Confusion Regarding Canadian or Mexican Medicare Coverage

Part 3, Chapter 9: Medicare and Medicare Related Programs: Medicare Page 10

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The same provision applies to Medicare beneficiaries who live in Texas, near the Mexican border. As long as the Canadian or Mexican hospital is significantly closer than the nearest American hospital, and as long as the Medicare beneficiary is being treated for a medical emergency, Medicare may consider providing coverage. Decisions are made on a case-by-case basis.

Medicare may also provide coverage for emergency medical care received at a Canadian hospital for a Medicare beneficiary who is in the process of traveling through Canada on the way to or from Alaska. However, that provision applies only if the individual is traveling by a direct route to or from Alaska, and if the Canadian hospital is closer than the nearest hospital in the United States.

At this point, the Medicare system is so complicated that it can take months to straighten out errors. For example, Medicare may receive information about beneficiaries from a variety of sources, including other government agencies. In some cases, that information may be incorrect or outdated. However, once the information gets into the system, it can be very difficult to have it corrected. In the meantime, claims are often denied on the basis of the erroneous information.

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