Medicare paying in Mexico?

A friend of mine said that she had heard recently that some people Lakeside had gotten claims paid for services in Mexico. I have read the threads from the past and did not see anything. Does anyone have any first hand knowledge of Medicare paying claims here?

My supplemental is Health Net of Arizona. I asked my rep specifically about coverage in Mexico. She advised as long as we were not out of country over 180 consecutive days any emergency would be covered, however, I must pay out of pocket and submit for reimbursement. No I haven't had an emergency to test the system.

MEDICARE can and will reimburse you for EMERGENCY medical services provided that you have entered Mexico (i.e. ON VACATION).
I'm not sure about the timeline that Medicare may pay for such services. I had some patients tell me they were reimbursed 2 months after they arrived in Mexico for an Emergency Cardiac Procedure. Saved them quite a bit of money.

The same for the Canadian provincial medical plans. They will pay up to the amount the same procedure would have cost in Canada. If travelling to the US one needs supplemental insurance since their costs are so much higher. And as stated above, they will only pay for emergency things. If there was anyway you could have gotten on a plane and had the procedure done back in Canada they will deny the claim.

On the other hand any out of pocket medical expenses incurred in Mexico can be deducted on your Canadian Income Tax return.

The U.S. and Mexican governments have been discussing a plan that would allow American citizens to use their Medicare in Mexico. So far, they're still talking about it. There are a few doctors here in Mexico who will accept Medicare and bill it to the U.S. government through their U.S. offices. I do not think this is legal...or advisable.

Jim W wrote:My supplemental is Health Net of Arizona.  I asked my rep specifically about coverage in Mexico.  She advised as long as we were not out of country over 180 consecutive days any emergency would be covered, however, I must pay out of pocket and submit for reimbursement.   No I haven't had an emergency to test the system.  

This is the same information I have gotten, although I have not tried to use medicare here.
As I think about this ..... in order to keep the medicare coverage current here, it's a great excuse to go north every 6 months for a shopping trip!!

Chapalamed wrote:MEDICARE can and will reimburse  you for EMERGENCY medical services provided that you have entered Mexico (i.e. ON VACATION).
I'm not sure about the timeline that Medicare may pay for such services. I had some patients tell me they were reimbursed 2 months after they arrived in Mexico for an Emergency Cardiac Procedure. Saved them quite a bit of money.

When people refer to medicare, I assume they are talking about medicare part a and b. If they are talking about medicare supplemental or alternative plans, those plans are usually specific to an area and are called something other than blanket "medicare"

medicare part a and b will not cover you in mexico - unless the following applies. Medicare alternatives and supplemental plans may - but that is going to depend on your individual policy - and that should not be confused with medicare a and b coverage.

The medicare site is easy to access -http://www.medicare.gov/Pubs/pdf/11037.pdf- and if you have questions, you can probably find an answer on their website.

Here is the information about medicare paying for emergencies outside of the US

Medicare Coverage Outside the United States

This fact sheet explains coverage under Original Medicare.

Medicare coverage outside the United States is limited. In most situations, Medicare won’t pay for health care or supplies you get outside the United States (U.S.). The term “outside the U.S.” means anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. This fact sheet explains some of the exceptions that would allow you to get coverage outside the U.S. under Original Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance). When does Medicare cover health care services in a foreign hospital?

There are three situations when Medicare may pay for certain types of health care services you get in a foreign hospital (a hospital outside the U.S.):

1. You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat your illness or injury.

2. You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury. Medicare determines what qualifies as “without unreasonable delay” on a case-by-case basis.

3. You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it’s an emergency. Remember, in these situations, Medicare will pay only for the Medicare-covered services you get in a foreign hospital.

In my case, I have a medigap policy and understand from that policy that I'm covered for a short period when I leave the US ... after that, they assume a longer period is not a vacation, but a short-term resident. I was told that the 180 days (or whatever it is) used to not be part of the policy. But, because they had too many people out of country for periods too long to make it 'just travel' the limit was imposed.

I have not had to use my medicare .... so it's all theory at this point.

For more information, you can check with http://www.MedigapAdvisors.com/member-benefits.htm

The agent I used was Tom Lockwood.

The medigap policy I purchased works for any State in the US, or outside the country for the limited time period.

Cheers....