Guest columnist Elsa Nystrom is a frequent cruiser who reads the fine print before buying any sort of travel insurance. A few weeks ago, she wrote about using an insurance broker. Now, she tells us about Medicare coverage for guests traveling outside the United States. As always, we recommend that you consult with your travel advisor about insurance and protecting your cruise investment.

All travelers should be concerned about being properly insured when they step outside the boundaries of the United States. However, sometimes the information about coverage is confusing – to say the least. Trying to make complete sense of it in one article turned out to be impossible. The subject is too complicated. So here goes take two. This article covers onlywhat Medicare will pay for if you get sick or suffer an injury outside the United States. All information is from Medicare.gov, the official Medicare site.

According to Medicare.gov, Medicare usually doesn’t cover health care if you need it when traveling outside the U.S. What does this mean? You are only covered if you are traveling to any of the 50 states, and the District of Columbia. Puerto Rico, the U.S Virgin Islands, Guam, the Northern Mariana Islands and American Samoa are also considered part of the U.S.

There are some instances where Medicare Part B might cover treatment onboard a ship within the territorial waters of the U.S.  This may be hard to prove if you get sick when your ship is at sea. Medicare won’t pay for any health-related services if you get treatment when your ship is more than six hours from an American port. By this time, your ship will be traveling outside the U.S. territorial waters. These rules apply even if your ship is owned by an American company.

Before we go any further, let’s make sure we are aware of what is covered by the two parts of Medicare …

• Medicare Part A (hospital insurance) covers costs incurred after you are formally admitted by a doctor’s order as an inpatient, even in some cases to a foreign hospital.
• Medicare Part B covers both emergency and non-emergency ambulance and doctor treatment you have immediately before and during your covered inpatient stay in a foreign hospital. The key word here is covered stay …

However, Medicare probably won’t pay for any ambulance and/or doctor services that you incur after your hospital stay.

Ah yes, and then there is the payment. You will have to pay the part of the charge you would normally pay for Medicare-covered services. This includes doctors fees and ambulance service, which may or may not be part of a Medicare-covered hospital stay. Of course, you will have to pay co-insurance costs, copayments, and any deductibles you would pay inside the United States.

Remember: Foreign hospitals don’t have to file Medicare claims for your travel costs. You must submit your own itemized bill to Medicare if they haven’t done so. Always keep every receipt related to your health emergency, as you may have to work with Medicare yourself.

Finally, here are the occasions when Medicare may pay for inpatient hospital, doctor, ambulance services, or dialysis you might need in a foreign country. They are rare.

• First, if you are in the U.S. when you have a medical emergency and a foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition. I am still trying to imagine when this might happen.
• Second, and this seems more likely. You are traveling through Canada by a direct route between Alaska and another U.S. state when you have a medical emergency. The Canadian hospital might well be closer than the nearest U.S. hospital that can treat your condition. The wording seems to indicate that if you are not traveling directly from Alaska to the U.S. through Canada but are taking a leisurely trip, you won’t be covered.
• And finally, you live in the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat you, whether or not it is an emergency situation. Again, not very likely

In conclusion, once you step off U.S. soil, you are rarely covered by Medicare A & B. However, you may be covered by your Medicare Advantagepolicy.

Next, we will look at the pros and cons of relying on your Medicare Advantage policy for foreign travel, rather than buying an additional travel insurance policy.