Does Medicare Cover You Abroad? What Retirees Need Before a Cruise or Overseas Trip

Medicare’s own fact sheet gets to the point fast: in most situations, Medicare won’t pay for health care you get outside the U.S. That goes for Part A and Part B, in a hospital in Lisbon, at a clinic in a Mexican port town, and on a cruise ship once it’s more than six hours from a U.S. port.

The Centers for Disease Control and Prevention says a medical evacuation from a remote area to a good hospital “could otherwise cost more than $100,000.” That’s the flight alone, before treatment. Many hospitals abroad also expect payment before they discharge you.

None of this is a reason to stay home. It means the card in your wallet is a domestic document, and something else has to go in the bag. Four steps, best done the day you book.

Step 1. Write down what you already have

If you have Original Medicare alone, the honest line is “nothing.” For Medicare, the U.S. means the 50 states, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands. San Juan is covered like Ohio. Cozumel isn’t. There are three narrow exceptions, all involving a foreign hospital that happens to be closer than any U.S. one, and few travelers fit them. Drug plans can’t cover prescriptions bought abroad either, so pack the whole trip’s supply plus a few days, in the original containers.

If you have Medigap, check the letter of your plan. Medicare’s 2026 guide shows a foreign travel emergency benefit in Plans C, D, F, G, M and N. Plans A, B, K and L don’t have it.

Break a hip on day 4 of a Mediterranean cruise and run up a $40,000 hospital bill in Italy: after the $250 deductible, Medigap pays 80% of $39,750, or $31,800. You owe $8,200 plus the cost of getting home, and $31,800 of your lifetime cap is gone for good.

If you have Medicare Advantage, call the plan. Ask what the travel benefit covers, whether there’s a dollar limit, whether evacuation is included, and how a foreign claim gets filed. Then check the answer against the Evidence of Coverage. A thin benefit leaves you where Original Medicare does.

Write the answer on an index card in one line, and put it in your passport.

Step 2. Buy the policy that fills the gap

A travel medical policy is short-term health coverage for the days you’re outside the U.S. It is not “trip cancellation,” which reimburses lost deposits. Packages bundle the two under names that look almost identical at checkout; you can usually buy the medical piece alone.

Premiums climb with age and trip length, but policies differ far more in the fine print than in price. Two or three quotes side by side takes an evening.

• What’s the medical limit, what’s the evacuation limit, and are they separate?
• Is there a pre-existing condition waiver, and what’s the deadline to qualify?
• Is there an age cap? Some policies cut limits after 70 or 80.
• Does it cover what you’ll actually do: shore excursions, hiking, scuba?
• Who decides an evacuation is “medically necessary,” the doctor on site or the insurer?
• Does it pay the hospital directly, or reimburse you afterward?
• Is it primary, or does it pay only after other coverage?

That last one matters if you hold a Medigap plan with the travel benefit. Tell the travel insurer you have it, and make sure both documents agree on who pays first.

Step 4. Set up the paper trail before you go

Photograph your Medicare card, your Medigap or Advantage card and the assistance number, and store the images where a travel companion can reach them. If you’re the one in the hospital bed, your companion makes the calls.

When something happens, the assistance line comes first, before you agree to anything expensive. At the hospital, ask for itemized bills, in English if they can, and a discharge summary. Pay by card if you must, and keep every receipt.

Nobody files the Medigap claim for you. Foreign hospitals aren’t required to bill Medicare and generally don’t bill your Medigap insurer either, so the itemized bill and proof of payment go from you to the Medigap company. In the uncommon case where one of Medicare’s own exceptions applies, the claim to Medicare goes on Form CMS-1490S. The travel policy is a separate claim with its own deadline; send the discharge summary, and for an evacuation the assistance company’s case number.

Keep copies for a year. A second invoice from a foreign hospital months later isn’t unheard of.

Who to call

Your Medigap insurer, at the number on the policy, for one question: does my plan include the foreign travel emergency benefit, and how much of the $50,000 lifetime cap have I used? Ask before you travel, not after.

Your Medicare Advantage plan, at the member services number on the card, for the travel benefit and its limit.

1-800-MEDICARE (1-800-633-4227) for what Medicare itself does and doesn’t pay abroad, and to be connected to your State Health Insurance Assistance Program, whose counselors are free and have nothing to sell.

The U.S. embassy or consulate where you’re traveling, if you end up in a hospital without an assistance line to call. Consular staff can’t pay the bill, but they can help find medical care and reach family at home.

Your travel insurer’s 24-hour assistance line, saved in your phone and written on the card in your passport, before the trip starts.