TN 18 (04-26)
HI 00620.080 Services Not Provided Within the United States
CFR 424.120 Subpart HSpecial Conditions: Services Furnished in a Foreign
Country
Items and services which are provided outside the United States are not covered except
for certain services provided in Canadian and Mexican hospitals and physician services
and ambulance services furnished in connection with such inpatient care. See references
below for information and instructions concerning the coverage of Canadian and Mexican
services.
The term “United States” means the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the
Virgin Islands, Guam, and American Samoa, and includes the territorial waters adjoining
these entities. Generally speaking, the 3-mile limit off the shores of most of the
United States constitutes American territory. In the case of Texas and Florida, the
limit extends into the Gulf of Mexico within 9 miles (three leagues) off the shores
of these States.
A hospital which is owned or operated by the U.S. Government does not constitute American
territory if it is not located within one of the entities listed above. Similarly,
a ship or aircraft, even of American registry, is not considered to constitute American
territory when it is not within or above the land area or territorial waters of the
United States.
Payment may not be made for any purchased items provided or delivered to the beneficiary
outside the United States, even though the beneficiary may have contracted to purchase
the item while the beneficiary was within the United States or purchased the item
from an American firm. See HI 00610.240 for rules on rental and periodic purchase payments for durable medical equipment
used outside the United States.
TRICARE For Life (TFL)
TFL requires an individual to have Medicare Part A and Medicare Part B (see https://tricare.mil/tfl), and the person is responsible for Part B premiums, usually deducted from their
monthly Social Security benefit. However, Medicare has certain requirements for coverage
and will not cover health services received overseas. TFL becomes the primary payor
in areas where Medicare does provide coverage, unless the person has other health
insurance.
References:
Medicare Coverage Outside the United States Fact Sheet Pub. 11037
Medicare Benefit Policy Manual Chapter 16 General Exclusions from Coverage - Section
60 - Services
Not Provided Within United States