What exactly are the three CMS‑listed scenarios in which Original Medicare covers foreign hospital care, and where are they described?

1. The “closer to home” rule — when a foreign hospital nearer than any U.S. option is covered

CMS explicitly states that if a beneficiary lives in the United States and a foreign hospital is closer to their home than the nearest U.S. hospital that can treat the medical condition, Medicare may pay for inpatient hospital care and related doctor and ambulance services covered under Original Medicare; this applies “regardless of whether an emergency exists,” and is described in the Medicare fact sheet and the CMS CMS‑1490S foreign travel instructions ^{[1] [3] [2]}.

2. Emergencies in the U.S. when the nearest qualified hospital is abroad

Original Medicare will also cover services if a beneficiary experiences a medical emergency while physically in the United States and the nearest hospital qualified to treat the condition is in a foreign country — CMS guidance and multiple Medicare consumer pages list this as a permitted exception and note that covered services are limited to those normally paid under Part A and Part B ^{[2] [1] [4]}.

3. The Alaska‑Canada transit exception for emergencies

A separate, narrowly drawn exception covers emergency care in Canada when a beneficiary is traveling a direct route between Alaska and another U.S. state “without unreasonable delay” and a Canadian hospital is the closest capable facility; this Alaska‑Canada route exception is spelled out in Medicare guidance and reiterated by nonprofit Medicare information sites and insurers that summarize CMS policy ^{[4] [5] [6]}.

Where these scenarios are described and what that means in practice

CMS’s formal explanations appear across its consumer fact sheet “Medicare Coverage Outside the United States” and the Travel Outside the U.S. web page, and practical claim instructions are in the Patient’s Request for Medical Payment (CMS‑1490S) foreign travel form and guidance — those documents together identify the three exceptions, explain that beneficiaries must file their own itemized bills when foreign providers won’t submit claims, and clarify that only services normally covered by Part A and Part B are payable ^{[1] [2] [3] [7]}.

Limitations, administrative hurdles, and alternate routes

CMS and secondary sources repeatedly warn that these allowances are rare, that foreign hospitals are not required to file Medicare claims so beneficiaries often must pay up front and submit CMS‑1490S and itemized bills within a year, and that deductibles, coinsurance and other limits still apply — plus Medicare Advantage and Medigap plans may offer different or additional foreign travel benefits, so beneficiaries must check plan documents ^{[3] [7] [8] [9]}.

Hidden agendas and common misreads to watch for

Consumer and industry summaries sometimes conflate three exceptions with broader “Medicare covers abroad” claims; organizations summarizing CMS rules may emphasize travel‑insurance or Medigap benefits to sell products, while journalistic pieces can overstate portability — the original CMS materials (fact sheet, web pages, and CMS‑1490S form) remain the authoritative sources for the precise three scenarios and the procedural details required to seek reimbursement ^{[1] [3] [2]}.