Services Not Provided Within United States

Although the typical exceptions to Medicare's “foreign exclusion” involve services that are furnished in Canada and Mexico, it is possible for Medicare to make payment to foreign hospitals besides those located in Canada and Mexico. For example, if an emergency necessitated that inpatient hospital services be furnished to a Medicare beneficiary who is living in Guam and the nearest adequately equipped hospital to treat that beneficiary was located in the Philippines, Medicare payment would not be prohibited under Medicare's “foreign exclusion” because Medicare payment may be permitted for the services under section 1814(f) of the Social Security Act (the Act) (42 U.S.C. 1395f(f)). Section 1814(f)(2) of the Act permits payment to be made to a foreign hospital for emergency inpatient services provided to a beneficiary where the beneficiary was present in the United States at the time the emergency that necessitated the inpatient hospital services occurred and the hospital outside the U.S. was closer to, or substantially more accessible from, the place where the emergency arose than the nearest adequately equipped hospital within the U.S. For purposes of section 1814(f) of the Act, the United States includes the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, The Northern Mariana Islands, and for purposes of services rendered on board ship, the territorial waters adjoining the land areas of the U.S.

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