception that almost only applies to people in border areas.
2. You are traveling through Canada between Alaska and the lower 48 states
If you are driving the most direct route between Alaska and another U.S. state and you have a medical emergency, Medicare may cover care at a Canadian hospital. The route has to be reasonable. A scenic detour through Banff does not count.
3. You live in the U.S. and a foreign hospital is closer than any U.S. hospital
This is rare. It applies to people who live close to the U.S. border and a Canadian or Mexican hospital is genuinely closer than any U.S. one. It also has to be a non-emergency, and the foreign hospital has to be appropriate for the care needed.
That is the whole list. Outside of those three situations, Original Medicare does not pay for foreign care.
What about Medicare on a cruise ship?
Cruise ships are a special case. Medicare may cover care on a cruise ship if the ship is in U.S. territorial waters, or if the ship is within 6 hours of a U.S. port (whether it is leaving or arriving). The doctor on the ship must be properly licensed for Medicare to consider the claim.
Once you are more than 6 hours from a U.S. port, you are outside Medicare's coverage area, even if you have not left the ship.
The Medigap foreign travel emergency benefit
This is where Medicare Supplement (Medigap) plans come in. Most Medigap plans (specifically C, D, F, G, M, and N) include a foreign travel emergency benefit. Here is how it works:
- It covers emergency care that begins during the first 60 days of any trip outside the U.S.
- You pay a $250 deductible each year
- After the deductible, the plan pays 80% of the cost of medically necessary emergency care
- You pay the other 20%
- The plan has a lifetime maximum of $50,000
For most short-term travel, this is a meaningful safety net. A two-week trip to Europe is covered. A three-month winter in Spain is not, because the 60-day limit kicks in.
Medicare Advantage and foreign travel
Medicare Advantage plans set their own rules for foreign travel. Some include modest foreign travel emergency coverage. Others do not cover anything outside the U.S. at all. You have to check your specific plan's benefits.
If you have a Medicare Advantage plan and travel often, look at the Evidence of Coverage document under "foreign travel" or "emergency care outside the United States." Some plans only cover emergencies. Some have a daily or per-trip limit. Some give you nothing.
What about routine care abroad?
None of these benefits cover routine care abroad. If you live overseas for several months a year and want regular checkups, prescriptions, or non-emergency procedures, you need separate international health insurance. Medicare and Medigap are emergency safety nets, not full coverage.
Stand-alone travel insurance
For trips outside the country, especially long ones, many seniors buy a travel insurance policy on top of Medicare. Travel insurance typically covers:
- Emergency medical care while abroad
- Emergency medical evacuation (this is the big one, and it can cost $50,000 to $100,000 with no insurance)
- Trip cancellation and interruption
- Lost luggage and other travel hiccups
For most retirees traveling abroad, a travel insurance policy that includes medical and evacuation coverage is a smart add-on, even if you also have a Medigap plan with foreign travel emergency benefits.
Before you travel abroad: a 5-minute check
- Look at your Medigap policy. Do you have Plan C, D, F, G, M, or N? Then you have foreign travel emergency coverage.
- If you have a Medicare Advantage plan, check the Evidence of Coverage for "foreign travel" benefits.
- Decide whether to buy a travel insurance policy for the trip. Pay extra attention to medical evacuation coverage.
- Carry your insurance cards and policy numbers in your wallet and a backup copy on your phone.
- Know that if you pay out of pocket abroad, you may be able to submit some claims later, but you should not expect Medicare to reimburse you for routine care.
The bottom line
Original Medicare does not cover you outside the United States in almost any case. A Medigap plan can give you a real safety net for emergencies during the first 60 days of any trip. A travel insurance policy fills in for longer trips, evacuation, and routine care. Plan ahead before you board the plane.