Medicare Outside the United States: The Three Narrow Exceptions

The general rule, stated plainly

Care received outside the United States and its territories is not covered by Part A or Part B. That includes routine visits, planned procedures, and the medical care attached to a vacation, no matter how urgently it was needed. Medicare does not reimburse you afterward for a hospital in Portugal.

The three exceptions

First, if you have an emergency while physically in the United States and a foreign hospital is closer or more accessible than the nearest American one, Medicare may pay the foreign hospital. The comparison is distance-based and reviewed case by case.

Second, if you live in the United States and a foreign hospital is closer to your home than the nearest American facility capable of treating you, emergency or non-emergency care there can be covered. This is the rule that occasionally helps people near the Canadian and Mexican borders.

Third, if you are traveling a direct route between Alaska and another state and a Canadian hospital is closer than an American one, that care may be covered. These exceptions are about proximity, not preference, and none of them cover a planned medical trip abroad.

Cruise ships and territorial waters

Care aboard a ship is covered only while the ship is in a United States port or within territorial waters, generally within three miles of shore, or up to twelve miles in some cases. Once the ship is in international water or a foreign port, Medicare stops. The ship's infirmary bill is the passenger's.

What actually fills the gap

Medigap Plans C, D, F, G, M, and N include a foreign travel emergency benefit: eighty percent of medically necessary emergency care after a $250 deductible, with a lifetime maximum of $50,000. It is real money and it is capped, so it is a cushion rather than a solution for a serious event.

Medicare Advantage plans generally cover emergencies worldwide but not routine care abroad, and some add travel benefits. For anything planned, or for long stays outside the country, a standalone travel medical policy is the only tool that matches the exposure. Read its evacuation limit carefully, because medical evacuation is the most expensive line item in a foreign emergency.