Original Medicare does not cover you in Canada in almost any situation. There are three narrow exceptions, all involving inpatient hospital care where a Canadian hospital is closer than the nearest U.S. one. Outside those, you pay the full bill unless you carry a Medigap plan with a foreign travel benefit, a Medicare Advantage plan that adds international coverage, or a separate travel medical policy.
The Three Situations Where Medicare Will Pay
Medicare recognizes three scenarios in which it will help pay for inpatient hospital services at a Canadian hospital. In each one, the Canadian hospital must be closer or more accessible than the nearest U.S. hospital equipped to treat your condition.1eCFR. Title 42 Part 424 Subpart H – Special Conditions: Services Furnished in a Foreign Country
The first is an emergency that occurs while you are on U.S. soil, when a Canadian hospital across the border can treat you faster than any U.S. facility. This tends to matter for people living or traveling near the northern border in states like Michigan, New York, or Washington.
The second covers emergencies that happen while you are driving through Canada on the most direct route between Alaska and the lower 48, without unreasonable delay. Medicare decides case by case whether your route qualifies.
The third is the one most people don’t know about: if you live in the U.S. but a Canadian hospital is closer than the nearest U.S. hospital that can treat your condition, Medicare will cover care there — and this exception does not require an emergency. It applies to non-emergency care as well.2Medicare.gov. Medicare Coverage Outside the United States
What Gets Paid When an Exception Applies
Even when you qualify, coverage is narrower than it would be at home. Part A pays for the inpatient hospital stay itself — room, nursing, and related services — once a doctor has formally admitted you. Part B pays for ambulance services and doctor services received immediately before and during that covered inpatient stay.3Medicare.gov. Travel Outside the U.S.
Outpatient care, follow-up visits after discharge, and routine checkups are not covered, even if the underlying hospitalization was.
What Medicare Will Not Pay For in Canada
Outside the three hospital scenarios, Medicare pays nothing. A few gaps catch travelers off guard.
Medicare Part D plans do not cover prescriptions filled at Canadian pharmacies. If you need a refill during your trip, you pay retail.
Routine dialysis outside the United States is not covered. The only theoretical exception is dialysis received during a qualifying inpatient stay, which is an unusual set of circumstances. If you depend on regular dialysis, plan your treatments around travel dates or arrange private coverage for sessions in Canada.
Cruise coverage is more limited than most passengers assume. Medicare may pay for medically necessary services on a ship only when the ship is in a U.S. port or no more than six hours away from one, and the ship’s doctor is authorized to practice on board. Once the vessel is beyond that window — including while docked in a Canadian port — Medicare stops.
Medicare Advantage Plans and Canada
If you have a Medicare Advantage (Part C) plan, coverage abroad depends entirely on the plan. Advantage plans must follow all the same rules as Original Medicare, and many add emergency and urgent care benefits outside the United States as an extra feature. The scope varies widely. Some cover worldwide emergency care; others add almost nothing beyond the baseline. Follow-up care after the initial emergency visit is generally not covered abroad.
Check your plan’s Evidence of Coverage or call the plan directly before you leave. Knowing what is and isn’t covered before you cross the border is the single most useful thing you can do.
Medigap Plans With a Foreign Travel Emergency Benefit
Six of the ten standardized Medigap plan letters include a foreign travel emergency benefit: Plans C, D, F, G, M, and N.3Medicare.gov. Travel Outside the U.S. If you hold one of these, the plan pays 80% of approved charges for emergency care outside the United States after you meet a $250 annual deductible. There is a $50,000 lifetime cap, and the benefit only applies to emergencies that begin within the first 60 days of a trip.
Plans A, B, K, and L do not include this benefit, so those policies give you no Medigap protection in Canada. Medigap only works alongside Original Medicare, not Medicare Advantage.
Travel Medical Insurance
Whether or not you carry Medigap, a standalone travel medical policy is worth considering for any trip to Canada. These policies commonly cover emergency care, hospital stays, medical evacuation, and sometimes trip interruption due to illness.
The trap is the pre-existing condition exclusion. Most travel medical insurers will not pay for treatment tied to a condition that was symptomatic, treated, or had a medication change within a lookback period, often 90 days before departure. Some insurers offer a waiver that eliminates the exclusion, but you usually have to buy the policy within a set number of days after booking the trip and meet other eligibility requirements. For Medicare beneficiaries managing chronic conditions, this is where claims get denied most often. Read the lookback period carefully before you buy.
What Care in Canada Costs Without Coverage
Canada’s public health system covers citizens and permanent residents, not visitors. Without insurance you pay full price, and providers may require payment upfront.
Costs vary by province and facility. Emergency room visits for non-residents commonly run over $1,000. Inpatient ward rates at acute-care hospitals range from roughly $2,000 to $4,000 per day. Intensive care can exceed $6,000 per day, and at some facilities the non-resident ICU rate is several times the standard ward charge. Physician fees are often billed separately on top of hospital charges. A serious illness or injury requiring a multi-day stay can easily produce a bill in the tens of thousands.
Filing a Claim for Covered Care in Canada
If you receive emergency hospital care in Canada that falls under one of the three exceptions, you have to file the claim yourself. Canadian hospitals do not bill Medicare directly.
Use Form CMS-1490S, “Patient’s Request for Medical Payment.” Fill out the form, attach an itemized bill from the Canadian hospital, and mail everything to the Medicare Administrative Contractor that handles your state. If you don’t know which contractor that is, call 1-800-MEDICARE (1-800-633-4227).4Centers for Medicare & Medicaid Services. CMS-1490S Patient Request for Medical Payment – Foreign Travel Instructions
The itemized bill needs the date and location of each service, a description of the treatment, the charge for each service, and the provider’s name and address. Include a written explanation stating that the care was received outside the United States under one of the qualifying exceptions. Keep copies of everything, and expect at least 60 days for processing.5Centers for Medicare & Medicaid Services. CMS-1490S Patient Request for Medical Payment Form
Bringing Your Prescriptions Across the Border
Since Part D won’t cover refills in Canada, bring enough medication for the whole trip. Canada has specific rules about what you can carry across.
For controlled substances like opioid painkillers, stimulants, and barbiturates, you may bring whichever is less: a single course of treatment or a 30-day supply. The medication must be in its original pharmacy packaging, with a label showing your name, the prescribing doctor, and the drug name. Declare these at customs when you enter Canada. If your trip runs longer than 30 days, you would need a Canadian physician to write a new prescription.6Canada.ca. Travelling Into and Out of Canada With Prescription Medications Containing Controlled Substances
For targeted substances, which include common sleep aids and certain anti-anxiety drugs, the limit is more generous: up to a 90-day supply or a full container, whichever is less. Same labeling requirements apply.
Paying Canadian Medical Bills With HSA Funds
If you have a Health Savings Account, you can use those funds to pay for qualified medical expenses in Canada. Nothing in the tax code limits HSA-eligible expenses to services received in the United States. Doctor visits, hospital stays, prescriptions, and other qualifying costs can be paid from your HSA without taxes or penalties, as long as the expense would otherwise meet the IRS definition of a qualified medical expense.7Internal Revenue Service. Publication 502 – Medical and Dental Expenses
Keep detailed receipts. If charges are in Canadian dollars, record the exchange rate on the date of payment. You cannot claim an itemized medical expense deduction on your tax return for the same costs you paid with HSA dollars. It’s one or the other.