What Original Medicare Covers in Israel: Almost Nothing
Original Medicare does not cover medical care in Israel except in rare situations that have nothing to do with an ordinary trip. Medicare.gov defines the US, for coverage purposes, as the 50 states, the District of Columbia, Puerto Rico, the US Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Everywhere else, including Israel, is outside the US. The three official exceptions are: a medical emergency that happens while you are inside the US when a foreign hospital is closer, an emergency while traveling through Canada on the most direct route between Alaska and another state, and living in the US when a foreign hospital is closer to your home than any US hospital that can treat you. None of those describes a vacation or a family visit in Israel. Also worth knowing: foreign hospitals are not required to file Medicare claims, Medicare does not cover dialysis abroad outside those exceptions, and Medicare plans cannot cover drugs bought outside the US. With Original Medicare alone, care in Israel comes out of your own pocket.
Medigap Foreign Travel Emergency: The Actual Numbers
Here is the good news for Israel travelers. According to Medicare's official fact sheet, the Medigap plans sold today that include foreign travel emergency coverage are C, D, F, G, M, and N. The rules confirmed on Medicare.gov: after you meet a 250 dollar deductible for the year, the plan pays 80 percent of the billed charges for medically necessary emergency care outside the US, as long as the care begins during the first 60 days of your trip. The lifetime maximum is 50,000 dollars, and it is a lifetime cap, not a per trip cap. If you bought one of the discontinued plans E, H, I, or J before June 1, 2010, it also still covers foreign travel emergencies. Two practical points: the 60 day rule matters a great deal for long stays in Israel, and you will typically pay the Israeli hospital yourself and then file for reimbursement, so keep every receipt and every medical record from the visit.
Medicare Advantage: It Depends Entirely on Your Plan
Some Medicare Advantage plans include a worldwide emergency benefit, but unlike Medigap there is no standard version. Medicare.gov says Advantage plans must follow Medicare's rules, including for coverage outside the US, that they may add coverage for additional services abroad, and that you should check with your plan before traveling to confirm what is covered. In practice, when the benefit exists it is usually limited to emergencies, with cost sharing and caps that each plan sets on its own. Remember that an Advantage plan's provider network is in the United States, so routine care, follow up visits, and prescriptions in Israel will not be part of the coverage. For someone who flies to Israel several times a year or is considering an extended stay, the differences between plans can be significant, and it is worth asking about the plan's rules for long absences from its service area. One phone call before the flight can prevent an expensive surprise in an emergency room.
Before a Flight or a Long Stay in Israel: Your Checklist
First, know what you hold. If you have Medigap, confirm that your plan includes the foreign travel emergency benefit and how much of the 50,000 dollar lifetime maximum you have left. Second, plan around the 60 day rule: the benefit applies to emergencies that begin in the first 60 days of a trip, so for a six month stay consider supplemental travel medical insurance. Medicare.gov itself notes that travel insurance is an option and warns that not every travel policy includes health coverage, so read the terms. Third, Advantage members should call their plan and ask about worldwide emergency benefits and service area rules. Fourth, arrange medications in advance, because Medicare cannot cover drugs bought in Israel, and save receipts and records for any reimbursement claim. Finally, talk it through in Hebrew or English with us: Lara Goulson in Century City, (818) 472-5484, will review your coverage before you fly, at no cost.
Plan the coverage around the travel
If Israel is part of your year, the plan you choose in the fall decides what happens if something goes wrong there. That is a solvable problem, but only before you enroll.
Splitting time with Israel? Call (818) 472-5484 and we will build coverage around it.
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