New Medicare Direct Billing Eases Costs for Expats in Mexico and Central America

New Medicare Direct Billing Eases Costs for Expats in Mexico and Central America
New direct billing options help expats avoid big upfront medical costs abroad.|©iStock/AleksandarNakic

If you’ve ever worried that a major medical bill could derail your dream of living in Mexico or Central America, there’s finally good news.

A growing number of hospitals and clinics across the region now work directly with certain Medicare Advantage plans, meaning you may no longer need to pay large sums upfront and wait months for reimbursement.

Here’s what’s changing, and why it’s making life abroad much simpler for Medicare-eligible expats.

For years, Mexico and Central America have attracted expats and travelers alike. One of the biggest headaches has always been the complicated process for paying Medicare-covered expenses overseas.

Medical costs in this region can easily run to $50,000, $100,000, or more. Paying that up front and waiting for reimbursement was a deal breaker for all but the wealthiest expats.

Mexico led the way several years ago when an innovative medical group began partnering with Medicare carriers in the U.S. and local healthcare providers. What began in one city now extends to doctors and hospitals in over a dozen destinations, from Mérida to Puerto Vallarta, Mazatlán to San Carlos-Guaymas, Ajijic, Cabo San Lucas, Todos Santos, and more.

Panama is joining in, too. The Johns Hopkins International-affiliated Pacífica Salud Hospital Group and other facilities in expat-friendly areas are beginning to bill Medicare Advantage carriers directly, sparing you from having to pay upfront and wait for a refund. Costa Rica is following suit. Hospitals like CIMA in San José are exploring similar billing arrangements.

One thing to know: all these programs require pre-registration and, in some cases, enrollment in a no-cost membership.

This isn’t likely to be a passing trend. Tighter U.S. border controls and stronger efforts to reduce fraud and waste mean direct billing could keep expanding, helping expats save money and avoid stress.

How Does Worldwide Travel Coverage Work in Mexico, Central America, and Beyond

Worldwide travel coverage typically includes emergency services, urgent care services, and emergency ground transportation. Here’s how each is defined:

Medical Emergency:

A medical emergency is when you, or any prudent layperson with an average knowledge of health and medicine, believes that your symptoms require immediate medical attention to prevent loss of life (or, in the case of a pregnant woman, loss of an unborn child), loss of a limb or its function, or serious impairment to a bodily function. These symptoms may be due to an illness, injury, severe pain, or a medical condition that is rapidly worsening.

Urgent Care Services:

An urgently needed service is a non-emergency situation that still requires immediate medical care but, given your circumstances, it is not possible or reasonable to get these services from a network provider.

Examples of urgently needed services could include a severe sore throat that occurs over a weekend or outside your service area, or an unexpected flare-up of a known condition when you cannot reach your network provider or are temporarily outside the service area.

Does Medicare Cover Worldwide Travel?

This is a common question, and the answer is both yes and no; it depends on which parts of Medicare you have.

Original Medicare (Parts A and B) generally does not cover you outside the U.S. or its territories, with a few narrow exceptions:

  • You are in the U.S. and have a medical emergency, and the nearest hospital that can treat you is across the border.

  • You are traveling through Canada, without unreasonable delay, on 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 you. Medicare determines on a case-by-case basis what qualifies as “without unreasonable delay.”

  • You live in the U.S., and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat you, even if it’s not an emergency.

Medicare Supplement (Medigap) plans offer foreign travel coverage for emergency and urgent care through six of the ten plans available today. Standard coverage includes:

  • You pay a $250 yearly deductible.

  • You are responsible for 20% coinsurance; you pay 20% of all Medicare-covered charges for each event.

  • Coverage has a $50,000 lifetime cap.

  • Coverage is good for the first 60 days of each trip outside the U.S.

Medicare Advantage Plans typically offer the following foreign travel emergency and urgent care coverage:

  • You pay a copayment for each event; standard copays range from $0 to $145.

  • Advantage Plans rarely include coinsurance; your copay usually covers your share of Parts A and B services.

  • There is usually no annual limit to coverage. However, be aware that a few plans cap coverage at $25,000, $50,000, or $100,000 per year. I generally recommend my clients avoid these plans.

  • Coverage is good for the first 180 days (six months) of each trip while traveling outside the U.S.

Some Advantage Plans vary in their level of worldwide emergency coverage, and some offer none at all. Although Advantage Plans often provide broader worldwide coverage than Supplement Plans, they require more careful research to make sure you get the protection you need.

Both Supplement and Advantage Plans generally require you to pay upfront and submit paid receipts for covered services to get reimbursed. However, the majority of direct-billing arrangements abroad work only with Medicare Advantage Plans.

Ready to Learn More?

If you’d like to explore how this affects you, I’m here to help.

For comprehensive guidance, check out my book Medicare Made Easy: What Expats, Frequent Travelers, and You Need to Know, available through the International Living Bookstore.

For free, no-obligation Medicare coaching, email me at ron@ronelledge.com or schedule a call: https://calendly.com/ron-elledge/medicare-review. I’m licensed throughout the U.S., and there’s never a fee for my help.

Share