Appeal type: unknown
Decision: unknown

The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 CFR 422.101.

The rules say that items and services furnished outside the United States are excluded from coverage except for the following services, and certain services rendered on board a ship:
-	Emergency inpatient hospital services where the emergency occurred:
o	While the beneficiary was physically present in the United States; or
o	In Canada while the beneficiary was traveling without reasonable delay and by the most direct route between Alaska and another State.
-	Emergency or nonemergency inpatient hospital services furnished by a hospital located outside the United States, if the hospital was closer to, or substantially more accessible from, the beneficiary's United States residence than the nearest participating United States hospital which was adequately equipped to deal with and available to provide treatment of the illness or injury;
-	Physician and ambulance services furnished in connection with a covered foreign hospitalization. Program payment may not be made for any other Part B medical and other health services, including outpatient services furnished outside the United States;
-	Services rendered on board a ship in a United States port, or within 6 hours of when the ship arrived at, or departed from, a United States port, are considered to have been furnished in United States territorial waters. Services not furnished in a United States port, or within 6 hours of when the ship arrived at, or departed from, a United States port, are considered to have been furnished outside United States territorial waters, even if the ship is of United States registry; and

The term "United States" means the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, American Samoa and, for purposes of services rendered on a ship, includes the territorial waters adjoining the land areas of the United States. You can find these rules in Medicare Benefit Policy Manual Chapter 16, Section 60.

The rules say that sales taxes are included in the calculation of the Medicare fee schedule. For this reason, Medicare does not make separate payment for sales tax. You can find this rule in the Medicare Claims Processing Manual, Chapter 23, Section 80.3.1.

The Internal Revenue Service (IRS) defines an excise tax as "taxes paid when purchases are made on a specific good, such as gasoline." The IRS also says that excise taxes are often included in the price of the product. You can find this rule on the IRS website at https://www.irs.gov/businesses/small-businesses-self-employed/excise-tax.

If you want to read these Medicare rules, you can go to this web site www.medicareappeal.com.

The Plan contract says that the Plan covers items and services in accordance with Medicare rules. The Plan contract says that the Plan covers emergency services if you are traveling outside of the United States for less than 6 months. Coverage is limited to $25,000 per year for worldwide emergency services. This is a supplemental benefit that is not covered by the Federal Medicare program. You must pay all costs over $25,000 and all costs to return to the Plan's service area. You can find this information in Chapter 4 on pages 57 to 58 of the Plan's 2019 Evidence of Coverage.