Límites de Medicare fuera de los EE. UU.

In most situations, Medicare won’t pay for healthcare or supplies you get outside the U.S. The term “outside the U.S.” means anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. There are some limited exceptions that would allow you to get coverage outside the U.S. under Medicare Part A (Hospital Insurance) and or Part B (Medical Insurance).

 

What if I have a Medicare Supplement Insurance (Medigap) policy?

Your Medigap policy may cover services that Original Medicare doesn’t cover, like emergency medical care that you get outside the U.S.
Most Medigap plans (C, D, E, F, G, H, I, J, M, and N) provide foreign travel emergency health care with a lifetime limit of $50,000. These Medigap plans:

• Pay 80% of the billed charges for certain medically-necessary emergency care outside the U.S. after you meet a $250 deductible for the year.

• Cover foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care.
   

If you have plan E, H, I, or J, which are no longer sold, you may keep it if you bought one of these plans before June 1, 2010. They still cover foreign travel emergency care. Before you travel outside the U.S., ask your Medigap company or insurance agent for more information about your Medigap coverage while traveling. To learn more about Medigap policies, visit Medicare.gov/health-drug-plans/medigap or call 1-800-MEDICARE

 

What if I get my health care from a Medicare health plan instead of Original Medicare?
 

Medicare Advantage Plans and other Medicare health plans must follow rules set by Medicare, including for coverage outside the U.S. However, your plan may cover additional health care services you get outside the U.S. Check with your plan before traveling to find out what’s covered.

 

Can I buy travel insurance to help pay for the cost of health care services?
 

Yes. Because Medicare has limited coverage of health care services outside the U.S., you can choose to buy a travel insurance policy to get more coverage. An insurance agent or travel agent can give you more information about buying travel insurance. Travel insurance doesn’t necessarily include health coverage, so it’s important to read the conditions or restrictions carefully.
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When does Medicare cover health care services in a foreign hospital?
 

There are 3 situations when Medicare may pay for certain types of health care services you get in a foreign hospital (a hospital outside the U.S.):

• You’re 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 you.

• You’re 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 you. Medicare determines on a case-by-case basis what situation qualifies as “without unreasonable delay.”

• You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat you, regardless of whether you have a medical emergency.
   

Medicare drug coverage (Part D) covers all vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends, including certain vaccines you might need to get before you travel outside the U.S. (like yellow fever, chikungunya, and Japanese encephalitis). Your Part D plan won’t charge you a copayment or apply a deductible for vaccines ACIP recommends. Contact your Medicare drug plan for details and talk to your provider about which ones are right for you.

 

What kind of health care services does Medicare help pay for in
these 3 situations?
 

Medicare covers these services:

• Part A covers inpatient hospital care (care you get when you’ve been formally admitted with a doctor’s order to the foreign hospital as an inpatient).​

• Part B covers emergency and non-emergency ambulance and doctor services you get immediately before and during your covered foreign inpatient hospital stay. However, if Medicare doesn’t cover your hospital stay and/or you get ambulance and doctor services outside the hospital after your covered hospital stay ends, Medicare generally won’t pay for these services. For example, Medicare won’t cover return ambulance trips home or doctor services you get in a foreign country after your covered foreign hospital stay ends.
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Remember, Medicare only pays for its share of Medicare-covered services. If you only have Part A, Medicare only covers inpatient hospital care.

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Does Medicare pay for dialysis treatments when I travel outside the U.S.?
 

No. Unless you get dialysis during an inpatient hospital stay under one of the 3 situations described on page 1, Medicare doesn’t cover dialysis when you travel outside the U.S.


Does Medicare pay for prescription drugs outside the U.S.?

No. Medicare plans can’t cover drugs you buy outside the U.S. Contact your plan for more information. However, this limitation does not deter many seniors from moving abroad, because we have found in our many years abroad that in most countries, the cost of prescription drugs is actually cheaper than the Medicare Part D copayments and its ever increasing prescription drug deductible.

 

What do I pay if I get Medicare-covered services outside the U.S.?

Except in the limited situations described on page 1, Medicare doesn’t pay for health care services you get outside the U.S. If your circumstances don’t meet these limited situations, you pay the full cost to the health care provider.

If your situation matches one of the 3 situations on page 1 and Medicare covers the items or services you get, you would pay the related coinsurance or copayments and

deductibles.
 

Although U.S. hospitals must submit claims to Medicare for you, foreign hospitals aren’t required to file Medicare claims. If the foreign hospital doesn’t submit Medicare claims for you, then you’ll have to pay the full cost to the health care provider. You’ll need to submit a claim to Medicare to be reimbursed for your doctor, inpatient, and ambulance services described on page 1.
 

If you got Medicare-covered services on a cruise ship under a situation described on page 2, the doctor must submit the Medicare claim. You may also file a claim directly to Medicare.

Visit Medicare.gov/providers-services/claims-appeals-complaints/claims for information on where to send a foreign claim and get the “Patient’s Request for Medical Payment” form (CMS-1490S). Print out the form and instructions that apply to your situation (like for services you got on a cruise ship or during other foreign travel).

Or call 1-800-MEDICARE (1‑800-633-4227). TTY users can call 1-877-486-2048.


Will Medicare pay for medically-necessary health care services I get on a cruise ship?

Medicare doesn’t cover health care services you get when the ship is more than 6 hours away from a U.S. port.

Medicare may cover medically-necessary health care services you get on a cruise ship if:

• The doctor is allowed under certain laws to provide medical services on the cruise ship.

• The ship is in a U.S. port, or no more than 6 hours away from a U.S. port, when you get the services (regardless of whether it’s an emergency).
   

For more information
 

• Visit Medicare.gov/coverage to find out what Medicare covers.

• Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
  
   

To gain a clear understanding of available travel health insurance options to overcome Medicare’s covered benefits abroad, which are limited to only emergency medical care with a $50,000. lifetime maximum on both Medicare Supplements and Medicare Advantage Plans that are most suitable to your healthcare needs and your chosen destination,
 

Please contact us to schedule a telephone call at your earliest convenience with a licensed and certified Medicare specialist from AccessHMO