What happens to your Medicare coverage when you cross the border into Mexico – will you be covered if there’s a medical emergency?
Original Medicare Part A (hospital insurance) and Part B (medical insurance) coverage outside of the U.S.A. is limited. But you never know when illness or injury is going to happen, so if you’re planning a trip to Mexico in the future, understanding your Medicare coverage and what costs may be should you receive care should be an important part of your planning.
Or, if you are considering retiring in Mexico, you may be wondering if your Medicare coverage is still valid there. Read on to learn more.
Does Medicare cover healthcare services in Mexico?
Medicare typically doesn’t cover healthcare while you’re traveling outside of the U.S., including to Mexico, though there are some exceptions, including:
If you’re in the U.S. when a medical emergency occurs and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition, or…
You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.
Additionally, Medicare may pay for medically necessary services you get on a cruise ship. If you are on a cruise to Mexico, services may be covered if the doctor is allowed (under certain laws) to provide medical services on the cruise ship, and the ship is in a U.S. port or no more than 6 hours away from a U.S. port when you get the services.
Unfortunately, if your cruise ship is more than six hours away from a U.S. port, services will not be covered.
What services are covered by Medicare in Mexico?
In the above situations, Medicare will only pay for the Medicare-covered services you get in the foreign hospital. For example, Part A would cover inpatient hospital care and Part B would cover emergency ambulance and doctor services you get immediately before and during your covered foreign inpatient hospital stay.
Note that if Medicare doesn’t cover your hospital stay, and/or you get ambulance or doctor services outside the hospital after your covered hospital stay ends, Medicare typically won’t pay for these services, and you’d owe 100% of the cost out-of-pocket.
Medicare prescription drug plans will also not cover prescription drugs you may buy outside of the U.S.
Do Medicare Advantage plans provide coverage in Mexico?
Part C Medicare Advantage (MA) plans are sold by private insurance companies and are required to offer the same coverage and benefits as Original Medicare, though many offer additional benefits as well such as hearing, vision, dental, prescription drug coverage, and more.
If you are in Mexico and have a Medicare Advantage plan, it must provide coverage for the situations listed above. However, your plan may also offer additional coverage for services you get outside of the U.S. Check with your plan prior to traveling to understand what it does and doesn’t cover.
If you plan to travel frequently, you may want a Medicare plan that covers you in the event of a medical emergency when you’re in another country. When comparing plans, look at the benefits to see if they include international travel – something that’s easy to do with our Find a Plan tool. Just enter your zip code to get started.
Do Medigap plans provide coverage in Mexico?
Medicare Supplement Insurance (Medigap) policies may cover emergency care when you travel outside of the U.S. This is called foreign travel emergency care. When traveling, most plans will cover emergency services with a lifetime limit of $50,000.
Plans may cover foreign travel emergency care if it begins during the first 60 days of your trip and if Medicare doesn’t otherwise cover the care, or pay 80% of the billed charges for certain medically necessary emergency care outside of the U.S. (after meeting a $250 deductible per year).
Even if you have plans E, H, I, and J that are no longer sold, they still cover foreign travel emergency care.
How much do Medicare-covered services cost if I get treatment in Mexico?
In most cases, if you get inpatient or outpatient care or other healthcare services in Mexico, they will not be covered by Medicare, and you will owe 100% of the cost out-of-pocket. The total cost will completely depend on the services you receive.
If your care is covered because you meet one of the situations above, you would pay any related deductibles, co-pays, and co-insurance. For example, if the care is covered by Part B, you would have to meet the Part B deductible and then you’d likely owe 20% of the Medicare-approved amount.
Note that foreign hospitals are not required to file Medicare claims. So, if you’re admitted into a hospital in Mexico and your situation may be covered, you must file a claim and submit an itemized bill to Medicare for those services. Otherwise, you’ll have to pay the full cost out-of-pocket.
If you receive Medicare-covered services on a cruise ship, the doctor must submit the claim to Medicare.
Can I have Original Medicare if I live in Mexico?
Outside of the 50 states and District of Columbia, Medicare is only available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. If you live elsewhere, such as in Mexico, you cannot be enrolled in Medicare.
If you plan to retire or snowbird in Mexico, you must purchase private health insurance for coverage of any medical expenses.
How do I get coverage for my trip to Mexico?
If you’re traveling to Mexico or another foreign country, you may want to consider purchasing a separate travel insurance policy. Because Medicare has limited coverage of healthcare services outside of the U.S., you can buy a travel insurance policy to get more coverage should you get sick or injured. You can get more information from an insurance agent or travel agent.
Note that not all travel insurance policies include health coverage, so read all terms and restrictions carefully.