What to Know Before You Travel. Medicare Coverage in Mexico


As you prepare to travel abroad, it’s important to note that Medicare usually does not cover healthcare costs abroad. Healthcare costs incurred while traveling internationally are generally the responsibility of the traveler.

Medicare drug plans do not cover any prescription drugs you purchase while traveling internationally.


Original Medicare Does Offer Coverage Outside the U.S. in Some Rare Cases

There are some specific circumstances in which Original Medicare plans are required to pay for your inpatient hospital bills, doctor bills, ambulance charges, or dialysis expenses abroad, according to Medicare.gov.

These situations include:

  • You experience a medical emergency or need treatment for a medical condition while in the U.S. and a foreign hospital is the nearest hospital qualified to treat your condition.
  • You experience a medical emergency in Canada while traveling the most direct route between Alaska and another U.S. state. A Canadian hospital is the nearest hospital that’s qualified to treat your ailment or illness.
  • You can receive medically necessary healthcare services on a ship located in the territorial waters adjacent to the land areas of the United States.

*Note that Medicare will not pay for any medical care you receive while the ship is over 6 hours away from the nearest U.S. port.

Here’s How Much You’ll Pay for Covered Medical Expenses Outside the U.S.

Remember, in most cases, you will pay 100% of the medical costs you incur while traveling internationally.

However, if you’re covered under Original Medicare due to one of the circumstances listed above, you will pay only 20% of the expenses approved under Medicare.

Please note that you will need to pay your Part B deductible first, before your Original Medicare coverage starts covering the approved charges. In addition, you will also be responsible for paying any copayments that you would normally owe if you received the same health services or supplies within the United States.

Original Medicare will pay its share of the following expenses in covered situations:

  • Hospital care you receive after your doctor formally orders you to be admitted to a foreign hospital as an inpatient (covered under Medicare Part A)
  • Emergency and non-emergency ambulance services you receive before you are formally admitted to a foreign hospital as an inpatient for a covered stay (covered under Medicare Part B)
  • Emergency and non-emergency doctor services you receive before and during your covered stay as an inpatient at a foreign hospital (covered under Medicare Part B)

Original Medicare will not cover:

  • Any medical expenses stemming from an uncovered hospital stay
  • Healthcare services you receive outside the hospital once you are no longer an inpatient

The amount you owe typically depends on:

  • The type of medical facility
  • How much your healthcare provider charges
  • Whether or not your doctor accepts Medicare assignment
  • Any other insurance you have

PRO TIP: Talk to your doctor or healthcare provider to determine how much any necessary tests, services, or supplies will cost.

Medigap May Cover Certain Healthcare Costs as You Travel Abroad

According to Medicare.gov, some emergency healthcare expenses incurred abroad are covered by standard Medigap plans C, D, F, G, M, and N if two conditions are met.

  • You receive emergency medical care during the first 60 days of your trip
  • Medicare would not otherwise cover the care you receive

(Note that Medigap plans E, H, I, and J are no longer for sale. However, you may keep your E, H, I, or J plan if you purchased it before June 1, 2010.)

Here’s How Much You’ll Pay for Covered Medical Expenses Outside the U.S.

Medigap plans C, D, E, F, G, H, I, J, M, and N will pay 80% of your billed medical expenses for certain “medically necessary” treatments abroad. This means you will pay 20% of covered costs. However, your Medigap policy will only begin to pay its share after you have met your $250 deductible for the year.

PRO TIP: Contact your Medigap provider to learn more about your foreign healthcare coverage before you travel outside the United States.

Medicare Advantage Plans Cover the Same Unique Travel Situations as Original Medicare

Medicare Advantage plans are required to provide at least the same level of coverage as Original Medicare for eligible expenses incurred while traveling internationally. This means you’ll have equal coverage—or possibly more coverage—in the same limited scenarios highlighted above.

Some Medicare Advantage plans provide additional benefits beyond what Original Medicare covers abroad. Check with your Medicare Advantage provider to determine your benefits as you travel outside the United States.


How to File a Medicare Claim for Your Covered Expenses

U.S. laws require doctors to file Medicare claims for the covered services you receive inside the U.S. However, foreign hospitals are not required to file your Medicare claims for you.

If you’re admitted to a foreign hospital as an inpatient under one of the covered situations listed above, you’ll need to file your own Medicare claim. You must file your claim within the 12 months following the date you received treatment to be eligible for reimbursement.

Generally, you’ll need to submit the following with your claim:

  • A complete claim form titled “Patient Request for Medical Payment (CMS-1490S)”
  • An itemized bill that lists the ambulance, doctor, and hospital services you received
  • A letter explaining your reason for submitting the claim yourself
  • Any additional documents that support your claim

Follow the instructions included within the claim form to submit your claim to Medicare.

Learn more about how to submit a Medicare claim.


Don’t Have Adequate Overseas Health Coverage? Consider Travel Medical Insurance for Unexpected Healthcare Costs

Travel medical insurance (also called travel health insurance) is temporary health coverage designed to pay for emergency medical expenses stemming from an unanticipated illness or injury abroad.

Say you’re golfing at Ballybunion Golf Club in Ireland when you fall and break your ankle. Depending on the circumstances and the plan you choose, you may be covered for:

  • The cost of a local ambulance to transport you to the hospital (when hospitalized as an inpatient)
  • Your emergency room co-payment
  • The bill for your hospital room and board
  • All other eligible medical expenses

Travel health insurance generally does not cover pre-existing conditions, regular prescriptions, or preventive care. But it does offer more than just emergency medical coverage.

Source. www.worldtrips.com