If you’re traveling abroad after age 65, you’ll want to consider a supplement to your Medicare coverage, because, for the most part, Medicare won’t cross the border with you.
Medicare covers your health care in the 50 states and all U.S. territories — including Puerto Rico, Guam, American Samoa, the U.S. Virgin Islands and the Northern Mariana Islands. Elsewhere, you’ll need supplemental insurance since Medicare will cover emergencies only in some very limited circumstances. Those include emergency services in Canada if you are traveling between Alaska and another state — “without unreasonable delay” — and a Canadian hospital is closest.
Medicare may pay for services at a foreign hospital if it is closer to your home than an American hospital. That circumstance could apply to Americans living on the Canadian or Mexican borders. The program will also cover you if you suffer a medical emergency while traveling in the U.S. and treatment at a foreign hospital is closest.
Medicare also covers medical care on cruise ships that are in U.S. territorial waters, meaning that the vessel is within six hours of an American port.
But beyond that, you need to plan for coverage in traveling abroad. To ensure emergency medical coverage — and peace of mind — you’ll need a policy that falls under one of three categories: Medicare Supplement, Medicare Advantage, or trip-specific travel health insurance.
Supplemental plans for foreign travel
Most Medicare Supplement (or Medigap) plans, include a foreign travel benefit; check to see if yours does. Medicare Supplement plans C, D, E, F, G, H, I, J, M, and N that cover travel, pay for 80% of the cost of medically necessary emergency care outside of the U.S. and its territories.
You’ll be responsible for a separate $250 deductible. The medical emergency must occur within 60 days of the start of your trip. So it won’t work if you leave the country indefinitely. Plus, there’s a $50,000 lifetime limit to the amount this benefit will payout.
Medigap plans are not a Medicare replacement. They’re an additional benefit on top of your existing coverage under Original Medicare (Parts A and B). And be aware that Medicare Part D prescription benefits also do not extend outside the U.S. and its territories.
Medicare Advantage Abroad
Unlike Medigap coverage, Medicare Advantage (or Part C) plans are a government-approved alternative to Medicare offered by private health insurance companies. These plans differ in which added benefits they provide. Check with your Medicare Advantage provider to see if your plan includes health insurance for foreign travel; many do.
If your Medicare Advantage plan does have travel insurance, make sure that it explicitly covers health issues — such as pre-existing conditions or medically necessary emergencies. Be mindful that Part C plans may not cover travel in every country or may even be limited in covering domestic travel emergencies. Part C plans operate in limited geographic areas. Your benefits will be equal to or better than Original Medicare, but they don’t apply everywhere. If your Medicare Advantage plan becomes aware that you’ve lived away from your plan’s service area for 6 months or more, you may be automatically disenrolled.
Travel Health Insurance
Trip-specific travel health insurance is an option for if you don’t want or need the ongoing premiums of a Medigap or Part C plans but want coverage while traveling abroad. Coverage varies in scope and price depending on several factors, including trip length and the traveler’s age.
Make sure to find a plan that covers medical emergencies, including medical-team “medevac” evacuations, and not just “trip protection” cancellations because of illness. Also, be aware of policy exclusions, such as pre-existing conditions and penalties for cancellations in the event your trip is postponed or put off altogether.
Many experts recommend getting insurance for at least $50,000 in medical expenses and $100,000 in evacuation costs. Some plans feature benefits over that, such as $250,000 in medical coverage and $1 million in evacuation costs.
Carriers generally offer travel health insurance for trips of up to a year in length. There are also health insurance options for Americans who visit foreign countries for longer periods. For extended stays abroad, you’ll want to seek out long-term expatriate health insurance.
Those plans generally will include more comprehensive coverage beyond emergencies and evacuations. In general, healthcare outside of the United States is less costly. Still, even those lower costs can mount without insurance.