Medicare in DR

It was mentioned in another thread that Medicare covers healthcare in the DR. US Embassy in DR states that "Medicare and Medicaid programs do not provide payment for medical services outside the United States." What are your experiences regarding Medicare in DR?

Medicare only covers out of USA emergency care. You would have to pay it here and claim it in the US. This is on a Medicare Advantage Plan, I assume regular Medicare may pay 80%.

But I would not bank on this for sure. What is an emergency or not an emergency?

SKY said:

Medicare only covers out of USA emergency care. You would have to pay it here and claim it in the US. This is on a Medicare Advantage Plan, I assume regular Medicare may pay 80%.

But I would not bank on this for sure. What is an emergency or not an emergency?

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Medicare Advantage Plan falls under Medigap, not Medicare. Medigap (a supplement to Medicare) may cover healthcare in DR.

According to medicare.gov,

"Medicare may pay for inpatient hospital, doctor, ambulance services, or dialysis you get in a foreign country in these rare cases:

You're in the U.S. when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
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 the emergency.
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 an emergency exists.
In some cases, Medicare may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won't pay for health care services you get when a ship is more than 6 hours away from a U.S. port.

Medicare drug plans don't cover prescription drugs you buy outside the U.S."

oops deleted due to post above

kcdmps said:

Medicare Advantage Plan falls under Medigap, not Medicare. Medigap (a supplement to Medicare) may cover healthcare in DR.

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Supplemental Medicare plans like Blue Cross Blue Shield may have a rider that covers "emergency" medical care (ER visits) outside of the US. But they will not cover outpatient visits or prescriptions. I would suggest to confirm with the Medigap provider.

Forget Medicare in the DR. If you live in the DR get DR insurance. You can still use Medicare with a short plane ride.

SKY said:

Forget Medicare in the DR. If you live in the DR get DR insurance. You can still use Medicare with a short plane ride.

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Exactly. Whoever mentioned this " It was mentioned in another thread that Medicare covers healthcare in the DR" is completely incorrect. The US Embassy site is correct. You are not covered by Medicare in the DR.

windeguy said:

Exactly. Whoever mentioned this " It was mentioned in another thread that Medicare covers healthcare in the DR" is completely incorrect. The US Embassy site is correct. You are not covered by Medicare in the DR.

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I thought Sky mentioned this but it may have been misinterpreted on my part. But if you read the first part of this thread, Sky seems to be saying Medicare covers care in DR. I was interested in getting inputs with regard to Medicare related claims from expats living in the DR.

Ricardo900 said:

Supplemental Medicare plans like Blue Cross Blue Shield may have a rider that covers "emergency" medical care (ER visits) outside of the US. But they will not cover outpatient visits or prescriptions. I would suggest to confirm with the Medigap provider.

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Exactly this. We have United Healthcare Insurance plan F through AARP as a supplement. They cover emergency health care anywhere in the world, with a $250 deductible, but only for the first 90 days you’re out of the USA. The year Mr AE had dengue, we went way over the $250, but never bothered to file, so I can’t say how difficult or easy it is.

kcdmps said:

I thought Sky mentioned this but it may have been misinterpreted on my part. But if you read the first part of this thread, Sky seems to be saying Medicare covers care in DR. I was interested in getting inputs with regard to Medicare related claims from expats living in the DR.

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Why don't you read what Sky said. In an emergency my Medicare Advantage plan might cover it. I also said what is an emergency or not an emergency. And that is with MY plan, not all or straight Medicare.

If you think you will be covered by Medicare in the DR you are WRONG............Get local insurance and fly back to the US for serious matters where you CAN use Medicare.......................

AlterEgo said:

Exactly this. We have United Healthcare Insurance plan F through AARP as a supplement. They cover emergency health care anywhere in the world, with a $250 deductible, but only for the first 90 days you’re out of the USA. The year Mr AE had dengue, we went way over the $250, but never bothered to file, so I can’t say how difficult or easy it is.

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This is the same company that I have, but with a Medicare Advantage plan. And exactly what you stated is in my policy. But I like you, have never used it.

SKY said:

This is the same company that I have, but with a Medicare Advantage plan. And exactly what you stated is in my policy. But I like you, have never used it.

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Medicare and the U.S. EMBASSY !
If you have a problem with your Medicare as i have you will get no absoulty no Embassy assistance.
I asked the Embassy for assistance with an error on my Medicare. The only way to ask for assistance from the Embassy is their internet request service. You get a automatic reply telling you they will reply within 15 days [In an emergency in 15 days you can be DEAD!] In my case after more than 15 day's a very nice lady [no name] called my home and said she is going to resolve my problem. She said check your email for the answer to your problem. On my email their was 1-800 medicare. That resolved the embassy's problem but not mine. The 800 number is long distance. I called and was on hole for someone for about 2 hours listening to their music and getting the message all operators are busy please stand by. When a medicare [I assumed] assistant came on i told him the problem. he verified that i had a problem with my application information. He said to correct this call your embassy. So resent request to Embassy they said again call 1-800 medicare to resolve the problem. At this point i decided to send medicare a snail mail request for assistance with the problem this was on 18 june 2019. At this time i have rec. no reply so sent request to embassy to please ask medicare if the are aware of my request by mail [real mail] the automatic reply was you will receive an answer within 15 days this was over a week ago. As you can not go to the Embassy without appointment you can not get in. [i asked for appointment never got yes or no just ignored that i asked for appointment [i assumed as they never sent appointment]. I'm still waiting for some sort of information that will get my problem solved before i am laid to rest in the event i am dead the Embassy is off the hook and all is well with our new Ambassador .
Any one else had good results with getting help from our U.S. Embassy? NOTE they never keep internet correspondence so each request must be repeated over over over again !

Let me clue you in on something. You will get NO HELP regarding anything from the US Embassy......................

The only thing given out there is AGGRAVATION..............

A good place to start when looking for help.


https://www.medicare.gov/what-medicare-covers