One of the great things about retirement is that there is finally time to travel and see the sights. A lot goes into planning a foreign vacation: searching for the best prices on flights and hotels, mapping out which sights to see, and packing the right wardrobe.

One thing that may not be on your pre-trip to-do list is checking up on your health insurance. You might be living with a known health condition, or you could suddenly develop an issue or have an injury while traveling internationally.

But if you’re 65 and have Medicare, you can’t count on coverage outside of the U.S.

That’s because Original Medicare stops at the U.S. border, in most cases, and not all Medicare Advantage and Medicare Supplement policies extend overseas either.

To protect yourself against crushing medical bills from emergency care if your vacation goes awry, you may need additional insurance. Even then, shopping can be tricky.

Here’s what you need to know before you leave on your next trip.

Does Medicare cover international travel?

If you have traditional Medicare, which consists of Part A (hospital insurance), and Part B (medical insurance), in most cases, your insurance does not cover care or supplies outside the U.S.

There are some exceptions, though. For example, Medicare Part B could cover medical care that you receive on a ship that is still within US territorial waters. However, once the ship has moved out of territorial waters, Part B would not cover medical care. There are a few other exceptions that would cover care if your medical problem originated while you were in the US, but the closest care available was in a foreign country.

Special rules also apply if you are on a cruise ship and within six hours of a U.S. port. In that case, Medicare may pay.

Does Medicare cover foreign travel emergencies? 

Medicare does cover some particular travel emergencies. As mentioned above, you are covered by Medicare if you are aboard a ship within US waters. If you are further than six hours from a US port, then your Medicare coverage will not apply.  

Another situation where your Medicare coverage will apply is if you are traveling the most direct route between Alaska and the contiguous US through Canada and have a medical event. If you are closer to a Canadian hospital than a US hospital, then Medicare will cover the cost of the emergency treatment. 

Finally, if you live within the US, but the closest hospital that can treat your medical condition is in another country, then your Medicare will cover your care. In this case, Medicare will apply even if the care is not for an emergency. 

You can get Medicare coverage if you are also traveling within US territories, such as Puerto Rico or Guam. 

What countries accept US Medicare? 

Your Original Medicare coverage will not apply in any other country than the US unless you meet the specific requirements in the previous section. Within the US, your Medicare policy is good in all 50 states. In addition, your policy will also work in US territories. These territories include: 

• Guam
• Puerto Rico 
• The District of Columbia 
• American Samoa 
• The Northern Mariana Islands 
• The US Virgin Islands 

If you are traveling in any of these territories, medical facilities will accept your Medicare policy.

When do private Medicare policies fill the gap?

As a result, if you suddenly find yourself in need of medical or emergency care in a foreign country, you may have to pay 100 percent of the costs out of pocket unless you have a private Medicare Supplement Insurance policy, also called Medigap. In addition, you’ll need to scrutinize your prescription drug coverage in the same way. If you accidentally lose or misplace your medication while traveling, your current coverage may not be of much help.

Do Medicare supplement plans cover foreign travel? 

Supplement plans may cover some services after you meet some requirements. It may only cover some of the services, you may have to pay a deductible, and it can also depend on how long you’ve been in the country in which you’re seeking care.

The Medigap plans that provide some international coverage are C, D, E, F, G, H, I, J, M, and N. They pay for 80% of the cost of emergency care while you’re traveling overseas, up to a lifetime maximum of $50,000. You can no longer buy plans E, H, I, and J plans, but if you enrolled in one before 2010, you can keep that coverage.

In addition, your Medigap coverage may only apply if your emergency happens within 60 days of the beginning of your travel. And remember, you can’t have Medigap and Medicare Advantage at the same time. 

Do Medicare Advantage Plans cover international travel?

With a private Medicare Advantage plan, also known as Part C, the same foreign travel exceptions apply as you find with traditional Medicare. Some Medicare Advantage plans do include coverage that applies during international travel, but not all plans will have this component.

If you anticipate traveling or vacationing abroad between Annual Enrollment Periods (AEP), then you may want to carefully read through the available Medicare Advantage policies to find one that includes a travel plan. 

However, with Medicare Advantage traveling within the U.S. could also cost you. These plans will cover emergency care but may not cover any other kind of treatment outside of your service area. See a doctor for something routine on your cross-country vacation, and the bill may be painful.

Generally, with a preferred provider organization (PPO) Advantage plan, you can visit doctors that are not in the plan’s network, though you may pay more. With a health maintenance organization (HMO) plan, you typically must visit in-network providers.

And if you travel frequently, beware. Some Medicare Advantage plans will drop you if you travel outside of your plan’s service area for more than six months a year.

Since your Medigap or Medicare Advantage policies may have strict requirements for what they will cover, you might feel more comfortable traveling with a travel medical insurance policy. Don’t assume that a travel policy that safeguards against theft or loss of your property will also cover injuries or medical events. You must look for a policy that specifically provides medical coverage and will meet your needs.

How you can still be at risk

Keep in mind that a travel insurance policy may have gaps as well. “It’s important to understand what is covered at the time of purchase—not wait until claim time,” says Megan Cruz, executive director of the U.S. Travel Insurance Association.

If a plan says it covers only emergencies, a visit to a doctor abroad for, say, a cough may not be reimbursed. More importantly, even emergency treatment may not be covered if it’s related to a pre-existing condition.

Many travel insurance companies define a pre-existing condition as “any documented treatment, diagnostic test or exam, medical recommendation for tests or exams, or a change in prescribed medicine within the look-back period stated on the plan,” according to InsureMyTrip.com.

When you submit a claim, insurers can check your medical records for a certain window, usually within 60 to 180 days of you purchasing a comprehensive plan or 90 days to three years before your departure date for a medical plan.

Having a pre-existing condition shouldn’t keep you from taking your dream trip to Paris—it’s not hard to get around this limitation. “Travelers can request a pre-existing medical conditions waiver to cover emergencies related to a pre-existing medical condition while on a trip,” says Loffredi.

Most comprehensive travel insurance plans come with a pre-existing conditions waiver at no extra cost, but you must meet certain conditions, including purchasing your policy when you book your trip, or within a certain number of days after your initial deposit, and being fit to travel at that time, says Cruz.

So be sure to check with a travel insurance agent before you book.

Smoothing the way for safer travel 

Many people save up and are excited to explore the world after retirement, mainly because there is time to go without work obligations or very young children to tow along. But not preparing for medical possibilities can create additional stress on top of the difficulties of dealing with sickness or injury in a foreign country. You may want to look into healthcare costs and processes for the country or region you plan to visit and consider a policy specifically for international travel. Keep in mind that if you have a Medicare Advantage plan, it may not automatically have an international travel policy or may lack international prescription care coverage.  

A little upfront planning is critical to ensuring that your vacation goes off without a hitch. When you plan your medical care possibilities and budget ahead of time, you can focus more on the time spent together, seeing the fantastic sights, and enjoying this exciting time in your life.