Are you planning a vacation or two this summer? Make sure you know what your health insurance covers before you leave town. Medicare’s coverage of your medical care depends on where you travel and how you receive your Medicare benefits.
How Medicare Works When You Travel Inside the US and its Territories
If you have Original Medicare, you can travel anywhere within the US and its territories to get your doctor or hospital care. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Other than this, Original Medicare generally doesn’t cover any medical care abroad.
If you have a Medicare Advantage Plan (a Medicare plan offered by a private insurer), you may or may not be covered while traveling in the United States and its territories. Sometimes there is an extra cost associated with seeing providers outside of your network area. Some plans also require prior authorization (except for emergency and urgent care). Make sure to contact your plan provider and get all of the details before you leave town.
How Medicare Works When You’re on a Cruise Ship
Medicare may cover medically-necessary health care received on a cruise ship if:
- The ship doctor is allowed under certain laws to provide medical services; and
- The ship is in a U.S. port or no further than 6 hours away from one.
Medicare will not cover services received when the ship is further than 6 hours away from a U.S. port.
How Medicare Works with Health Care Abroad
Medicare only pays for very limited services outside of the U.S. Your circumstances must meet certain exceptions, otherwise you pay the full cost of your treatment to the health care provider. Exceptions include:
- You are in the U.S. when you have a medical emergency needing attention, and the foreign hospital is closer than the nearest U.S. hospital;
- You are traveling through Canada without unreasonable delay (determined by Medicare), by the most direct route between Alaska and another state, when your emergency occurs and the Canadian hospital is closer than the nearest U.S. hospital that can treat you; and
- You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital.