Does Medicare or Medicaid Cover Medical Treatment Outside the USA?

Patient's Medicare card and passport next to a stethoscope with an airplane and an international hospital visible through a window representing medical treatment abroad and travel insurance

Most federal and state public programs do not routinely pay for medical care received outside the United States. This article explains Medicare and Medicaid rules and exceptions, compares private travel and international health insurance options, and gives practical steps for U.S. patients planning care abroad so they can manage costs and risks.

How Medicare and Medicare Supplement Plans Handle Care Abroad

Original Medicare usually stops at the border. If you have Part A and Part B, you should know that the program generally does not pay for health care services or supplies outside the United States. For Medicare purposes, the “United States” includes all fifty states, the District of Columbia, and U.S. territories like Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. If you are traveling to Europe, Mexico, or Asia, your red, white, and blue card stays in your wallet. Medicare is designed to cover you within the domestic system and lacks the infrastructure to process claims from foreign doctors or hospitals. Additionally, Medicare Part D prescription benefits do not extend outside U.S. territories, meaning any medications prescribed by a foreign doctor will not be covered.

There are three very specific situations where Original Medicare might pay for care in a foreign hospital. These exceptions are rare and depend on your geographic location at the time of the medical event. If you believe you fall into these categories, you should call 1-800-MEDICARE to verify the proximity of the foreign hospital before receiving treatment.

Emergency in the United States
Medicare may cover inpatient hospital care if you are in the U.S. when a medical emergency happens and a foreign hospital is closer than the nearest American hospital. This situation sometimes occurs in border towns where the quickest route to a trauma center involves crossing into Canada or Mexico. Medicare will pay for the emergency services and any ambulance transportation required to get you there.

Travel Through Canada
If you are traveling between Alaska and another U.S. state, Medicare might cover you if a medical emergency occurs while you are in Canada. This only applies if you are taking the most direct route without unreasonable delay. You cannot be on a vacation in the Canadian Rockies. The law requires that the Canadian hospital be closer than the nearest U.S. hospital that can treat your condition. This is a very narrow exception for people driving the Alcan Highway.

Living Near the Border
If you live in the United States and a foreign hospital is closer to your home than the nearest U.S. hospital, Medicare might cover you. In this specific case, the coverage can apply even if it is not an emergency. This rule helps people in remote border areas access the nearest available medical care regardless of the national boundary.

Medicare also has a specific rule for cruise ships. It will cover medically necessary services if the doctor is legally allowed to provide them and the ship is in a U.S. port. It also covers you if the ship is in U.S. territorial waters. The ship must be no more than six hours away from a U.S. port for this coverage to apply. If the ship is further out at sea, Medicare will not pay for any medical care you receive on board.

Medicare Advantage plans work differently than Original Medicare. These plans are offered by private companies like UnitedHealth Group or Humana. By 2025, about 54 percent of all Medicare beneficiaries are projected to choose these plans, representing roughly 34.1 million people. Most Medicare Advantage plans offer some level of worldwide emergency and urgent care coverage, a significant benefit compared to Original Medicare. However, the rules vary between plans. You must check your Evidence of Coverage document to see the details, specifically looking for sections labeled Worldwide Emergency Coverage. Some plans require you to pay the full bill upfront and submit a claim for reimbursement, while others may require prior authorization for certain services even when abroad. It is a good idea to get written confirmation of these benefits and any specific international assistance phone numbers before you leave the country.

Medicare Supplement insurance, which people call Medigap, is another way to get coverage for travel. Standard Plans C, D, F, G, M, and N, as well as the discontinued Plans E, H, I, and J, include a foreign travel emergency benefit. This benefit is designed for people who travel outside the U.S. for short periods.

How Medigap Foreign Coverage Works
The plan pays for 80 percent of the cost of medically necessary emergency care. You must pay a 250 dollar deductible every year before the coverage starts. There is a lifetime limit of 50,000 dollars. Once you reach this limit, the plan will not pay for any more foreign emergency care. This coverage only applies during the first 60 days of your trip. If you stay outside the U.S. for longer than two months, the coverage ends. This makes it a good option for vacations but not for people living abroad permanently.

Medigap Benefit Feature Standard Coverage Details
Coinsurance Amount 80 percent of billed charges
Annual Deductible 250 dollars
Lifetime Maximum 50,000 dollars
Trip Duration Limit First 60 days of travel

If you want to verify your coverage, start at Medicare.gov. You can find the official PDF titled Medicare Coverage Outside the United States for the most current rules. You can also check the Travel outside the U.S. page for general guidance. For those with private plans, the 2025 enrollment data shows that companies like UnitedHealth and Elevance Health have expanded their reach. You should always call your plan provider to ask about international emergency coverage. Ask them specifically about the claims procedure and what documentation you need to bring back.

The 2025 Medicare Trustees Report indicates that the program continues to evolve. While the core rules for foreign travel have remained stable, the growth of Medicare Advantage means more people have access to private travel benefits. You should always verify your specific plan documents for any changes that occurred after mid-2024. If you are planning a trip, consider reading Senior Medicare Overseas to understand why relying on Medicare alone while traveling is risky. Most experts recommend buying a separate travel medical policy to cover gaps like medical evacuation, which Medicare and Medigap do not pay for.

Medicaid and State Programs plus Private International Insurance Options

Medicaid functions as a state-administered program. This means the rules change depending on where you live. Most people do not realize that Medicaid coverage stops at the water’s edge. It generally does not pay for services outside the fifty states and the District of Columbia. This restriction exists because the program relies on both state and federal funding. The government cannot easily regulate the quality or the cost of care in foreign countries.

Geographic Exceptions and Territories
U.S. territories are a notable exception to the rule. If you travel to Puerto Rico, Guam, or the U.S. Virgin Islands, your Medicaid might still work. You should check for American Samoa and the Northern Mariana Islands too. These locations are considered part of the United States for insurance purposes. If you are a resident of one of these territories, your local Medicaid rules apply. If you are visiting from the mainland, you must verify if your home state has an agreement with the territory. Most states do not have these agreements. This means you should not assume you are covered just because you are on U.S. soil.

Rare Approvals and Border Situations
Rare exceptions exist for people living near the borders of Canada or Mexico. If a life-threatening emergency happens and the closest hospital is in a foreign country, some states might pay. This usually requires a state waiver or a special-case approval. You should call your state agency to ask about their specific policy and request a written copy of their out-of-country authorization rules weeks before you plan to travel. Most of the time, the answer will be no. Medicaid is designed for domestic use only. This is why seniors shouldn’t rely on Medicare overseas or Medicaid when they leave the country.

Private Travel Medical Insurance
Since Medicaid and Medicare offer so little help, private insurance is the only real safety net. Short-term travel medical insurance is the most common choice. These policies focus on emergencies, sudden illnesses, and accidents, but do not cover planned surgeries. You can choose between single-trip and multi-trip policies. Single-trip plans cover one specific vacation, while multi-trip plans are better for people who travel several times a year.

These plans usually have a look-back period for pre-existing conditions, typically 60 to 180 days before the policy start date. The insurer will review your medical history; if you had a heart condition that flared up abroad, they might deny the claim. To avoid this, look for a policy that offers a Pre-existing Condition Waiver. You usually must buy the insurance within 14 to 21 days of making your first trip payment to qualify for this waiver.

Comprehensive International Plans
Comprehensive international private medical insurance is different. These are often called expat plans. They are meant for long stays and often include elective care and routine checkups. These plans are much more expensive than short-term travel insurance. The cost depends on your age, medical history, and the country you are visiting. If you are seeking planned treatment abroad, this is the type of policy you need. It provides a higher level of medical case management, meaning the insurer helps coordinate your care with the foreign hospital.

Medical Evacuation and Repatriation
Medical evacuation and repatriation coverage is vital. This is not the same as standard health insurance. It pays for a private plane to fly you to a better facility, a medical escort, or to send your remains home if the worst happens. Without this, an air ambulance can cost over one hundred thousand dollars. Standalone policies for this usually cost between 100 and 500 dollars for a single trip. Many travel policies include this, but you should check the limits. A limit of fifty thousand dollars is often too low for a long-distance flight. Look for limits of at least 250,000 dollars. This ensures you can get back to the United States for long-term recovery.

Billing Models and Networks
You should look for plans that offer direct billing. This means the insurance company pays the hospital directly. If the plan only uses a reimbursement model, you must pay the bill yourself first, often via credit card or cash, and then submit a formal claim. This requires an itemized bill, discharge summary, and complete medical records (potentially translated). Many foreign hospitals require payment before they discharge you; if you cannot pay, they might hold your passport. A good policy will have a provider network with pre-existing agreements with specific hospitals, making the claims process much faster.

Purchasing Guidance and Red Flags
You must buy your policy before you leave the United States. If you try to buy it while you are already abroad, many companies will reject you. Keep all your documentation in a digital folder. Watch out for red flags: avoid plans with exceedingly low limits or ambiguous pre-existing condition clauses. If the wording is not clear, the insurer can use that to deny your claim. Check the financial strength of an insurer through A.M. Best; you want a company with an A rating or higher. You can find more information on official sites like Medicare.gov. They provide guidance on why you need extra coverage. You can also review the Medicare coverage outside the U.S. guide for more details on the limits of federal programs.

Conclusions and Practical Next Steps

Practical Next Steps Checklist

Verify your current Medicare or Medicaid status
Call 1-800-MEDICARE to confirm your enrollment details. Ask specifically about your coverage area. If you have Medicaid, contact your state agency. Ask if they have any reciprocal agreements or waivers for the country you are visiting. Do this at least two months before you leave.

Review your Medigap or Medicare Advantage policy
Find your plan documents. Look for the section titled Foreign Travel Emergency. If you have a Medicare Advantage plan, look for International Emergency Coverage. Check for prior authorization requirements. Some plans require you to call them within 24 hours of an admission. Write down the international phone number for your insurer.

Compare travel medical and international health plans
Standard travel insurance often focuses on trip cancellations. You need medical travel insurance. Compare the limits for pre-existing conditions. Many policies have a look back period of six months. If you have a chronic illness, ensure the policy covers acute onset of that condition. Look for plans that offer at least 100,000 dollars in medical coverage.

Confirm direct billing with the foreign hospital
Most foreign hospitals expect payment at the time of service. They do not bill American insurance companies directly. Contact the international patient department at your chosen hospital. Ask if they accept your specific private insurance. If they do not, ask for a written estimate of the total costs. You will need to pay this via credit card or wire transfer.

Secure medical evacuation coverage
This is the most important part of your safety net. Ensure your policy includes repatriation of remains and emergency medical evacuation. Check if the policy allows you to choose the destination hospital. Some plans only fly you to the nearest adequate facility. You want a plan that brings you back to your doctors in the U.S.

Gather and translate your documentation
Collect your recent medical records. Include your current prescriptions and allergy lists. Have these documents translated into the local language of your destination. Keep digital copies on a secure cloud drive. Also, keep physical copies in your carry on luggage. You will need itemized bills and discharge summaries to file a claim later.

Obtain written pre-authorizations
If you are using a private international plan for elective care, get everything in writing. Do not rely on a phone conversation. Get a letter that states the procedure is covered. It should also list the maximum amount the insurer will pay. This prevents surprises when the final bill arrives.

Risk Management and Final Advice

Traveling for medical care involves significant financial risk. Cost uncertainty is a major factor. Foreign hospitals might quote a low price, but complications can double or triple that number. Always have an emergency fund that is separate from your insurance. You should also verify the credentials of your foreign providers. Look for hospitals accredited by the Joint Commission International. This ensures they meet high safety standards. Before you finalize any travel plans, consult with a licensed insurance agent who specializes in international health. They can help you navigate the fine print that Medicare and Medicaid leave behind. Your health is too important to leave to chance in a foreign country.

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