TN 18 (09-25)

HI 00630.001 Medicare Program Outside the United States - General

Medicare health insurance programs under social security help pay hospital and medical expenses for most persons 65 and over; for individuals, regardless of age, if entitled to social security disability benefits for more than 2 years; and for insured persons, their dependents and survivors who suffer severe kidney disease requiring dialysis or kidney transplant, see HI 00801.196.

Benefits are generally available only for medical services provided in the United States. The only exceptions are medical services provided in Canada or Mexico to United States residents who either cross the border for facilities closer than those available in the United States, or who suffer a medical emergency in the United States or while traveling in Canada between Alaska and another State and are taken to the closest hospital.

Since enrollment in the SMI program will cost the beneficiary a monthly premium, a special effort is made to ensure that a beneficiary outside the United States does not mistakenly enroll. They should be furnished information about the limitations of the program outside the United States.

Individuals attaining age 65 and disability beneficiaries are automatically enrolled under Part B as they become eligible for Part A hospital insurance coverage. However, this automatic enrollment does not apply to people living in Puerto Rico or foreign countries.

Beneficiaries outside the United States are initially notified of their eligibility for SMI 3 months before the month of their 65th birthday or 3 months before their 24th month of entitlement to a disability benefit. Claimants outside the United States filing for monthly benefits who are within 3 months of age 65 or older may enroll for SMI during a designated enrollment period by checking the appropriate block on their applications, see HI 00805.010).

For eligibility and enrollment procedures for foreign residents, see HI 00805.007 and HI 00805.120; for termination and withdrawal procedures, see HI 00820.000; and for premium collection, see HI 01001.020.

The instructions in the following sections are specific for the aspects of the health insurance program for beneficiaries residing outside the United States.