Medicare Coverage Outside the United States
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This document explains limits and exceptions for Medicare Parts A, B and D coverage when services, supplies, or drugs are obtained outside the United States, and describes cost, claims, and related Medigap/Medicare Advantage considerations for affected beneficiaries.
No material clinical or coverage changes in this revision.
Medicare Coverage for Services Outside the United States
Coverage criteria and rules
Medicare coverage outside the U.S. is limited; certain services are covered only under specified conditions.
ALL of the following
One of the following must apply:
- You are in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat you.
- You are traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat you (Medicare decides on a case-by-case basis what qualifies as 'without unreasonable delay').
- You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat you, regardless of whether you have a medical emergency.
Claims, Coding Rules, and Special Conditions
| No codes listed |
Claims Submission and Provider Billing Guidance
When foreign hospitals won't file: beneficiary must pay and file CMS‑1490S
If a foreign hospital does not file Medicare claims on the beneficiary's behalf, the beneficiary must pay the provider directly and submit a claim to Medicare (use form CMS‑1490S, “Patient's Request for Medical Payment”) to seek reimbursement. For cruise ship services that meet a qualifying situation, the physician must submit the Medicare claim, though the beneficiary may also file directly.
- Print and complete CMS‑1490S (Patient's Request for Medical Payment) and follow the form instructions for foreign travel or cruise-ship services.
- If care was received on a cruise ship under a qualifying situation, verify whether the doctor submitted the claim; if not, the beneficiary may file directly.
- Refer to Medicare.gov/providers-services/claims-appeals-complaints/claims or call 1‑800‑MEDICARE for where to send foreign claims and form guidance.
Key Definitions
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