Medicare does not cover out-of-country healthcare in most situations. Federal law bars the program from paying for services furnished outside the United States, with only three narrow exceptions involving inpatient hospital care near a border or when a foreign hospital is closer than any American one that can treat you.1Social Security Administration. Social Security Act 1862 – Exclusions From Coverage and Medicare as Secondary Payer Everything else — outpatient visits, prescriptions filled abroad, and the flight home if you need to be evacuated — is on you unless you carry a Medigap plan with a foreign travel benefit or a separate travel medical policy.
What Counts as Outside the United States
For Medicare purposes, “the United States” means the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the Northern Mariana Islands, and U.S. territorial waters for care delivered on board a ship.2eCFR. 42 CFR 411.9 – Services Furnished Outside the United States Everywhere else is foreign territory, including hospitals operated by the U.S. government on foreign soil. A doctor visit in France, an ER trip in the Bahamas, a hospital stay in Mexico — none generate a Medicare payment under the general rule. Foreign providers have no obligation to bill Medicare, and the program’s billing and payment infrastructure is built around domestic facilities.
The Three Exceptions That Do Pay
Federal law carves out three situations in which Medicare Part A will pay for inpatient care at a foreign hospital.3Office of the Law Revision Counsel. 42 USC 1395f – Conditions of and Limitations on Payment for Services All three turn on the foreign hospital being closer or more accessible than the nearest American hospital equipped to treat the condition.
- You are physically in the United States when a medical emergency occurs and a foreign hospital is closer or more accessible than any domestic one that can treat you. This mostly comes up along the Canadian and Mexican borders.
- You are traveling the most direct route between Alaska and another state through Canada, without unreasonable delay, when an emergency occurs and a Canadian hospital is nearer than an American one. Detours or extended stops break the exception.4Medicare.gov. Travel Outside the U.S.
- You live in the United States and a foreign hospital is closer to your home than any American hospital able to handle your condition. This applies whether or not the situation is an emergency, and it mainly helps people in remote border areas.4Medicare.gov. Travel Outside the U.S.
When one of these applies, Part A covers the inpatient stay and Part B covers physician services and ambulance transport furnished immediately before and during that stay.5Medicare.gov. Medicare Coverage Outside the United States Part B does not cover anything after discharge. In the non-emergency scenario, the foreign hospital must also be accredited by the Joint Commission or an equivalent program recognized by CMS.
One detail trips people up: these exceptions only reach inpatient hospital care. If a foreign ER treats you as an outpatient and sends you home, Medicare will not pay. The treatment must result in a formal inpatient admission.
How to Get Reimbursed
Foreign hospitals are not required to submit claims to Medicare. In most cases you will pay the full bill up front and then file for reimbursement yourself.5Medicare.gov. Medicare Coverage Outside the United States
To do that, submit Form CMS-1490S (Patient’s Request for Medical Payment) along with an itemized bill showing the date, location, and description of each service, the charge for each service, and the treating provider’s name and address.6Centers for Medicare & Medicaid Services. Patient’s Request for Medical Payment Form – Foreign Travel Include a written explanation of why you believe the foreign care exception applies. Keep every receipt and record, and have anything in another language translated into English before you file.
Even when Medicare pays, you still owe the standard cost sharing — the Part A deductible and coinsurance, and any Part B deductible and coinsurance that would apply to the same care at home.4Medicare.gov. Travel Outside the U.S.
Prescription Drugs Bought Abroad
Medicare Part D does not cover prescription drugs purchased outside the United States, period.4Medicare.gov. Travel Outside the U.S. That holds whether you fill a prescription in Canada, pick up medication at a European hospital, or buy drugs anywhere else overseas. Drugs administered during a covered inpatient stay under the exceptions above fall under Part A, not Part D. Any outpatient medication you need while traveling comes out of pocket.
Fill maintenance medications before you leave. Most Part D plans allow a 90-day mail-order supply, which is enough for a long trip.
Cruise Ship Care
Cruise ships sit in a middle zone. Medicare may cover medically necessary physician services on a cruise ship when the ship is in a U.S. port or no more than six hours away from one.5Medicare.gov. Medicare Coverage Outside the United States This holds whether or not the care is for an emergency. The treating doctor must be authorized to provide services on the ship and must submit a claim to Medicare.
Once the ship is more than six hours from any U.S. port, coverage stops. On a weeklong Caribbean cruise, that can mean coverage disappears before the first full day ends and does not return until the ship is heading back.
U.S. Territories Are Not Foreign
Travel to Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands does not trigger any of the foreign-care restrictions.2eCFR. 42 CFR 411.9 – Services Furnished Outside the United States Your Medicare card works the same way it does at home, with the same Part A and Part B rules, the same providers, and the same cost sharing. No special claims process applies.
If You Have Medicare Advantage
Medicare Advantage (Part C) plans must cover at least what Original Medicare covers, which includes the three foreign hospital exceptions. Some Advantage plans add supplemental benefits for emergency or urgent care during foreign travel, which can include coverage for ER visits abroad that don’t lead to inpatient admission. The specifics vary widely. Check your Evidence of Coverage document for whether a benefit covers only emergencies or also urgent care, and whether a separate deductible or copay applies. Contact your plan before you leave to confirm the claims process and any prior authorization or network rules.
The Medigap Foreign Travel Emergency Benefit
Most beneficiaries who get meaningful international coverage get it through Medigap. Standardized Medigap Plans C, D, F, G, M, and N include a foreign travel emergency benefit.7Medicare. Compare Medigap Plan Benefits Plans A, B, K, and L do not. Plans C and F are only available to people who became eligible for Medicare before January 1, 2020.
The benefit works this way:
- Emergency care must begin during the first 60 days of your trip.
- You pay a $250 annual deductible, then the plan pays 80% of billed charges for medically necessary emergency care received outside the United States.
- The benefit has a $50,000 lifetime maximum. Once you reach that total across all trips combined, it does not come back.
You will almost certainly pay the foreign provider directly and then submit a claim to your Medigap insurer. Keep itemized bills and records, ideally translated. The 60-day window resets with each new trip, but the lifetime cap does not, which makes this benefit thin for anyone spending long stretches abroad or facing a catastrophic event overseas.
The Medical Evacuation Gap
This is where travelers get hit hardest. Medicare does not cover medical evacuation or transport back to the United States.4Medicare.gov. Travel Outside the U.S. If you are hospitalized abroad and need to be flown home for continued care, the cost is yours. Air ambulance transport from Mexico or Canada to the U.S. runs $30,000 to $75,000. From Europe, $80,000 to $150,000. From Asia or the Pacific, more than $200,000 is common, and remote locations push the number higher.
Medigap plans do not cover evacuation either. Some Medicare Advantage plans include a limited evacuation benefit, but it is not standard. The reliable way to cover this risk is a standalone travel medical insurance policy or a medical evacuation membership, which typically costs a small fraction of a single evacuation bill.
Travel Medical Insurance to Fill the Gap
Because Medicare’s foreign coverage is so narrow, Medicare.gov itself suggests buying a separate travel insurance policy before going abroad.4Medicare.gov. Travel Outside the U.S. Travel medical policies written for seniors can cover emergency room visits, outpatient care, prescription drugs, medical evacuation, and trip interruption, all areas where Medicare and Medigap leave real gaps.
When comparing policies, check whether pre-existing conditions are covered and what the look-back period is, whether evacuation and repatriation are included, and whether the insurer pays foreign providers directly or only reimburses you after you file. Read the exclusions. Some policies exclude countries under U.S. travel advisories or set age-based caps on coverage amounts. For trips longer than 60 days, confirm the policy does not stop paying at the same window Medigap uses.