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Coverage in a Foreign Country

Q. Will Medicare cover any medical treatment in a foreign country? If not, what are my options?

A. Medicare does not pay for medical services outside the United States and its territories except in very limited circumstances:

* if you’re en route between Alaska and another state and have a medical emergency that requires you to be treated in Canada.
* if a medical emergency occurs while you’re in the United States or territories but the nearest hospital is in a foreign country (for example, across the border in Canada or Mexico).
* if you live within the United States or territories but your nearest hospital is in a foreign country, whether or not it’s an emergency.

Some medigap supplementary insurance policies (C, D, E, F, G, H, I and J) cover emergency or urgently needed treatment abroad. In these circumstances, you pay a $250 deductible and then 20 percent coinsurance for medical services costing up to a lifetime maximum of $50,000; after this limit is met, you pay all costs.

Some employer-sponsored and Medicare Advantage health plans also cover care abroad in approved situations. And you can independently purchase travel insurance that includes coverage for emergency medical treatment (whether life-threatening or not) that suddenly becomes necessary while you’re abroad.

What if you have a medical condition and wish to be treated in another country? If you have employer-based insurance, check with the company to see whether your policy allows it. After all, very often the cost of medical services is much lower abroad. But neither Medicare nor medigap insurance covers treatment in these circumstances. Travel insurance usually excludes treatment for any medical condition that you developed within at least 90 days (and sometimes 180 days) before your trip begins.

If you need an experimental treatment that is provided in a foreign country but not in the United States, it's very unlikely that Medicare would cover it, as explained here.

Patricia Barry is a senior editor at the AARP Bulletin.

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