Many Medicare beneficiaries may encounter a situation where they need medical care while traveling outside of the United States. This presentation is designed to educate on how Original Medicare, Medicare Supplements (Medigap Plans), Medicare Advantage and Part D coverage may provide some benefits while outside the U.S.

Outside the United States

According to Medicare, “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 Norther Mariana Islands.

Coverage Options

Beneficiaries should know what kind of coverage they have prior to traveling outside the U.S. These options include:

• Original Medicare (Parts A & B)

• Medicare Supplement (Medigap)

• Medicare Advantage

• Part D

Original Medicare

With Original Medicare Parts A & B, there are only three situations where they may pay for certain types of health care received in a foreign hospital.

1. The beneficiary is in the United States when they have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat their illness or injury. This is especially important for beneficiaries living near the Canadian or Mexico border.

2. The beneficiary is traveling through Canada without unreasonable 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 their illness or injury. Medicare determines what qualifies as “without unreasonable delay” on a case-by-case basis.

3. The beneficiary lives in the United States and the foreign hospital is closer to their home than the nearest U.S. hospital than can treat their medical condition, regardless of whether

it’s an emergency. Once again, this is important to know for beneficiaries living near the Canadian or Mexico border.

In these situations, it’s important to remember that Medicare will only pay for the Medicare-covered services they receive in the foreign hospital. Anything that is not Medicare-approved will have to be paid 100% by the beneficiary.

Like all covered services and supplies under Original Medicare, the beneficiary will be responsible to pay any related coinsurance, copays or deductibles under Parts A and B.

If the foreign hospital doesn’t submit the claims for the beneficiary, they must pay the full cost of their care to the provider or hospital, then submit an itemized till to Medicare for their doctor, inpatient and ambulance services.

Hot Topic – Cruises

Medicare may cover medically necessary services on a cruise ship, but only in these situations:

• The doctor is allowed under certain laws to provide medical services on the cruise ship (example: the doctor is employed by the cruise ship company)

• The ship is in a U.S. port or no more than 6 hours away from a U.S. port when the beneficiary receives the services, regardless of whether it’s an emergency

Medicare Supplement (Medigap)

Many Medicare Supplement policies offer additional coverage for emergency health care services or supplies a beneficiary may receive outside of the United States. Policies that offer this coverage include:

• Plans C, D, E, F, G, H, I, J, M or N. Remember, some policies, like E, H, I, and J, are no longer offered for sale as of 6/1/2010, but there may be beneficiaries that are still insured under these plans.

• With the Foreign Travel rider in the state of Wisconsin

• Basic and Extended Basic plans in Minnesota

• Core, Plan 1 and Plan 1A in the state of Massachusetts

If the beneficiary has one of the qualifying plans, their policy:

• Covers foreign travel emergency care only, as long as it begins during the first 60 days of their trip, and if Original Medicare doesn’t otherwise cover the care as described in the three previous scenarios

• Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S.

• After the beneficiary pays a $250 yearly deductible

• NOTE: Foreign Travel Emergency coverage is limited to $50,000 per lifetime

The foreign hospital or health care provider may not submit the claims on the beneficiary’s behalf. In that case, the beneficiary will be responsible for paying the hospital or provider directly for all billed charges and will need to submit an itemized bill to their Medicare Supplement insurance company for reimbursement. They can obtain additional information and guidance by reaching out to their insurance company directly.

Medicare Advantage

All Medicare Advantage (Part C) plans offer worldwide emergency coverage, urgently needed services, and emergency transportation benefits.

The beneficiary will pay the full cost of emergency services received outside the U.S. at the time they receive the care, and then submit for reimbursement from the insurance company. To receive reimbursement, they must do the following:

• Save all receipts and send copies to their insurance company

• The company will reimburse them for the difference between the amount of their bill and their cost share for those services

• NOTE: The company may need to get more information from the beneficiary or the foreign provider in order to pay them back for their share of the cost

It’s important to note that coverage is limited to emergency or urgently needed care only. Once the beneficiary is no longer in a emergency/urgent situation, they must seek care in the United States or through their normal network of providers for coverage to continue.

Prescription Drug Coverage (Part D)

All Medicare Part D plans, regardless if they’re a stand-alone plan or part of a Medicare Advantage plan, cannot cover drugs that are purchased outside of the United States. Beneficiaries should ensure they have enough of their medications prior to their travel, otherwise they will be responsible for 100% of the cost of any prescriptions they pick up at a foreign pharmacy.

Remember

Their Medicare coverage will determine what may be covered outside of the United States, with both Medicare Supplement and Medicare Advantage plans providing emergency coverage while traveling. Prior to leaving, it’s important for the beneficiary to check with their plan to see what may be covered and understand what documentation they should collect if anything were to occur. If they are concerned that their coverage may not provide enough benefits, they should consider purchasing a travel medical policy.

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