One of our clients, Joby M., asked us, “How can I get Medicare to cover the medical needs of expats living abroad?”
Thank you Joby for sending us your question! Let’s get into it.
Limited Medicare Coverage Outside of the U.S.
Unfortunately, Medicare does not cover medical services outside of the United States, except for a few rare exceptions. The term “outside of the U.S,” means anywhere aside from the 50 states, District of Columbia, Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
The 3 Situations Medicare May Pay for Health Care Outside of the U.S.
There are only 3 situations in which Medicare may pay for health care services rendered in a foreign hospital. In these situations, Medicare will only pay for the Medicare-covered services you receive in a foreign hospital. (Source: Medicare)
You are in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat your illness or injury.
You live in the U.S., and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your illness or injury, regardless of whether it’s a medical emergency.
You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when you have a medical emergency. The Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury. (Please note: Medicare determines what is considered “without unreasonable delay” on a case-by-case basis.)
The Medical Services Covered in Foreign Hospitals
Please keep in mind that Medicare will only pay for for Medicare-covered services received in a foreign hospital in the 3 specific situations mentioned above. These Medicare-covered services include:
Part A– Inpatient hospital care
Part B– Emergency and non-emergency ambulance and doctor services rendered immediately before and during your covered inpatient hospital stay in a foreign hospital. However, if you get an ambulance and doctor services outside the hospital after your covered hospital stay ends, Medicare generally will not pay for those services. Also, if Medicare doesn’t cover your hospital stay (meaning it does not fall into one of the 3 specific situations mentioned above), Medicare will not pay for the services rendered in a foreign hospital either. For example, Medicare will not cover health care services you get in Canada after your covered Canadian inpatient hospital stay is over.
Remember, if you are only enrolled in Part A (and not Part B), Medicare will only pay for Part A Medicare-covered services in a foreign hospital. You will not have Part B coverage in a foreign hospital.
Part D’s Coverage of Prescription Drugs Outside the U.S.
Unfortunately, Medicare Part D drug plans are even less flexible than Original Medicare when it comes to providing coverage outside the U.S.
Part D plans will not cover any prescription drugs that purchased outside of the U.S. because you must live in the U.S. in order to qualify for Part D. You must also live in your Part D plan’s area in order to receive service.
Medigap’s Coverage Outside the U.S.
Your Medigap plan may cover health care services rendered outside of the U.S. Medigap plans C, D, F, G, M, and N have foreign travel emergency benefits. (Refer to this Medigap comparison chart to compare benefits from each plan.) These plans will pay 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet the yearly deductible.
Consult with your Medigap company or GoMedigap agent before traveling outside the U.S. to learn more about Medigap coverage outside the U.S.
Returning to the U.S.
More and more Americans are choosing to retire outside of the U.S. to stretch their retirement savings. There are options expats should consider want Medicare coverage at some point.
If an expat chooses to return back to the U.S., he or she will be covered by Medicare Part A, which covers inpatient hospital care. Part A is “free” (citizens pay Social Security tax through their working life to receive this benefit during retirement), and anyone over 65+ who is eligible for Social Security can benefit from Part A.
However, Medicare Part B is not free; it comes with a monthly premium. Unless you continued to pay Part B premiums while you were abroad, you will not be covered by Part B upon your return. In addition, you will face an enrollment penalty in which premiums increase by 10% for each year you were not enrolled in Part B. The penalty is very costly and is in addition to your monthly premiums. That is why it may be prudent for expats to enroll and pay for Part B premiums while abroad if they anticipate returning to the U.S.
For more info, visit Medicare’s page on signing up for Part B if you’re outside the U.S.
Medicare does not cover medical services outside of the U.S., except for in 3 specific situations. Medicare Part D does not cover the cost of drugs purchased outside the U.S. Some Medigap policies offer the benefit of foreign travel emergency benefits, which will pay 80% of the bill once the yearly deductible has been met. For expats, the easiest way to get Medicare coverage is to come back to the U.S. for medical services.
For more information, you can read Medicare’s publication on Medicare Coverage Outside the U.S. You can also call 1-800-Medicare (1-800-633-4227) for more information.
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