Does Medicare Cover Me in Canada?

[JerArdra]

ALL,

Another item that might be discussed is, those folks on Medicare health insurance might have to buy a supplemental health insurance policy for the duration of their trip in Canada or Mexico.  I think that Medicare does NOT cover you in Canada or Mexico.

JerryF

[Steve, CDN]

Jerry,

Thanks for introducing an interesting topic!   As a Canadian, I can address the question form our point of view, and will look forward to some insights from the point of view of a U.S. traveller.

In Canada our National Medicare coverage has become fragmented in it's coverage over the years due to political manipulation and depends on the Province in which one resides.

The first consideration for a Canadian is the length of time one can be out of Province in order to retain Medicare benefits.  Most Provinces require that one is in Province 180 days to retain coverage, except Ontario which requires 150 days and Yukon Territories that has no requirement.

Next is the amount paid for out of Province care which varies from one jurisdiction to another.  People who do not have group insurance coverage for the excess need to buy independent insurance.

What are the requirements and limitations for coverage for U.S. residents?

[Ron]

ALL,

Another item that might be discussed is, those folks on Medicare health insurance might have to buy a supplemental health insurance policy for the duration of their trip in Canada or Mexico.  I think that Medicare does NOT cover you in Canada or Mexico.

JerryF

Good topic Jerry.  I'm not sure what Medicare will cover if not withing the US.  This is an important thing to consider when traveling ooutside the US for sure.

[JerArdra]

I did find out something on this topic by calling Medicare.  Basically Medicare will NOT pay medical expenses in foreign countries.  The will pay medical expenses in Canada and Mexico in the following case.

If you are traveling between two US states, by the most direct route, and the Canadian or Mexican hospital is the closest one, they will pay.

JerryF

[Ron]

Thanks for that info Jerry.  We have no plans to travel outside the US now but that could change.

[JerArdra]

ALL,

Here is what I have found.  Medicare gave me an insurance web site to look at:   www.travelinsure.com  and a phone number to call for travel insurance information 1-800-937-1387.  I also contacted Dan Pucher, a Canadian insurance broker at http://www.pucherinsurance.com/.  Dan sent me the three attached files.  It is good info if you're going to Canada this summer.  Dans email is dan@pucherinsurance.com.  The rate table (cost) is in $Canadian as are the benefits.

JerryF

[Jim Godward]

>>Basically Medicare will NOT pay medical expenses in foreign countries.<<

Pat and checked on this a while ago and after finding that Medicare would not pay ecxept as noted, we checked with our respective companies insurance for coverages.  We found that we are covered anywhere in the world IF medicare does not cover.  I think we ae very very lucky!!

Jim

[pavo]

I just thought I'd post a few random thoughts about medical care and insurance in Mexico for us Yankees.

There is a move afoot to get a trial program in the State of Jalisco (Guadalajara) which would offer Medicare coverage in that state only but it has been under discussion for some time and appears to be no closer to happening than it ever was.

If you are a veteran with a service connected disability the VA will extend benefits for treatment in Mexico and probably most other countries. If you are a US veteran and belong to the American Legion you will probably also qualify for treatment in Mexican Military hospitals. The treatment there is generally viewed as excellent and the cost is less than my deductibles at a VA facility in the US. As an example, a private room costs less than $25 per day and a Specialist consultation costs a little over $7.

If you are retired and/or retired in Mexico on an FM3 (a resident visa) you may qualify for membership in the IMSS system, the Mexican Social Security medical plan, for about $260 per year. The first year of membership provides primarily for emergency treatment, mostly broken bones, etc. The second year provides greater coverage and the third and subsequent years provide quite comprehensive coverage. The quality of coverage also varies considerably depending on where you are. We have found coverage quite good in Guadalajara, mediocre or worse in Oaxaca. Also, you will not believe the things you will encounter; for example, plan to take your own toilet paper. Nevertheless, medical treatment will probably still be quite good

If you have some types of Blue Cross coverage in the US you may have reombursement available for Mexican treatment. You pay and they reimburse several months later.

We just returned from living in Mexico and plan to return as soon as possible, depending on the family situation which brought us back.

Feel free to email if there are specific questions.

[TravelingTexans]

We have a medicare supplement that covers all our travels outside the US.  I think we have plan G on the list of medicare supplement coverages but I would not bet on it.  Some supplements cover travel outside the US some don't.  There is a deductable but I don't remember the amount.  It was cheaper than getting one time coverage plus we needed the supplement.

[hankpac]

According to the VA site at VA.GOV if you are service connected, 100%, the Canadian socialised medical plan will cover you in Canada.

[BruceinFL]

For active/retired US military, does anyone know if Tricare for Life will cover while traveling outside the US?

[Carl L]

I did find out something on this topic by calling Medicare.  Basically Medicare will NOT pay medical expenses in foreign countries.  The will pay medical expenses in Canada and Mexico in the following case.

If you are traveling between two US states, by the most direct route, and the Canadian or Mexican hospital is the closest one, they will pay.

JerryF

That sounds like something that the folks caravaning to Alaska from the Lower 48 should become aware of.   Here is a cute and paste from the SSA website on Medicare

There are three situations when Medicare may pay for certain types of health care
services you get in a foreign hospital. This happens only if the foreign hospital is closer
or easier to get to than any hospital in the U.S.
1. You live in the U.S. near a foreign hospital, and you need emergency or
non-emergency medical treatment. If a foreign hospital is closer or easier to get to
from your home than the nearest U.S. hospital that can treat your condition,
Medicare may pay for the services.
2. You’re in the U.S. when you have a medical emergency. If a foreign hospital is
closer or easier to get to than the nearest U.S. hospital that can treat your
emergency, Medicare may pay for the services.
3. You’re crossing through Canada without delay between Alaska and another state,
and you have a medical emergency. If a Canadian hospital is closer or easier to get
to than the nearest U.S. hospital that can treat your emergency, Medicare may pay
for the services.Normal or other Medicare coverage criteria also applies to the services you get in
foreign settings.
What kind of health care services does Medicare pay
for in the three situations described above?
If you have Part A (Hospital) and Part B (Medical) in the Original Medicare Plan,
Medicare covers the following services:
• Inpatient hospital care (care you get when you have been admitted to the hospital
as an inpatient).
• Doctors’ services that you get during your covered inpatient hospital stay.
However, if you aren’t admitted to a hospital and/or you get doctors’ services
outside the hospital, Medicare generally won’t pay for these services.
• Ambulance services to get you to the hospital in an emergency situation. Medicare
will only cover ambulance services for the trip to the hospital if you’re admitted as
an inpatient. Return trips aren’t covered.
Medicare only pays for its share of the costs for services covered in the Original
Medicare Plan. If you only have Part A, Medicare only covers inpatient hospital care.

[Jim Godward]

Carl,

I love the "MAY" in all the statements!!  :-((

[Carl L]

That may is Nature's way of saying don't go berserk just because you are on the Alcan.

[northernlites]

Having worked in both hospitals and medical clinics in Canada for many years, all I can say is that out-of-country insurance is never accepted.  We always expect the patient to pay for his/her medical care and they are totally responsible for being reimbursed by their insurance company.  It may differ in different parts of the country, but this has been my experience.  It is just too difficult to deal with these companies/insurance providers.

[BernieD]

When we traveled to Newfoundland 2 years ago, Medicare would not pay for my monthly blood tests while in Canada.

[John From Detroit]

A very interesting and, since my wife is now 65, timely thread. 

I have nothing other than thanks to contribute however

[ArdraF]

Wow, this is an old thread.  We learned that Medicare definitely does not cover foreign travel and that we could buy special health insurance for travel abroad.  We did that when we went to Newfoundland, knowing that we would be in Canada for at least two months.

ArdraF

[Ron from Big D]

Wow, this is an old thread.  We learned that Medicare definitely does not cover foreign travel and that we could buy special health insurance for travel abroad.  We did that when we went to Newfoundland, knowing that we would be in Canada for at least two months.

ArdraF

Ardra:   We checked and our Suplement by Blue Cross & Blue Shield of Texas does cover us in Canada.  Not sure we would need to purchase the travel insurance.

[Carl L]

Wow, this is an old thread.  We learned that Medicare definitely does not cover foreign travel and that we could buy special health insurance for travel abroad.  We did that when we went to Newfoundland, knowing that we would be in Canada for at least two months.

ArdraF

Yes indeed it is old.   And given that Medicare is a government program usually coupled with private supplemental insurance, DO NOT TRUST TWO YEAR OLD ADVICE, including (especially?)mine.  Check the current sources and read your own policies.   General does not work here.

[ArdraF]

Ron,

At the time we had Blue Cross Blue Shield of Colorado and it did not cover foreign travel, so Carl gave good advice.  Each person should check his/her own policy for foreign coverage.

ArdraF

[JerArdra]

One other point, sometimes your Medicare supplemental policy says they will cover you in Canada BUT it may be ONLY if Medicare pays first.  Get a clear answer on this point!

JerryF

[rankjo]

One of the points to consider, of course, is how much you are at risk in Canada, compared to the United States.

In Canada, doctor's fees are controlled by the Govt. so a regular operation for an emergency like a gallbladder attack or an appendix is going to cost a good bit under $1000 for the surgeon's fee.  Hospital bed days used to be $400 per day (I'm out of date on this).  It is the reverse of when Canadians go to the US----we have to insure for the worst possible occurrence which might cost $30K, $50K, $100K etc. and on up.

Americans in Canada would have difficulty pushing a medical bill above $10K for routine emergencies. And if you discover that you need a heart bypass or an esophagectomy, then you have the option of going home, in most cases.

It's a tricky problem, because you may be faced with something cataclysmic, like a stroke/brain haemorrhage, but in no instance will you be refused treatment.

It's a situation where you may want to consider a limit on your coverage, whereas Canadians in the US have no such option.

Just my 2c

Rankjo
(ex-vascular surgeon)

[Tom]

I'm curious .... can Americans cross the border and have elective (non-emergency) surgery in Canada? Is one place responsible for all the billing (e.g. the hospital), or do doctors and other providers bill separately?

[BernieD]

I'm curious .... can Americans cross the border and have elective (non-emergency) surgery in Canada? Is one place responsible for all the billing (e.g. the hospital), or do doctors and other providers bill separately?

Tom

As noted above, Medicare does not cover any medical expenses outside the US. Non-Medicare policies may or may not, depending on the policy. You need to check, and have confirmed, with your insurance carrier.

Sorry for the post to Tom's 2008 message, I didn't look at the date before responding and thought that our multiple responder (spammer ) was replying to the message.

[Tom]

Not a problem Bernie, but what multiple responder?

[WilleyB]

I'm curious .... can Americans cross the border and have elective (non-emergency) surgery in Canada?

Well if you're not in much of a hurry you might be able to. 
Truth is unless you're dying or on the way to it you'll have to get in the line up even to see a doctor.  Let's see in the Spring of  2007 I went to our family doctor because of a hearing problem. He got me an appointment with a specialist which took place in Jan 2008. The specialist then made me an appointment at the Hospital for a hearing evaluation, well it seems maybe my turn will be sometime this summer.
So much for the Govt. sponsored stuff. I got an assessment at a hearing aid place, by a consultant for the Province ( who by the way trained most of the techs at the Hospitals) who sent the results to my doctor and the specialists and the Dept of health. So far I haven't heard from any of them but I did buy a hearing aid (just short of $1700).
Just an idea of how far our medical system has been degraded. She aint whut she usta be b'ys 

Cheers
Willis

[BernieD]

Not a problem Bernie, but what multiple responder?

Tom

A staffer (you?) probably deleted the message, but when I posted there was a message between yours and mine. The same message was on about 3-4 other threads, word for word.

[Tom]

Bernie,

I removed those messages 

[ArdraF]

can Americans cross the border and have elective (non-emergency) surgery in Canada?

From what I've heard the Canadian doctors and health care system are sending patients south to us so they don't have to wait a year to get procedures done.  I read somewhere that the Canadian health care system in some cases actually reimburses the American hospital for their services.  Seems to me it also includes getting diagnostic tests like MRIs and CAT scans because we have so many more of these sophisticated pieces of equipment.  In some provinces there may be only one CAT machine, unlike here where there may be a dozen in the same city.  It's called health care rationing.

ArdraF