Medicare Reimbursement Regarding Foreign Expenses
Part 3, Chapter 9: Medicare and Medicare Related Programs: Medicare Page 9
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Clearly, the rules could be simplified without much difficulty. In the meantime, if you are uncertain whether Medicare or another insurance company represents your primary insurer, call or write to Medicare or to an organization such as the Medicare Rights Center or the United Seniors Health Cooperative. You can also get in touch with the state-sponsored health insurance counseling service for Medicare beneficiaries in your area (See Appendix B).
The rules regarding coverage of claims for medical care outside of the United States are also complex. The general rule is that Medicare does not provide coverage for medical care outside of the United States. However, there are several exceptions to that rule. For example, Medicare may provide coverage for emergency medical care received in a Canadian or Mexican hospital if a Medicare beneficiary lives near the Canadian or Mexican border, and if the Canadian or Mexican hospital is closer than the nearest hospital in the United States.
Let's assume that a Medicare beneficiary lives in upstate New York, near the Canadian border, that there's a Canadian hospital just across the border, and that the nearest American hospital is twenty or thirty miles away. If the individual has a serious accident or experiences severe chest pains -- the beginning of a heart attack -- in the middle of the night and decides to go to the Canadian hospital for treatment because it's closer, Medicare may provide reimbursement.
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