Medicare generally does not cover care outside the United States. Original Medicare pays for services only within the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. Everywhere else, including Canada, Mexico, the Caribbean, and Europe, counts as foreign territory where coverage disappears except in a few narrow situations.1Medicare.gov. Medicare Coverage Outside the United States
The exceptions matter, though, and so do the supplemental options that can fill part of the gap. Here is what actually gets paid, and what does not.
What Counts as “Outside the United States”
For Medicare purposes, the U.S. territories listed above are treated the same as the mainland. A hospital stay in San Juan or Saipan is domestic care. A hospital stay a mile across the Canadian or Mexican border is foreign care, no matter how close to home you were when it happened.1Medicare.gov. Medicare Coverage Outside the United States
Part D drug plans follow the same rule. Prescriptions filled at a foreign pharmacy are not covered, period.1Medicare.gov. Medicare Coverage Outside the United States
Three Situations Where Original Medicare Pays a Foreign Hospital
Original Medicare can pay for inpatient hospital care, doctor services, and ambulance transport at a foreign hospital in three specific situations. Each one turns on geography: the foreign facility has to be closer or more practical than a U.S. hospital that could treat you.2Medicare.gov. Travel Outside the U.S.
- You are in the United States when a medical emergency happens, and the nearest hospital able to treat you sits across the border.
- You are traveling the most direct route between Alaska and another state, an emergency occurs in Canada, and a Canadian hospital is closer than the nearest U.S. hospital that can treat you. Medicare decides case by case whether the route qualifies as “without unreasonable delay.”
- You live in the United States and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat your condition. This one applies whether or not it’s an emergency, so it can cover planned admissions for people in border communities.
In all three, you still owe your usual deductibles and coinsurance, and Medicare pays only for services it would ordinarily cover at home. Foreign hospitals are not required to bill Medicare, so expect to pay the hospital yourself and request reimbursement afterward.2Medicare.gov. Travel Outside the U.S.
Cruise Ships
Medicare can cover medically necessary care on a cruise ship, but only while the ship is in a U.S. port or within six hours of arriving at or leaving one. Once the ship is farther out than that, it is foreign waters as far as Medicare is concerned, even under a U.S. flag.3Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual Chapter 16 – General Exclusions From Coverage – Section: 60
Most multi-day itineraries spend the bulk of the voyage well beyond that window, which leaves a real gap for anyone who relies solely on Medicare while cruising.
Filing the Claim Yourself
When a foreign hospital does not submit a claim on your behalf, you file one using Form CMS-1490S, the Patient’s Request for Medical Payment. You send the completed form, an itemized bill, and any supporting documents to the Medicare contractor for your state, and Medicare pays you directly once it processes the claim.4Centers for Medicare & Medicaid Services. Form CMS-1490S – Patient’s Request for Medical Payment – Foreign Travel
You have 12 months from the date of service. After that, Medicare cannot pay its share regardless of circumstances.5Medicare.gov. Filing a Claim
What Medigap Adds for Foreign Travel
Several Medigap policies include a foreign travel emergency benefit. Plans C, D, F, G, M, and N carry it, and it pays this way:1Medicare.gov. Medicare Coverage Outside the United States
- 80% of billed charges for medically necessary emergency care outside the U.S., after a $250 annual deductible.
- A $50,000 lifetime cap across every trip you ever take.
- The emergency has to begin within the first 60 days of your trip.
Plans C and F are not sold to people who turned 65 on or after January 1, 2020. Plans D and G are the closest substitutes for anyone newly eligible.6Medicare.gov. Compare Medigap Plan Benefits
The benefit covers emergencies only. Routine care, a planned procedure, or a dental visit abroad does not qualify. And a serious hospitalization overseas can chew through $50,000 quickly.
Medicare Advantage Plans Abroad
Medicare Advantage (Part C) plans are sold by private insurers approved by Medicare, and they must follow the same core coverage rules as Original Medicare. Many plans layer on extra benefits, including coverage for emergency or urgent care outside the country, but the scope varies plan by plan.7HHS.gov. What Is Medicare Part C Check your plan’s evidence of coverage before you leave.
These add-ons are built for emergencies, not routine care. Follow-up visits, elective procedures, and non-urgent appointments in a foreign country generally are not covered.
What Still Is Not Covered
Even with a good supplemental plan, three gaps remain worth knowing about.
Prescriptions. Bring enough medication for the full trip in original labeled containers. Part D will not reimburse a foreign pharmacy.1Medicare.gov. Medicare Coverage Outside the United States
Dialysis. Medicare does not cover dialysis outside the United States unless it happens during an inpatient stay that qualifies under one of the three foreign-hospital exceptions above. Routine outpatient dialysis at a foreign clinic is on you.1Medicare.gov. Medicare Coverage Outside the United States
Medical evacuation back to the U.S. Neither Original Medicare nor Medigap covers the cost of flying you home. Medicare may pay for an ambulance ride to a foreign hospital under one of the qualifying exceptions, but not the trip back. According to figures cited by the CDC, international air evacuations typically run between $25,000 and more than $250,000 depending on distance and complexity.2Medicare.gov. Travel Outside the U.S.
Travel Insurance
Medicare.gov itself recommends that beneficiaries consider a travel insurance policy before going abroad, and warns that not every travel policy actually includes health coverage. Read the conditions carefully.2Medicare.gov. Travel Outside the U.S.
When comparing policies, look for emergency medical treatment, medical evacuation, and repatriation of remains. Confirm the coverage limits are high enough for a serious hospitalization, and check how the policy treats any pre-existing conditions you have. A Medigap foreign travel benefit helps, but its $50,000 lifetime ceiling and 80% payment rate leave real exposure that a dedicated travel policy can close.