Does Medicare Cover You Outside the U.S.? Travel and International Coverage

The Short Answer: Medicare Generally Does Not Cover You Abroad

If you are planning a trip overseas, retiring abroad, or spending winters south of the border, here is the reality: Medicare was designed to cover health care within the United States and its territories. In the vast majority of situations, Original Medicare (Part A and Part B) will not pay for medical services, hospital stays, doctor visits, or prescriptions you receive in a foreign country.

This surprises many beneficiaries. After all, Medicare covers you in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. But the moment you cross an international border, your coverage essentially stops. That gap leaves millions of traveling seniors at financial risk every year.

Understanding the exceptions, the supplemental coverage options, and the planning strategies available can mean the difference between a worry-free trip and a devastating medical bill. To understand how all the pieces of Medicare fit together before diving into travel coverage, review our guide to the four parts of Medicare.

The Three Exceptions: When Medicare Does Pay Outside the U.S.

Congress carved out three narrow exceptions where Medicare will cover care at a foreign hospital. All three involve emergencies and geographic proximity to the United States. None of them apply to routine care, elective procedures, or planned medical tourism.

Exception 1: Emergency on a Ship Near a U.S. Port

If you have a medical emergency while on a ship within the territorial waters of the United States — generally within six hours of a U.S. port — Medicare may pay for medically necessary services provided on the ship. This exception is most relevant for cruise passengers who experience a health emergency shortly after departure or just before docking. Once the ship moves beyond U.S. territorial waters, Medicare coverage ends. Cruises that spend most of their time in international waters offer little Medicare protection.

Exception 2: A Canadian Hospital Is the Closest Hospital

If you live in the United States near the Canadian border and have a medical emergency, Medicare may cover your care at a Canadian hospital if it is substantially closer than the nearest U.S. hospital that can treat your condition. This applies regardless of whether you were in Canada at the time of the emergency. The key requirement is that the foreign hospital must be closer to your location than any American hospital capable of providing the needed care. This exception primarily benefits residents of border communities in states like Michigan, New York, Vermont, and Washington.

Exception 3: Traveling Through Canada Between Alaska and Another State

If you are traveling through Canada on the most direct route between Alaska and another U.S. state and experience a medical emergency, Medicare may cover your treatment at a Canadian hospital. The logic is that driving between Alaska and the contiguous 48 states requires passing through Canada, and it would be unreasonable to deny coverage during that transit. This exception does not apply to detours, sightseeing through Canada, or extended stops that are not on the most direct route.

In all three exceptions, the care must be emergency or urgently needed — not elective or routine. Medicare also pays based on its own fee schedule, which means the foreign hospital may bill you for any difference between what Medicare pays and what the hospital charges. You typically must pay the foreign provider upfront and submit a claim to Medicare for reimbursement after the fact.

Medigap Foreign Travel Emergency Benefit

For beneficiaries enrolled in Original Medicare, a Medigap (Medicare Supplement) plan is the most straightforward way to gain some international health coverage. Six of the ten standardized Medigap plans include a foreign travel emergency benefit: Plans C, D, F, G, M, and N.

Here is how the Medigap foreign travel emergency benefit works:

• Deductible: You pay the first $250 per calendar year for foreign emergency care out of pocket.
• Coverage rate: After the deductible, the Medigap plan pays 80% of the cost of medically necessary emergency care.
• Lifetime cap: There is a $50,000 lifetime maximum on the foreign travel emergency benefit. Once you hit that cap, the benefit is exhausted permanently.
• Emergency only: The benefit covers emergency care during the first 60 days of a trip. It does not cover routine care, check-ups, elective procedures, or non-emergency situations.

Medigap Plans A, B, K, and L do not include the foreign travel emergency benefit. If international travel is part of your lifestyle, this benefit should factor into your plan selection. Plan G is the most popular Medigap plan sold today and does include foreign travel emergency coverage.

While the Medigap foreign travel emergency benefit is valuable, it has real limitations. The $50,000 lifetime cap may not cover a serious hospitalization abroad. It does not pay for medical evacuation, which alone can cost $50,000 to $250,000 depending on the distance and circumstances. And it only applies to emergencies — not to a bad cold, a twisted ankle that is not an emergency, or ongoing care for a chronic condition. For help choosing a Medigap plan that fits your travel needs, weigh the foreign travel benefit alongside other coverage differences.

Medicare Advantage Plans and International Travel

Medicare Advantage (Part C) plans are private-insurer alternatives to Original Medicare. Like Original Medicare, most MA plans do not cover routine care outside the United States. However, MA plans have more flexibility to offer supplemental benefits, and a growing number now include some form of international travel coverage.

The travel benefits offered by Medicare Advantage plans vary significantly. Some plans offer worldwide emergency coverage for a set number of days per trip. Others provide an annual dollar allowance for foreign emergency care. A few plans partner with travel assistance companies to provide emergency medical evacuation coordination. However, these benefits are always supplemental and plan-specific — they are not guaranteed across all MA plans.

If you are enrolled in a Medicare Advantage plan and travel internationally, check your plan's Evidence of Coverage (EOC) document carefully. Look for whether the plan covers emergencies abroad, what the dollar limits are, how many days per trip are covered, and whether medical evacuation is included. Do not assume your MA plan covers you internationally — verify it in writing before you travel.

One important caveat: Medicare Advantage plans use provider networks within the United States, and most are HMO or PPO structures. Even within the U.S., you may face coverage gaps if you travel to a state outside your plan's service area. Original Medicare, by contrast, works with any Medicare-accepting provider anywhere in the country, making it a more reliable option for domestic travelers as well.

Travel Medical Insurance: Filling the Coverage Gap

For any Medicare beneficiary who travels outside the United States, standalone travel medical insurance is the most comprehensive solution. These policies are specifically designed to cover health care expenses abroad and offer protections that neither Medicare nor Medigap can match.

A typical travel medical insurance policy covers:

• Emergency medical treatment: Hospital stays, surgery, emergency room visits, and physician fees abroad.
• Emergency medical evacuation: Air ambulance and transport to the nearest adequate medical facility or back to the United States. Evacuation costs can exceed $100,000 without insurance.
• Repatriation of remains: Coverage for returning your remains to the United States in the event of death abroad.
• Urgent and non-emergency care: Many policies cover non-emergency doctor visits, urgent care, and prescription medications abroad — something Medigap foreign travel emergency benefits do not.

Travel medical insurance for seniors on Medicare typically costs between $2 and $10 per day depending on your age, destination, coverage amount, and trip length. A two-week European vacation might cost $50 to $150 to insure. Compared to a potential $200,000 hospital bill abroad, the cost is minimal.

When shopping for travel medical insurance, pay attention to pre-existing condition exclusions. Many policies exclude coverage for conditions diagnosed or treated in the 60 to 180 days before the trip unless you purchase a pre-existing condition waiver. If you have a heart condition, diabetes, or another chronic condition, make sure the policy will cover complications related to that condition abroad.

Living Abroad and Medicare: What Expatriates Need to Know

A growing number of American retirees are choosing to live abroad — in Mexico, Costa Rica, Panama, Portugal, and other countries with lower costs of living. If you are considering expatriate retirement, the Medicare implications deserve careful thought.

Medicare will not pay for your health care abroad. That much is clear. The question is whether you should keep paying for Medicare coverage you cannot use while living overseas.

Part A: If you qualify for premium-free Part A (most people do), there is no reason to drop it. It costs you nothing and will be waiting for you if you return to the United States. You can keep it active indefinitely while living abroad.

Part B: This is the difficult decision. Part B costs $185.00 per month in 2025, and that premium buys you nothing if you are living in another country. Many expatriates drop Part B to save money. But the permanent late-enrollment penalty looms: if you drop Part B and later re-enroll, you pay a 10% premium surcharge for each full 12-month period you were not enrolled. Drop Part B for five years and your premium is permanently 50% higher — an extra $92.50 per month in 2025 dollars, for life.

Part D: Similar to Part B, Part D prescription drug coverage only works at pharmacies in the United States and its territories. Dropping Part D while abroad triggers a late-enrollment penalty of 1% of the national base beneficiary premium for each month you lacked creditable coverage. The penalty is smaller than Part B's but still adds up over time.

The decision comes down to whether you believe you will ever return to the United States for health care. If there is any meaningful chance you will move back — for a health crisis, to be near family, or because plans change — keeping Part B active protects you from the penalty. If you are certain you will never return, the monthly savings may be worth the risk. But certainty is hard to come by when it comes to health and aging.

Expatriates should also explore the health care system in their country of residence. Many countries offer public health care systems, private insurance markets, or residency-based coverage that may be affordable and high quality. Some countries require proof of health insurance as part of the residency visa process.

Snowbird Tips: Wintering Abroad vs. Wintering in Another State

Millions of Medicare beneficiaries are snowbirds who escape cold winters by heading to warmer climates. Your Medicare coverage depends entirely on whether your winter destination is inside or outside the United States.

Wintering in Another U.S. State

If you winter in Florida, Arizona, Texas, or any other U.S. state, Original Medicare covers you just as it does at home. You can see any doctor or visit any hospital that accepts Medicare, anywhere in the country. There is no service area restriction with Original Medicare — it is truly nationwide.

However, Medicare Advantage snowbirds face a different reality. Most MA plans operate within a defined service area. HMO plans typically require you to use in-network providers, and your network may not extend to your winter state. PPO plans offer more out-of-network flexibility but at higher cost-sharing. Before heading south for the winter, MA enrollees should check whether their plan covers care in their destination state and what the out-of-network costs are.

If your MA plan does not work well in your winter location, you have options. Some snowbirds switch to Original Medicare during the Annual Election Period (October 15 through December 7) so they have nationwide coverage. Others choose a PPO-type MA plan that offers better out-of-area benefits.

Wintering Outside the United States

Snowbirds who winter in Mexico, the Caribbean, Central America, or other foreign destinations face the full brunt of Medicare's international coverage gap. Neither Original Medicare nor Medicare Advantage will cover your routine or emergency care abroad, with only the three narrow exceptions discussed above.

If you are a snowbird who winters abroad, take these steps to protect yourself:

1. Purchase travel medical insurance for the entire duration of your stay abroad. Look for a policy that covers emergency care, hospitalization, medical evacuation, and pre-existing conditions.
2. Fill prescriptions before you leave. Get 90-day supplies through your Part D plan or MA plan's mail-order pharmacy. Medicare Part D does not cover prescriptions filled at foreign pharmacies.
3. Keep your Medicare active. Even though you are abroad for months, maintain your Part A and Part B enrollment. You will need it when you return to the U.S., and dropping Part B triggers the permanent late-enrollment penalty.
4. Carry your Medicare and travel insurance cards. If you need emergency evacuation back to the United States, Medicare will cover your care once you arrive at a U.S. hospital.
5. Know the local health care system. Research hospitals and clinics near your winter home. Many popular snowbird destinations have quality private hospitals that cater to foreign patients at costs far below U.S. prices.

Cruises and Medicare: What You Should Know

Cruises are popular among Medicare-age travelers, and the coverage question comes up frequently. Medicare generally does not cover medical services provided aboard a cruise ship. The only exception is the territorial waters rule: if you experience a medical emergency while the ship is within six hours of a U.S. port, Medicare may cover services delivered on the ship.

Once the ship is in international waters or docked at a foreign port, Medicare does not apply. Shipboard medical clinics charge their own rates, and those charges can be steep — a doctor's visit on a cruise ship can cost $200 to $500, and serious medical care or stabilization can run into the thousands. Medical evacuation by helicopter from a ship at sea can cost $50,000 or more.

Most cruise lines offer or recommend travel medical insurance at the time of booking. Alternatively, you can purchase a standalone policy. For any cruise that leaves U.S. territorial waters — which is almost every cruise — having travel medical insurance is essential for Medicare beneficiaries.

How to File a Claim for Emergency Care Received Abroad

If you receive emergency care abroad that falls under one of Medicare's three exceptions, or if you have Medigap foreign travel emergency coverage, you will likely need to pay the foreign provider upfront and seek reimbursement afterward. Foreign hospitals and doctors generally do not bill Medicare or U.S. insurance companies directly.

To file a Medicare claim for covered foreign emergency care, obtain an itemized bill from the foreign provider, have it translated into English if necessary, and submit a claim to your Medicare Administrative Contractor. For Medigap claims, contact your Medigap insurance company directly for their claims submission process. Keep copies of all receipts, medical records, and correspondence. Filing deadlines apply, so submit claims promptly after returning to the United States.

The Bottom Line

Medicare is one of the most comprehensive health coverage programs in the world — within the United States. But its international coverage is extremely limited. Three narrow exceptions cover rare emergency scenarios near the Canadian border, on ships near U.S. ports, and while transiting Canada between Alaska and the lower 48 states. Beyond those situations, you are on your own.

If you travel internationally, your best protection comes from a Medigap plan with a foreign travel emergency benefit — available in Plans C, D, F, G, M, and N — combined with a standalone travel medical insurance policy for comprehensive coverage including medical evacuation. Medicare Advantage enrollees should verify whether their specific plan offers any international travel benefits and supplement accordingly.

For expatriates and long-term snowbirds living abroad, the key decision is whether to keep paying for Part B. The permanent late-enrollment penalty makes dropping Part B a one-way door — if you ever return to the United States, you will pay more for the rest of your life. When in doubt, keep Part B active and purchase local health coverage or international health insurance for your day-to-day care abroad.

The world is open to you in retirement. With the right combination of Medicare, supplemental coverage, and travel insurance, your health care can keep up with your adventures — no matter where they take you.