If you’re considering hip, knee, or spine surgery abroad, understanding Medicare coverage is critical. This article explains Medicare’s general rule against overseas coverage, the limited exceptions, how Medicare Advantage and Medigap may differ, and practical planning steps for orthopedic tourists—hospital selection, accreditation, insurance alternatives, and recovery planning to reduce risk.
How Medicare Applies to Care Outside the United States
The standard rule for traditional Medicare is simple. It does not pay for health care services received outside the United States. This applies to both Part A and Part B. If you schedule a hip replacement in Mexico or a knee surgery in Thailand, you should expect to pay the entire bill yourself. This policy remains the firm stance of the Centers for Medicare and Medicaid Services as of December 2025. The geographic boundaries of coverage include the fifty states, the District of Columbia, and U.S. territories. These territories are Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands. Outside these areas, the program effectively stops at the border.
The Limited Statutory Exceptions
There are very few situations where Medicare might pay for care in a foreign hospital. These exceptions are narrow and defined by specific laws. One exception occurs if you are in the United States when an emergency happens, but the nearest hospital capable of treating you is in a foreign country. Another exception applies if you are traveling through Canada on a direct route between Alaska and another state. In that case, Medicare might cover emergency care if the Canadian hospital is the closest option. A third exception exists for people who live in the United States but find that a foreign hospital is closer to their home than any domestic facility. This applies even if there is no emergency. These rules are strict and do not cover elective orthopedic procedures. You can find the full details in the Medicare Coverage Outside the United States publication.
Emergency Coverage and Costs
If you qualify for one of the rare emergency exceptions, Medicare does not pay the full amount. It pays 80 percent of the billed charges for medically necessary care. You must first meet a 250 dollar deductible for the year. This deductible is specific to foreign emergency care. You are responsible for the remaining 20 percent of the costs and any charges that Medicare deems unreasonable. Foreign providers are not required to submit claims to Medicare, so you will likely have to pay the hospital upfront. You must then submit an itemized bill and all medical records to Medicare for reimbursement. This process is slow and requires perfect documentation.
Medicare Advantage Plan Variations
Medicare Advantage plans are private insurance plans that must cover everything Original Medicare covers, often offering extra benefits. Some plans include coverage for emergency care outside the United States, but they rarely cover elective surgeries like a planned spinal fusion abroad. Every plan has its own contract. You must check your Evidence of Coverage document, which lists exactly what is covered and the costs you must pay. Some plans require you to use a specific network of providers or require pre-authorization for any care received outside your home area. Relying on a verbal promise from a representative is not enough because claims for foreign care are often denied. You should call your plan provider before you leave the country and ask for a written statement or formal coverage determination.
Medigap and Foreign Travel Benefits
Medigap policies are supplemental plans that help pay for costs Original Medicare does not cover. Some Medigap plans include a Foreign Travel Emergency benefit, usually found in Plans C, D, F, G, M, and N. This benefit covers 80 percent of the cost for emergency care that begins during the first 60 days of your trip. You must meet a 250 dollar deductible each year, and there is a lifetime limit of 50,000 dollars. It is vital to understand that this benefit is strictly for emergencies. It will not pay for a planned joint replacement. If you have a Medigap policy, check the issue date and specific plan letter. State rules can change how these benefits work, so contact your Medigap issuer to confirm your specific terms.
The 2025 Regulatory Landscape
The 2025 Medicare Physician Fee Schedule introduced important updates for surgical billing. One major change involves the use of modifier 54, which is used when a surgeon performs a procedure but does not provide the follow-up care. This is relevant for patients who have surgery abroad. If you return to the United States for recovery, your domestic doctor will need to use specific codes. The 2025 conversion factor for physician payments is 32.3465 dollars. This affects how much Medicare pays for any covered follow-up visits. You can read more about these changes in the 2025 MPFS impact guide.
Additionally, an OIG report from August 26, 2025, highlighted concerns about postoperative visit data. The government is looking closely at how global surgery packages are billed. Major orthopedic surgeries usually have a 90-day global period. If you experience a medical emergency or a complication like an infection after you return home, Medicare may cover the necessary treatment in a U.S. hospital by treating the complication as a new medical event. However, Medicare will not pay for the original surgery costs or any routine follow-up care that was part of the foreign surgeon’s package. Medicare rules for these periods are detailed in the MLN Global Surgery booklet.
Financial Risks and Practical Warnings
Relying on assumptions about coverage is dangerous. If Medicare denies your claim for foreign surgery, you are responsible for the entire cost. This includes the hospital stay, surgeon fees, and the cost of the implants. These costs can reach tens of thousands of dollars. You also face the risk of currency fluctuations; if the U.S. dollar weakens against the local currency between the time of your quote and the time of payment, your costs will increase. You should always document your communications with insurers. Keep a log of every phone call, including the date and the name of the person you spoke with. Save every email. If you need help understanding your options, contact the State Health Insurance Assistance Program (SHIP). They provide free counseling and can help you navigate the complex rules of Medicare Advantage and Medigap plans. You can also call 1-800-MEDICARE for official answers. Always get your coverage decisions in writing before you commit to a procedure overseas.
Documenting Your Care
If you decide to proceed with surgery abroad, you must keep excellent records. Medicare will require itemized statements if you try to file a claim for an emergency. These statements must be in English and show the date of service, specific procedure codes, and the cost of each item. You should also keep copies of your medical records, including operative reports, discharge summaries, and imaging like X-rays or CT scans. Having these documents is vital for your health and any future insurance claims. If a complication happens after you return home, your U.S. doctors will need this information. Medicare might cover the treatment of a complication in the U.S. even if they did not cover the original surgery, depending on the medical necessity of the new treatment and standard Medicare rules.
Planning Orthopedic Surgery Abroad Safely and Cost Effectively
Planning a major orthopedic surgery like a hip replacement or spinal fusion is a massive undertaking when it happens in your home city. Moving that entire process to a foreign country adds layers of complexity that require a meticulous, step-by-step strategy. You are essentially acting as your own medical case manager. This means you must verify every detail from the hospital accreditation to the specific lot numbers of the implants being used.
Selecting a Safe Destination
Hospital Accreditation Standards
The gold standard for international care is accreditation by Joint Commission International (JCI). You can verify a hospital’s status and their last survey date directly on the JCI website. These surveys happen every three years. If a hospital has let its accreditation lapse, that is a major red flag. You should also look for national certifications like NABH in India or ACHS in Australia. These organizations ensure the facility meets strict safety and quality benchmarks.
Surgeon Credentials and Volume
Credentials matter, but case volume is often a better predictor of success. Ask the surgeon how many primary total hip arthroplasties or lumbar fusions they performed in the last twelve months. High volume surgeons generally have lower complication rates. You want a doctor who is board certified in their country and has completed fellowships in their specific subspecialty. Do not be afraid to ask for their personal infection and revision rates for the past three years.
Legal and Language Barriers
Language is a safety issue. Confirm that the clinical staff speaks fluent English or that the hospital provides certified medical interpreters. Legal liability is another hard truth. Malpractice laws in Mexico, Thailand, or India are not the same as in the U.S. Caps on damages are often much lower and the process for filing a claim can be nearly impossible for a foreigner. You must read the treatment agreement carefully to see where disputes are settled.
The Presurgery Clinical Checklist
Medical Records and Second Opinions
Before you book a flight, get a formal second opinion from a U.S. orthopedic surgeon. This provides a baseline for what kind of implant and approach you need. Collect all your imaging in DICOM format on a CD or secure cloud drive. A U.S. radiologist should review these before you leave. You also need medical clearance from your primary care doctor and any specialists, such as a cardiologist if you have heart issues.
Perioperative Safety Protocols
Verify the hospital’s protocols for preventing blood clots and infections. They should use standard venous thromboembolism (VTE) prophylaxis like blood thinners or mechanical compression sleeves. Ask about their surgical site infection (SSI) rates. They should follow international standards for antibiotic timing, usually giving the first dose within sixty minutes of the first incision. Confirm they have a 24/7 Intensive Care Unit (ICU) and an on site blood bank in case of emergencies.
Device Compatibility and Implant Warranties
Many international hospitals use implants from major companies like Zimmer Biomet or Stryker. You must verify that the specific model is approved for use in the United States. If the implant is not FDA approved, a U.S. surgeon might have trouble finding the right tools to repair or revise it later. Manufacturer warranties usually only cover the cost of the part if it fails due to a defect. They do not cover the cost of the hospital stay or the surgeon’s time for a revision surgery. If you have a problem, the warranty might only be valid if the original surgeon performs the repair. Obtain the written warranty from the implant manufacturer and record the specific batch numbers for every component used in your surgery.
Logistics and Convalescence
Travel Timing and Companions
Air travel soon after joint surgery carries a high risk of deep vein thrombosis (DVT). Most surgeons recommend waiting at least two to six weeks before flying home. You should bring a companion to help with mobility and to act as an advocate if you are incapacitated. Check the visa requirements for medical travel in your destination country. Some countries offer specific medical visas that allow for longer stays during recovery.
Medications and Vaccinations
Check the CDC travel notices for your destination. Ensure your routine vaccines and tetanus shots are up to date. Importing medications can be tricky. Some countries have strict rules against bringing in opioid pain medications. You will need a formal letter from your doctor and copies of your prescriptions to clear customs. Always keep your medications in their original bottles in your carry on bag.
Financial Planning and Insurance Gaps
Realistic Cost Comparisons
While a hip replacement in the U.S. might be billed at $50,000, a package abroad might be $15,000. However, these packages often exclude the ICU, extra imaging, or treatment for complications. You need an itemized estimate that includes surgeon fees, anesthesia, the facility fee, and the cost of the implant itself. Ask if the quote is in U.S. dollars or local currency as exchange rates fluctuate.
| Cost Component | Typical U.S. Range (Uninsured) | Typical Foreign Package Range |
|---|---|---|
| Primary Hip/Knee Surgery | $30,000 to $60,000 | $8,000 to $20,000 |
| Implant Only | $3,000 to $6,000 | Included in package |
| ICU Stay (Per Day) | $5,000 to $10,000 | $500 to $1,500 |
| Physical Therapy (Per Session) | $150 to $300 | $30 to $70 |
Medicare and Supplemental Limits
Medicare generally does not pay for elective surgery outside the U.S. as noted in the Medicare Coverage Outside the United States guide. If you have a Medigap plan with foreign travel emergency benefits, it usually has a $50,000 lifetime cap and only covers emergencies. It will not pay for your planned hip replacement. You will likely be responsible for 100% of the costs out of pocket. The table below summarizes where coverage typically stops.
| Coverage Type | Elective Surgery Abroad | Emergency Care Abroad | Key Limitation |
|---|---|---|---|
| Original Medicare | No Coverage | Very Limited | Only in Canada/Mexico border cases |
| Medigap (G, N) | No Coverage | 80% Covered | $50,000 lifetime maximum |
| Medicare Advantage | Rarely Covered | Varies by Plan | Check Evidence of Coverage |
| Travel Medical | Requires Rider | Usually Covered | Excludes elective surgery by default |
Risk Mitigation and Evacuation
Standard travel insurance often excludes complications from elective surgery. You need specialized medical tourism insurance. Most importantly, you must have medical evacuation coverage. An air ambulance back to the U.S. can cost between $15,000 and $100,000. Ensure your policy covers repatriation and that the insurer has a 24/7 assistance line. Keep a contingency fund of at least 25% to 50% of your total budget for unexpected hospital days.
Hospital Checklist for Orthopedic Tourists
- Current JCI accreditation certificate and survey date.
- On site ICU with 24/7 intensivist coverage.
- Surgical site infection rates for the last 12 months.
- Availability of intraoperative neuromonitoring for spine cases.
- Standardized WHO Surgical Safety Checklist usage.
- English speaking international patient coordinator.
- Clear written policy on refunds and cancellations.
Continuity of Care
Before you leave, secure a U.S. doctor who agrees to see you for follow up care. Medicare rules for the 90 day global surgery period are strict. According to the CMS Global Surgery Booklet, postoperative visits are usually bundled into the payment. Since Medicare did not pay for the foreign surgery, your U.S. doctor will need to bill for follow up visits separately. Ensure you bring home a full discharge summary, operative reports, and immediate postoperative X-rays in DICOM format. This allows your U.S. provider to monitor the implant and wound healing effectively. For the latest on how these visits are coded, you can check the Medicare Global Surgery Updates 2025.
Final Conclusions and Practical Next Steps
The reality of seeking orthopedic surgery outside the United States is often a cold shower for those relying on federal insurance. Original Medicare, which includes Part A and Part B, does not pay for elective procedures performed in foreign countries. This is a statutory limitation that leaves very little room for interpretation. If you schedule a hip replacement in Mexico or a spinal fusion in Germany, you should expect to pay the entire bill yourself. Medicare only steps in for very narrow emergency situations. These exceptions usually involve being in a location where a foreign hospital is significantly closer than a U.S. facility during a life-threatening crisis. Even in those rare cases, Medicare only pays 80 percent of the billed charges after you meet a 250 dollar deductible for the year. This is a fixed rule for 2025 and applies only to medically necessary emergency care.
Private alternatives like Medicare Advantage and Medigap offer a bit more complexity. Medicare Advantage plans are managed by private insurers and they set their own rules for international care. Some plans might offer supplemental benefits for travel, but these are rarely designed to cover a planned elective surgery. You must check your specific Evidence of Coverage document. Medigap plans, specifically Plans C, D, F, G, M, and N, often include a Foreign Travel Emergency benefit. This benefit typically covers 80 percent of the cost for emergency care that begins during the first 60 days of a trip. However, these plans usually have a lifetime limit of 50,000 dollars. This amount might sound substantial, but it can be exhausted quickly if a major surgical complication requires an extended stay in an intensive care unit.
The financial landscape for 2025 is also shaped by how Medicare handles follow-up care once you return home. Major orthopedic surgeries carry a 90 day global surgical period. Under the Medicare Global Surgery Updates 2025, the billing for postoperative visits is strictly regulated. If you receive surgery abroad, the foreign surgeon is not part of the Medicare system. When you return to the U.S. and see a local doctor for routine follow-up, Medicare might not cover those visits if they are considered part of the global package for a non-covered surgery. This creates a gap where you might be responsible for the costs of physical therapy and wound checks that would normally be bundled into a domestic surgical payment.
To navigate these risks, you need a structured plan. Following a prioritized checklist can prevent a medical journey from becoming a financial disaster.
Step 1. Verify Coverage Directly
Do not take the word of a medical tourism coordinator or a foreign hospital representative. Call 1-800-MEDICARE to confirm the current status of your benefits. If you have a Medicare Advantage plan, contact your insurer and ask for a written determination regarding elective surgery abroad. Ask specifically if they will cover complications that arise after you return to the United States. Having these answers in writing is the only way to protect your savings.
Step 2. Validate Hospital and Surgeon Quality
Look for hospitals accredited by Joint Commission International. Use the JCI online database to check the current accreditation status and the date of the last survey for any hospital you are considering. You should also verify the surgeon’s credentials through their national medical council. Ask for their specific case volume for the last 12 months. A surgeon who performs hundreds of joint replacements annually is generally a safer choice than one who only does a few dozen. Request their surgical site infection rates and compare them to U.S. benchmarks.
Step 3. Secure Specialized Insurance
Standard travel insurance is not enough for a surgical patient. You need a policy that specifically covers medical complications resulting from elective procedures. Additionally, you must arrange for medical evacuation coverage. An air ambulance back to the U.S. can cost upwards of 100,000 dollars depending on the distance and the level of care required. Confirm that the policy includes repatriation of remains and hospital-to-hospital transfer services. Ensure the policy does not have a pre-existing condition exclusion that would apply to your surgery.
Step 4. Formalize Financial Agreements
Request an itemized estimate that includes the surgeon fee, anesthesia, the cost of the implant, and the daily rate for the hospital room. Ensure the agreement specifies what happens if you need to stay in the Intensive Care Unit. You should also get a clear policy on refunds and cancellations in writing. Use the 2025 Medicare Physician Fee Schedule conversion factor of 32.3465 dollars as a mental baseline to understand how U.S. doctors are valued compared to the quotes you receive abroad.
Step 5. Prepare Medical Documentation
Gather all your U.S. medical records, including imaging files in DICOM format. You will need these for the foreign surgeon and for your follow-up care back home. Ensure that all consent forms and discharge summaries are provided in English. Ask the foreign hospital for a sample of their discharge paperwork to ensure it includes the level of detail your U.S. doctor will require. If the local language is different, hire a certified translator to review the documents before you sign them. This ensures you actually understand the risks and the surgical plan.
Step 6. Plan for Complications
Identify a U.S. orthopedic surgeon who is willing to provide follow-up care before you leave the country. Schedule a consultation with them to ensure they are willing to treat potential complications. Many domestic doctors are hesitant to take on patients who had surgery elsewhere due to liability concerns. You must also have a contingency fund. This fund should cover at least 50 percent of the total surgical cost to handle unexpected medication needs or extended hotel stays during recovery. If an implant fails or an infection occurs, the costs of revision surgery can be double the price of the initial procedure.
Before committing to any overseas plan, you must discuss it with your primary care provider and your current U.S. orthopedic surgeon. They understand your comorbidities and can provide a realistic assessment of your surgical risk. They can also help you optimize your health, such as managing blood sugar or blood pressure, to reduce the chance of a prosthetic joint infection.
For official guidance, rely on trustworthy resources. Medicare.gov and the State Health Insurance Assistance Programs (SHIP) provide free counseling on plan details. The U.S. Embassy health desks in your destination country can provide lists of local providers and emergency contacts. Using these official channels is the best way to ensure your information is current as of December 2025. Surgery abroad can offer significant savings, but only if you account for the hard truth that Medicare will not be there to catch you if the financial or medical plan fails.
References
- Medicare Global Surgery Updates 2025: Coding & Billing Guide — 10 days of international coverage- Minor surgery and less than post-operative care under the global surgery payment guidelines. 90-day …
- Medicare Global Surgery Coding and Billing Changes in 2025 — This guide will help you walk through the new coding requirements, postoperative services, and how to comply with Medicare regulations.
- CMS updates global surgery billing guidance | NAHRI — CMS updated its global surgery coding and billing guidelines to reflect changes in the 2025 Medicare Physician Fee Schedule (MPFS) final rule.
- [PDF] MLN907166 – Global Surgery – CMS — It covers surgery, endoscopy, and split global surgical packages' billing and payment rules between 2 or more providers. Global Surgical Package Definition. We …
- CMS Should Confirm It Is Receiving Medicare Postoperative Visit … — CMS Should Confirm It Is Receiving Medicare Postoperative Visit Data on Global Surgeries When Reporting Is Required. Issued on 08/26/2025 …
- [PDF] MedPAC Consideration of Global Surgical Payments in the … — The ACS shares MedPAC's goal of ensuring accurate Medicare payments to physicians through the Resource Based Relative Value System (RBRVS). This.
- What Surgeons Need to Know About 90-Day Surgical Globals and … — A 90-day surgical global period refers to the bundled payment system used by Medicare and other insurers for certain surgical procedures.
- How Will the 2025 MPFS Impact Your Practice? | ACS — Absent Congressional intervention, the 2025 MPFS conversion factor (CF)—which is the amount Medicare pays per relative value unit—is $32.3465, …
- Global Surgery Coding in 2025 – AAPC Knowledge Center — Medicare does not start a new global period with use of modifier 78. Example: During the global period of a surgery, the patient develops …
- [PDF] Medicare Coverage Outside the United States — Pay 80% of the billed charges for certain medically-necessary emergency care outside the U.S. after you meet a $250 deductible for the year. Cover foreign …
Legal Disclaimers & Brand Notices
The content provided in this article is for informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition, surgical risks, or recovery planning. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
All product names, logos, and brands mentioned—including but not limited to Zimmer Biomet and Stryker—are the property of their respective owners. All company, product, and service names used in this article are for identification purposes only. Use of these names, logos, and brands does not imply endorsement or affiliation.
