Does Medicare/Medigap Coverage really cover you in Mexico?

There is a common assumption among United States citizens that their Medicare health insurance policy will cover them while they are traveling and/or living abroad. This assumption is very wrong, and can end up being very costly. Being admitted into a foreign hospital under the assumption that you will have coverage from your Medicare plan will result in you needing to pay your medical expenses out of pocket. There are only 3 circumstances in which Medicare will cover you outside of the US, and they are very unique circumstances at that. They are;

1. You have a medical emergency while in the U.S., and the closest medical facility that can treat your illness or injury is in a foreign country.
2. You are traveling through Canada, without reasonable delay, by the most direct route between Alaska and another state, when a medical emergency occurs and the closest medical facility that can treat your illness or injury is a Canadian facility. Medicare will determine what constitutes “without reasonable delay” on a case-by-case basis.
3. You are living in the US and a foreign medical facility that can treat your medical condition is closer than the nearest U.S. facility. It does not need to be a medical emergency.

However the Medicare supplement plans of Medigap do provide foreign travel emergency coverage. Plans C, D, F, G & N provide foreign travel emergency healthcare coverage when you travel outside the U.S. There are also limits and circumstances under which these Medigap plans will cover you while you are in a foreign country. The specifics are;

Medigap Plans pay 80% of the billed charges for certain medically necessary emergency care in a foreign country. These Plans have a 250 USD deductible per year. Foreign travel emergency care is covered if it begins within the first 60 days of your trip, if Medicare does not otherwise cover the care. Foreign travel emergency care Medigap Plans have a 50,000 USD lifetime sum insured limit.

Having said that, it is always better to check with your specific provider before you travel to make sure that you have coverage, as different Medigap plans are provided by numerous different private insurance providers.

Besides Medicare and Medigap, there are other HMO, PPO and supplemental health insurance policies available. These policies will also offer coverage outside of the US, but since there are many different types of plans, offered by numerous different insurance providers, it is always best to check with your specific plan provider to see what is exactly covered abroad.

It is always recommended to people traveling to a foreign country not to rely solely on their Medicare/Medigap coverage and/or the coverage provided by their credit card. For short-term travelers, travel medical insurance policies can be bought for an exact number of days, and are very inexpensive, especially compared to the extent of coverage that they provide.

For people that spend a majority or the entirety of the year living outside of the US, there are many great private health insurance plans available. These policies have a large extent of coverage, making them a better option that their US plans or travel medical insurance policies. The advantages far outweigh the cost of the policy, especially in a medical emergency. Plus, there are numerous options to choose from so that there is a policy for each person’s unique situation.

Consult with an agent or brokerage that speaks your language, has a physical presence in the country you are traveling to, and has a claims department that will help you with that process. Making sure you find a brokerage that meets those three criteria is the best way to make sure that your interests and your well-being are being looked after.