The short answer
Medicare usually does not cover health care while you are traveling outside the United States. It names three exceptions, and all three depend on a foreign hospital being closer than the nearest United States hospital that can treat you. Cruise ship care has its own separate rule.
You are planning a trip and you want to know whether your Medicare card is worth anything once the plane lands. Medicare's page answers with three exceptions. Read them closely and two of the three describe someone who never left the country at all.
Does Medicare cover you overseas?
Medicare usually does not cover health care while you are traveling outside the United States, and its page says so in the heading. The same page carries a Not Covered badge and a Covered by Part B badge at the same time, because a small number of situations do qualify.
The first thing to settle is what outside the United States means, because Medicare defines it rather than leaving it to a map. The 50 states, the District of Columbia, Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands and American Samoa are considered part of the United States. Anywhere else is considered outside it.
The status line under those badges is the practical answer for most readers. You pay all of the costs, in most cases.
When an exception does apply, Medicare describes what you owe in relative terms rather than in figures. You pay the part of the charge you would normally pay for covered services, plus the coinsurance, copayments and deductibles you would normally pay for the same services inside the United States.
What are the rare exceptions?
Medicare publishes three situations under a heading asking who is eligible. All three turn on the same test: a foreign hospital being closer than the nearest United States hospital that can treat you. Two of the three describe someone at home, and one of those needs no emergency at all.
The word rare is Medicare's own. Its sentence is that Medicare may also pay for inpatient hospital, doctor and ambulance services you get in a foreign country in rare cases, if you are eligible.
| The situation | What it requires | The trap |
|---|---|---|
| You are in the United States | An emergency, and the foreign hospital is closer | Thinking this one is about traveling |
| Traveling through Canada | An emergency between Alaska and another state | Missing the direct route condition |
| You live in the United States | Only that the foreign hospital is closer | Assuming an emergency is always needed |
Take the second one in Medicare's own words, because a condition sits inside it that is easy to read past. You are traveling through Canada without unreasonable delay by the most direct route between Alaska and another United States state when a medical emergency occurs, and the Canadian hospital is closer than the nearest United States hospital that can treat the emergency.
The third one is the one that changes what this page is. You live in the United States and the foreign hospital is closer to your home than the nearest United States hospital that can treat your medical condition, regardless of whether an emergency exists.
Call the thread running through all three The Nearest Hospital Rule. Every one of them carries the same distance test, and only one of them also asks anything about a journey.
Two of the three describe people at home. The third adds a condition the other two do not have, that you were traveling by the most direct route. All three sentences are Medicare's. Naming the test common to all of them, and that two reach people who never went anywhere, is ours.
What each part pays is split. Part A covers hospital care, meaning care you get when you have been formally admitted with a doctor's order to the foreign hospital as an inpatient. Part B covers emergency and non-emergency ambulance and doctor services you get immediately before and during that covered stay.
Two cases fall outside even then, and Medicare names both. It generally will not pay if it did not cover your hospital stay, and it generally will not pay for ambulance and doctor services you get outside the hospital after your covered stay has ended, such as a return ambulance trip home.
Ambulance transport carries its own condition. Medicare may cover medically necessary ambulance transportation to a foreign hospital only with admission for medically necessary covered inpatient hospital services.
What about cruise ships?
Cruise ships have their own rule and it is about distance again. Part B may pay for medically necessary services you get on a cruise ship if two conditions are both met, and the second one is measured in hours from a United States port rather than in miles from anywhere.
The first condition is about the doctor. The doctor must be legally allowed to provide medical services on the ship.
The second is about where the ship is. The ship must be in a United States port, or no more than 6 hours away from a United States port, when you get the services, and Medicare adds that this applies regardless of whether it is an emergency.
Paperwork has a rule of its own here too. If you get Medicare-covered services on a cruise ship, the ship's doctor must submit the Medicare claim, and you can also file a claim directly to Medicare.
Do Medigap plans cover foreign travel?
Medicare's travel page says one thing about supplement policies, and it is a narrow sentence rather than a broad one. Medicare supplement insurance, which is also called Medigap, may cover emergency care when you travel outside the United States. That single sentence is all the page states on the subject.
What such a policy actually pays, which plans carry the benefit, and what limits sit on it are questions about Medigap rather than about travel, and this article does not go further than its source.
This publication answers those in the Plans section, where the individual Medigap plans are compared against each other. That is where the detail belongs and where it already lives.
The one word to hold on to from Medicare's sentence is may. It is written as something a policy can include, not as something every policy does.
Do Advantage plans cover travel?
Medicare's travel page does not answer this. It describes what Original Medicare does, naming Part A and Part B by name, and it says nothing at all about what a Medicare Advantage plan does when you are outside the United States.
That absence is worth stating rather than filling. The sentence the page uses is that Medicare pays only for services covered under Original Medicare, and it then lists what Part A and Part B each cover in the rare cases above.
So the page a reader lands on when they search this question is silent on the product many of them are enrolled in. It is not that plans are excluded. It is that this page is not about them.
The comparison between Original Medicare and a Medicare Advantage plan, including how the two differ on care outside the country, is carried in this publication's Plans section. That is the honest place to send you, rather than repeating a comparison here from a page this article is not built on.
If you are in a plan, the answer that governs you is in your own plan's documents for this year.
What should I buy instead?
Medicare names one category of product and attaches a warning to it. Because Medicare has limited travel medical coverage outside the United States, you may choose to buy a travel insurance policy to get more coverage. It then says where to ask, and it recommends nothing at all.
An insurance agent or travel agent can give you more information about the cost of travel medical insurance, and that is the whole of Medicare's direction on where to go.
The warning is the part worth reading twice, and it is Medicare's sentence rather than a caution added here. Travel insurance does not necessarily include health insurance, so it is important to read the conditions or restrictions carefully.
This page recommends nothing. Medicare names a category, names who can quote you on it, and tells you to read the terms, and that is the whole of what the government says.
Two things about medicines belong here as well. Medicare drug plans do not cover prescription drugs you buy outside the United States.
But Medicare drug coverage does cover all vaccines that the Advisory Committee on Immunization Practices recommends, including certain vaccines you might need before you travel outside the United States, and Medicare names yellow fever, chikungunya and Japanese encephalitis as examples. Your plan will not charge you a copayment or apply a deductible for any vaccine the committee recommends.
What this means for you
Medicare usually does not cover care outside the United States, and the three exceptions it publishes are all decided by which hospital is closest rather than by where you were going. Two of them describe people who never left home.
If an exception does apply, the paperwork can land on you. Foreign hospitals are not required to file Medicare claims, so you may need to submit an itemized bill yourself.
Medicare names travel insurance as the category to look at and tells you to read the conditions carefully. For what a supplement policy or a plan does with care abroad, the Plans section carries both, and the Coverage section carries what Part A and Part B pay for at home.
FAQ
Which places count as outside the United States?
Medicare answers this with a list rather than leaving it to be assumed, and the list is wider than many people expect.
It states that the 50 states, the District of Columbia, Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands and American Samoa are considered part of the United States, and that anywhere else is considered outside the United States.
That matters in both directions. A trip to one of those five territories is not a trip outside the United States in Medicare's terms, so the ordinary rules apply there.
A short drive across a land border is outside it, even though the distance travelled is tiny. The definition is about the list, not about how far you went or how long you were away.
If Medicare does pay, who sends the bill?
It may well be you, and Medicare says so plainly. Foreign hospitals are not required to file Medicare claims for your travel medical costs.
Medicare states you need to submit an itemized bill to it for your doctor, inpatient and ambulance services if both of two things apply: you were admitted to a foreign hospital under one of the situations Medicare lists, and the foreign hospital does not submit Medicare claims for you.
So the coverage existing and the claim being made are two separate events, and the second one can fall to you. Keeping the itemized bill matters for that reason, because it is the document Medicare asks for by name.
Does Medicare cover vaccines I need before a trip?
Yes, through drug coverage rather than through the travel rules, and this is one of the more useful things on the page. Medicare drug coverage covers all vaccines that the Advisory Committee on Immunization Practices recommends, and Medicare says that includes certain vaccines you might need to get before you travel outside the United States.
It names three examples: yellow fever, chikungunya and Japanese encephalitis. It adds a cost rule alongside that. Your Medicare drug plan will not charge you a copayment or apply a deductible for vaccines the committee recommends. Medicare's own instruction is to contact your drug plan for details and to talk to your provider about which ones are right for you.
When does Medicare pay for care on a cruise ship?
When two conditions are both met, and one of them is a clock rather than a place. Medicare states that in some cases Part B may pay for medically necessary services you get on a cruise ship.
The first condition is that the doctor is legally allowed to provide medical services on the ship. The second is that the ship is in a United States port, or no more than 6 hours away from one, when you get the services.
It adds that this applies regardless of whether it is an emergency, which makes this rule different from the foreign hospital situations. The claim also works differently. If you get Medicare-covered services on a cruise ship, the ship's doctor must submit the Medicare claim, and Medicare says you can also file a claim directly yourself.
Will Medicare pay for an ambulance ride home?
Generally not, and Medicare names that case directly. It says Medicare generally will not pay for services such as return ambulance trips home in either of two cases: where Medicare did not cover your hospital stay, or where you got ambulance and doctor services outside the hospital after your covered hospital stay had ended.
The ambulance cover that does exist runs the other way. Medicare may cover medically necessary ambulance transportation to a foreign hospital, and only with admission for medically necessary covered inpatient hospital services. So the ride that gets you admitted can be covered and the ride that brings you back afterwards is a different question with a different answer.
