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Medicare Does Not Cover You Outside the United States

You can get Travel Insurance that fills the gaps in your Medicare / Medigap Policies C, D, E, F, G, H, I, J, K, L, M & N

The Original Medicare Plan does not cover health care when you travel outside the United States, except for some emergency situations in Mexico and Canada. Go here to learn about your options for getting coverage.

In rare cases, Medicare can pay for inpatient hospital services that you get in Canada or Mexico. Medicare can pay only if:

  1. You are in the United States when a medical emergency occurs and the Canadian or Mexican hospital is closer than the nearest U.S. hospital that can treat the emergency.
  2. You are traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
  3. You live in the United States and the Canadian or Mexican hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.

Important Information About Medigap Policies C, D, E, F, G, H, I, J, K, L, M & N

Your Medigap (Medicare Supplement) plan may provide worldwide coverage benefits for health care needs when you travel outside the United States. Medigap policies C, D, E, F, G, H, I & J provide Foreign Travel Emergency health care coverage when you travel outside the United States. Under these plans, Medigap policies pay for 80% of the cost of emergency care during the first 60 days of each trip after you pay the $250 deductible. Foreign Travel Emergency coverage with Medigap policies have a lifetime limit of $50,000.

You should check with your Medicare Supplement plan prior to traveling outside of the United States regarding your worldwide coverage benefits. Your Medicare Supplement plan will either tell you:

  • “We pay whatever Medicare won’t pay, subject to deductibles & copays.” or
  • “If Medicare’s not obligated to pay, we won’t pay either.”

Here’s why you’ll want to know how your Medigap plan pays:

Click here to learn about your options for getting Travel Insurance coverage to work with your Medicare

Here are the Basics of What is Medicare and What it Covers:

Here’s the Official US Government Medicare Coverage Outside the United States document

Medicare is the health insurance program for people over the age of 65. People under the age of 65 can qualify for the Medicare program with certain disabilities, and any age with End-Stage Renal Disease (ESRD – permanent kidney failure requiring dialysis or a kidney transplant).

Medicare has four parts

  • Part A (Hospital Insurance)– Helps cover inpatient care in hospitals, skilled nursing facilities, hospice care, and some limited home health care.
  • Part B (Medical Insurance) – Helps cover medically necessary services such as your doctor’s services, outpatient care, and other approved medical services not covered under Part A.
  • Part C (Medicare Advantage Plans) – Medicare Advantage Plans are a replacement of your original Medicare Part A & Part B. Medicare pays private health insurance companies to “Manage” your health care. Many of the Advantage plans come in the form of a HMO or PPO. These programs are required to provide the same coverage that the original Medicare Part A & Part B provide. Some plans even have coverage for Part D which you will read about next.
  • Part D (Medicare prescription drug coverage) – Helps cover prescription drug costs. If you are in the original Medicare program you may purchase a Part D plan from private insurers to help reduce your cost further. If you are enrolled in Medicare Part C, depending on which type of plan you have, may or may not allow you to purchase Part D. Check with your agent or call Medicare to verify your options.

What is a Medicare supplement policy?

A Medicare supplement policy is a health insurance plan sold by a private insurance company to fill the gaps in coverage from the original Medicare Part A & Part B. Sometimes called a Medigap policy. These plans will help you pay your share of the costs (coinsurance, co-payments, or deductibles) associated with Medicare-covered services.*You will need to qualify for Medicare Part A and Part B from above.

There are different Medicare supplement policies

Insurance companies can sell you only a “standardized” Medicare supplement policy. These policies are identified by letters (Plans A through L). Plans F and J also come in a high-deductible version. By law each type of Medicare supplement policy offers the same basic benefits, no matter which insurance company sells it. For example Plan D with company 1 has the exact same coverage as Plan D with company 2. The only difference between Medigap policies sold by different insurance companies is the cost.

What doesn’t a Medicare supplement policy cover?

They don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, and private-duty nursing. Please see www.medicare.gov for information on approved services.

Any new Medicare supplement policy issued today is guaranteed renewable

This means the insurance company can not cancel your policy as long as you pay the premium.

Prescription Drug Coverage

Although some Medicare supplement policies sold in the past covered prescription drugs, no new Medicare supplement policies are allowed to include prescription drug coverage as of 2005. If you want prescription drug coverage, you may want to join a Medicare Prescription Drug Plan (Part D) offered by private companies approved by Medicare.

When is the Best Time to buy a Medicare Supplement Policy?

Open Enrollment is the period that lasts for 6 months and begins on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. During this period, an insurance company can’t use medical underwriting. They can’t refuse to sell you any Medicare supplement policy it sells. They generally can’t make you wait for coverage to start. Finally, they can’t charge you more for a Medicare supplement policy because of you health problems.

Click here to learn about your options for getting Travel Insurance coverage to work with your Medicare

What about Tricare?

When you are receiving Medicare and you have Tricare for Life and you are traveling overseas, Tricare for Life becomes your primary medical insurance. If you are retired military but not yet receiving Medicare and have Tricare Prime then you just have to go here to the Tricare website and get the contact information for the area were you will be traveling. The Tricare site has all the contact information for every country.




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