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Extending Medicare to Eligible Beneficiaries in Mexico

 

 

About Medicare

Established during the Lyndon B. Johnson Administration, Medicare is a federal program that provides funds for older Americans to receive high quality health care.  Currently, only the following people are eligible to receive Medicare: 

  • persons 65 years or older
  • persons under 65 years who have end-stage renal disease
  • disabled persons entitled to cash benefits under the Social Security or Railroad Retirement Program.

How it Works

Medicare is divided into two forms of benefits:  Part A and Part B.

Medicare Part A:  Part A is also known as hospital insurance (HI), and it covers hospital services, inpatient skilled nursing facilities, and home health care.  It is financed primarily by payroll taxes through the hospital insurance portion of the Social Security Trust Fund.

Medicare Part B:  Part B is also known as supplementary medical insurance (SMI), and it covers most of the needs not covered for in Part A.  These include doctor visits, outpatient hospital care, durable medical equipment, ambulance services, and diagnostic tests.  Part B is financed by a monthly premium rate.  The amount of premium is generally tied to total projected costs for the next year.  This form of coverage is optional and and eligible to those covered under Part A. 

Medicare in Mexico:  Current Situation

As it stands today, Medicare does not cover health care for Americans outside the United States, except under two conditions:

1. The beneficiary is a border resident who requires hospitalization and the Canadian or Mexican hospital is either closer to the beneficiary's home than the participating U.S. hospital or when the Mexican or Canadian hospital offers covered services which the U.S. hospital does not or

2.  The beneficiary is not a border resident, but the emergency occurred in the United States and a Mexican or a Canadian hospital is in closer proximity.  Coverage is also provided if the beneficiary was on a direct route through Canada from Alaska to another state without reasonable delay in Canada.  In both instances, Medicare pays for physician and ambulance services furnished in Canada or Mexico in conjunction with a covered inpatient stay.  In no case does Medicare pay for such services outside the specific incident of care which inpatient hospital services were furnished."

This lack of coverage not only affects residents of Mexico, but tourists, short-term visitors, and people who choose to live in Mexico.

For a more detailed review on Medicare, consult the CMS site on Medicare.