Picture this: You’re three days into the trip of a lifetime in Italy. You trip on a cobblestone street and break your hip.
The hospital turns out to be excellent. Then the bill shows up, and you learn something far too many retirees discover the hard way.
Medicare usually won’t pay a dime.
According to Medicare.gov, Original Medicare generally won’t pay for care you get once you leave the country. The State Department is even blunter: Medicare and Medicaid don’t pay for care abroad, and the U.S. government doesn’t pay citizens’ medical bills overseas.
A broken hip is only the start. If you need to be flown home, the Centers for Disease Control and Prevention (CDC) says a medical evacuation can run from about $25,000 within North America to more than $250,000 from distant places. Medicare generally won’t cover that, either.
Winter travel season is coming, and Medicare open enrollment runs Oct. 15 through Dec. 7. That makes right now the perfect time to plug this hole. Here’s how.
1. Know how narrow the exceptions are
Medicare does cover care outside the U.S. in a handful of situations, according to Medicare.gov:
- You’re in the U.S. when an emergency happens, and a foreign hospital is closer than the nearest U.S. hospital that can treat you.
- You’re taking the most direct route between Alaska and another state through Canada, without unreasonable delay, and a Canadian hospital is closer than a U.S. one.
- You live in the U.S., and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat your condition.
- You’re on a cruise ship, the doctor is legally allowed to treat you there, and the ship is within six hours of a U.S. port.
That cruise exception is the one that fools people. It’s a six-hour leash, and a ship that’s a day or two out at sea can easily be past it. Once you are, you’re on your own.
When an exception does apply, Part B also covers the doctor and ambulance services you get right before and during the covered foreign hospital stay.
But don’t count on your drug plan. Medicare Part D doesn’t cover prescriptions you buy outside the U.S., so pack enough medication for the whole trip.
2. Check whether your Medigap plan covers foreign emergencies
If you have a Medicare supplement policy, also called Medigap, dig it out. Most Medigap plans sold today — C, D, F, G, M and N — include a foreign travel emergency benefit, according to Medicare.gov. The other plans don’t.
Here’s how the benefit works, according to a Centers for Medicare & Medicaid Services (CMS) fact sheet updated in April:
- It pays 80% of the billed charges for medically necessary emergency care outside the U.S.
- You pay a $250 deductible each year first.
- There’s a $50,000 lifetime limit.
- The care has to begin during the first 60 days of your trip.
That 60-day rule matters if you winter abroad or take long trips. Have a heart problem on day 61, and this benefit won’t help you.
And $50,000 sounds like plenty until you remember that a long-distance medical evacuation can cost five times that much. Think of this benefit as a floor, not a force field.
One more wrinkle if you’re shopping during open enrollment: Plans C and F are no longer available to anyone new to Medicare as of January 2020, according to Medicare’s Medigap guide.
3. If you have Medicare Advantage, call your plan before you book
As a rule, Medicare Advantage plans won’t pay for care abroad, according to Medicare’s guide to Advantage plans. Some add coverage for emergencies and urgent care during trips overseas.
The word “some” is doing a lot of work in that sentence. The only way to know is to ask your plan, and to get the answer in writing, including any dollar-amount limit.
If worldwide coverage matters to you, open enrollment is your chance to pick a plan that includes it.
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4. Buy travel medical insurance to fill the gap
For most retirees heading overseas, the real fix is a travel medical policy. Medicare.gov itself suggests travel insurance for extra coverage. The State Department strongly recommends medical evacuation coverage for trips to higher-risk areas or places where good care is hard to find.
Here’s what I’d look for:
- Medical coverage, not just trip cancellation. A policy that refunds your cruise won’t pay a foreign hospital.
- Medical evacuation, given what the CDC says it can cost.
- How it treats preexisting conditions. The CDC says travelers over 75 should start shopping early, because coverage for existing conditions gets harder to find.
- Whether it pays the hospital directly, so you’re not fronting the bill. The State Department notes that some short-term policies do.
Read the fine print before you buy. Medicare.gov warns that travel policies come with conditions and restrictions.
For more, see “Is Travel Insurance Worth It? Here’s How to Decide.” Tip: Use your favorite AI chatbot to go over your policy and point out things you need to know.
5. Keep every receipt, because you may have to file the claim yourself
Even when Medicare or your Medigap plan will pay, don’t expect the paperwork to take care of itself. U.S. hospitals have to submit Medicare claims for you. Foreign hospitals don’t, according to CMS. You may have to file the claim yourself to get reimbursed.
So hang on to everything: bills, receipts, discharge papers and proof of what you paid. It’s a lot easier to collect them at the hospital than to chase them from home.
Before you go
The State Department suggests seeing your doctor six to eight weeks before an international trip. It also recommends signing up for its free Smart Traveler Enrollment Program, known as STEP, so an embassy or consulate can reach you or your family in an emergency.
If you want the full list of what Medicare leaves you paying for, read “Retirees, Beware: Medicare Will Not Cover These 11 Medical Costs.”
Medicare was built for health care at home. The minute you leave the country, you’re mostly on your own, unless you plan ahead. A phone call to your plan and the right travel coverage beats a five- or six-figure bill every time.
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