What It Is
Coverage for healthcare while outside the United States
Neither Medicare Part A nor Medicare Part B covers medical care outside the United States, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
In an emergency, if someone is in the U.S. but a Canadian or Mexican hospital is closer than any U.S. hospital, Medicare Part A covers inpatient treatment there; Medicare Part B can cover doctor services provided while the patient is hospitalized. Similarly, if someone is in Canada while traveling directly between Alaska and another state, Medicare Part A covers emergency inpatient care if a Canadian hospital is closest.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for healthcare while outside the U.S., contact the plan directly.
What Medicare Pays
In most cases, Medicare pays nothing for care outside the United States and its territories.
If Medicare Part A covers inpatient care in a Canadian or Mexican hospital, it pays the same amounts, under the same payment schedule, as for inpatient care in a U.S, hospital. If Medicare Part B covers any services billed separately from hospital charges provided while hospitalized in Canada or Mexico, it pays 80 percent of the Medicare-approved amount.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.