Travel Insurance File is frequently asked if American citizens, or former residents of the US living in other countries, are covered by Medicare when travelling in the US. Sounds like a simple “Yes” or “No” question. Well, the answer is not simple, but here it is.
The first assumption is that you are a legitimate Medicare beneficiary, which means you are 65 or older and have worked and paid into Social Security and Medicare for the required period of time—40 quarters of Medicare-covered employment. More simply, do you have a Medicare card?
If you meet that requirement you qualify for Medicare Part A, which covers inpatient hospital costs. But be aware that Part A has some hefty deductibles and copayments that you will be responsible for. For example, you will have to pay the first $1,100 of your hospital stay for the first 60 days, and after that you pay $275 for each of the next 61–90 days. Also, Part A does not cover outpatient services or any doctor’s fees. For that, you need to be making monthly Part B payments, which now amount to $96.40 (more if you’re in a higher income bracket). If you’re not paying that, you will be expected to pay your doctor out of pocket. Most Medicare beneficiaries in the US buy supplemental private health insurance to cover those very large gaps.
If you ordinarily reside in Canada and are eligible for a provincial government health insurance plan, you might recover some of the fees not paid by US Medicare, but you will need to file a claim for reimbursement with your provincial agency and hope for the best. Expect anywhere between 90-day to 18-month waits to collect your reimbursement—and even then, your reimbursement will be very slight. Provinces pay only a very small share of out-of-country health costs and then only those that were true emergencies. Do not expect your provincial plan to pay US hospitals or doctors directly. They don’t do that.
When you do the math, it’s obvious that by counting on only Medicare Part A for coverage of your month-long vacation in Florida, or your weekend trip to visit relatives in Wisconsin, you are better off buying private travel insurance in your home country before crossing the border into the US. You will then be covered for emergencies from the first dollar, and you will be covered for repatriation (by air ambulance if necessary) to a hospital at home—something Medicare will not pay for. But you must also be aware of the various exclusions and pre-existing condition requirements that are built into private travel insurance plans.
At present, I know of no Canadian travel plan that wraps around US Medicare to give you the advantage of Part A hospital coverage. Perhaps some enterprising Canadian insurer will come up with such a plan in future. If so, you will read about it here first.
In the meantime, play it safe and get your insurance before you enter the US.