Medical Coverage Outside the United States
Individual and Family Plans and Medicare
In most situations, health plans don't pay for health care, supplies, or prescription drugs you receive outside the United States. You may be responsible for the full cost of medical care outside the U.S. and its territories (with limited exceptions). This includes anywhere other than the 50 states, Washington, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
Foreign hospitals aren't required to file health care claims. If a hospital doesn't submit health care claims for you, you must submit an itemized bill to your insurance carrier.
Before you travel outside of the U.S., speak with your insurance carrier for more information about coverage while traveling outside the U.S.
We recommend getting an international medical plan to help ensure you have coverage for any type of care you may need during your travels. Call us at 1-866-322-2824 (TTY: 711) to speak with a Via Benefits agent before you travel to review your options. The low cost of these plans compared to those offered by a travel service may surprise you!
Coverage While on a Cruise
Individual and Family Plans or Medicare may cover medically necessary health care services you receive on a cruise ship when:
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 six hours away from a U.S. port when you receive the services regardless of whether it's an emergency.
The doctor must submit the claim as usual if you received covered services on a cruise ship. However, you may also file a claim directly with your insurance carrier. You still pay the coinsurance or copayments and deductibles you would normally pay if you received these same services or supplies inside the U.S.
Note: Medicare only pays for its share of services covered by Original Medicare. If you only have Part A, Medicare only covers inpatient hospital care.
Medicare Only
Medicare Prescription Drug plans don't cover prescription drugs you buy outside of the U.S. Call your Prescription Drug plan provider for more information.
Medicare may pay for certain types of health care services outside the U.S. when:
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 what qualifies as "without unreasonable delay" on a case-by-case basis.
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 medical condition regardless of whether it's an emergency.
In the above situations, Medicare only pays for Medicare-covered services:
Part A covers care you receive when you've been formally admitted, with a doctor's order, to the foreign hospital as an inpatient.
Part B covers emergency ambulance, non-emergency ambulance, and doctor services you receive immediately before and during your covered foreign inpatient hospital stay. However, if Medicare doesn't cover your hospital stay, or you receive ambulance and doctor services outside the hospital after your covered hospital stay ends, Medicare generally doesn't pay for these services.
Coverage Under a Medicare Supplement Insurance (Medigap) Policy
A Medigap policy may offer additional coverage for health care services or supplies outside the U.S. (You can verify this in the plan benefits.)
Some Medigap policies cover foreign travel emergency care if it begins during the first 60 days of the trip.
Medigap policies typically pay 80% for certain medically necessary emergency care outside of the U.S., after the yearly deductible is met.
Medigap policies that offer foreign travel coverage have a lifetime limit of $50,000.
Coverage Under a Medicare Advantage Plan
Your Medicare Advantage plan, such as an HMO or PPO, may offer additional coverage for health care services outside the U.S.
Note: Foreign hospitals aren't required to file Medicare claims. If a hospital doesn't submit Medicare claims for you, you must submit an itemized bill to Medicare for your doctor, inpatient, and ambulance services. If you received Medicare-covered services on a cruise ship, the doctor must, ordinarily, submit the Medicare claim. However, you may also file a claim directly with Medicare.