What Medicare covers outside the United States
Almost nothing. Original Medicare (Parts A and B) pays for care only in the 50 states, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. The three exceptions are narrow:
- a medical emergency in the U.S. where the nearest hospital is in Canada or Mexico;
- an emergency while travelling directly between Alaska and another state through Canada, if a Canadian hospital is closer;
- care on a ship within six hours of a U.S. port.
A retiree in Cebu, Lisbon, or Chiang Mai has no Medicare coverage for anything that happens locally, full stop. Some Medicare Advantage plans and most Medigap plans C, D, F, G, M and N include a foreign travel emergency benefit — 80% of emergency care in the first 60 days of a trip, after a $250 deductible, with a $50,000 lifetime cap — but that is for travel, not residence, and you cannot keep a Medigap or Advantage plan without a U.S. address inside the plan’s service area.
The four parts, and what to do with each when you move
| Part | What it is | 2026 cost | Expat decision |
|---|---|---|---|
| Part A | Hospital insurance | $0 premium if you or a spouse paid Medicare tax for 40 quarters (10 years) | Keep it. It costs nothing, there is no penalty, and it is there if you ever return. |
| Part B | Doctors, outpatient, equipment | $202.90/month standard premium in 2026; higher with IRMAA if income is above about $109,000 single / $218,000 joint (based on your tax return from two years earlier). Verify the current figure at medicare.gov. | The real decision. See below. |
| Part C (Medicare Advantage) | Private plan replacing A and B | Varies | Cannot be kept without a U.S. residence in the plan area. Disenrol when you move; you revert to Original Medicare. |
| Part D | Prescription drugs | Plan premium plus income surcharge | Cannot be kept abroad. The Part D late-enrolment penalty (1% of the national base premium per month without coverage) applies on return — but is often small compared with Part B. |
| Medigap | Supplement to Original Medicare | Varies by plan and state | Generally cannot be kept abroad. Important: your guaranteed-issue Medigap window is the six months after you first enrol in Part B at 65 or later. If you drop Part B and re-enrol at 72, you get a new six-month Medigap window then. |
The Part B decision: the math
Part B is funded roughly 75% by taxpayers and 25% by premiums, which is why the government penalises people who opt out while healthy and opt back in when sick. The late-enrolment penalty is 10% of the standard premium for every full 12-month period you could have had Part B but did not, and it is added to your premium for life. There is no cap.
| Years abroad without Part B | Premiums saved (at ~$203/mo) | Penalty on return | Extra premium per year for life | Years until the penalty eats the saving |
|---|---|---|---|---|
| 3 | ~$7,300 | +30% | ~$730 | ~10 years |
| 5 | ~$12,200 | +50% | ~$1,220 | ~10 years |
| 10 | ~$24,300 | +100% | ~$2,430 | ~10 years |
| Never return | All of it | — | — | — |
Two things follow from that table. First, because both the saving and the penalty scale with the same premium, the break-even is always about ten years after you re-enrol, regardless of how long you were away — and the premium itself rises faster than inflation, so the real break-even is a bit shorter. Second, the only scenario where dropping Part B clearly wins is the one where you never come back to the U.S. for care. For a 65-year-old with a 20-year life expectancy, that is a big bet on your health, your spouse’s health, and your family situation in two decades.
When dropping Part B is reasonable
- You have permanent residence and strong local coverage — a national health system you are enrolled in (Portugal’s SNS, Spain’s convenio especial, France’s PUMa, Germany’s statutory insurance), or a private international plan you can actually keep at 80.
- Your family, assets, and spouse are abroad and a return to the U.S. is genuinely unlikely, not just unplanned.
- You have modelled the penalty and are comfortable self-insuring it.
- You are not relying on a Medigap guaranteed-issue window you have already used.
If you drop Part B, do it deliberately: file form CMS-1763 or call the SSA, and understand that the premium is normally deducted from your Social Security check, so your Social Security payment will rise by the premium amount.
When keeping Part B is the right call
- You are retiring abroad for the lifestyle or cost but your children, grandchildren, and medical history are in the U.S. — the typical case in the Philippines, Mexico, Thailand, Costa Rica, and Panama.
- You have a chronic condition that may need U.S. specialist care.
- You are the higher-earning spouse and the plan is that the survivor returns to the U.S.
- Your local coverage is private and age-rated — premiums that look fine at 65 can triple by 80, exactly when you need them.
- You are only partly abroad — snowbirds, six-months-and-a-day residents, and people who keep a U.S. home.
In those cases the $2,400 a year is the price of an option to come home insured. Most retirees with any U.S. ties should pay it.
Enrolment windows: living abroad is not a special enrolment period
This is the rule that hurts. Medicare has a Special Enrolment Period for people who delayed Part B because they had employer group coverage, and for a few other situations (volunteers serving abroad with a tax-exempt organisation who had health coverage; people released from incarceration; certain natural disasters and employer misinformation under the 2023 “exceptional conditions” rules). Simply living outside the U.S. is not one of them. If you drop Part B and return, you enrol in the:
- General Enrolment Period, January 1 to March 31 each year, with coverage starting the first of the month after you sign up (the old July 1 start date was abolished in 2023), and
- the penalty calculated on every full 12-month gap since your Initial Enrolment Period ended.
If you are still working abroad for an employer with 20+ employees that covers you under a group health plan, that coverage does count as the kind that earns a Special Enrolment Period — you can delay Part B penalty-free and enrol within eight months of the employment or coverage ending. Self-employed expats and people on individual or national-system coverage do not get this.
Turning 65 while already abroad
If you are already receiving Social Security when you turn 65, you are enrolled in Parts A and B automatically and the Part B premium starts coming out of your check; your Medicare card goes to your address on file, which for expats can mean it never arrives — contact the Federal Benefits Unit if you do not see it. If you are not yet receiving Social Security (common for people delaying to 70), nothing is automatic: you must apply for Medicare during your Initial Enrolment Period — the seven months around your 65th birthday — through the FBU or online. Many expats apply for Part A only (free, no penalty) and make a separate decision on Part B. You can enrol in Part A at any time without penalty, as long as you qualify premium-free.
What to use instead of Medicare abroad
- National health systems. Many countries let legal residents join on payment of a contribution (Spain, Portugal, France, Italy, Germany, Japan, Costa Rica’s CAJA) or free after a qualifying period. Quality and waiting times vary; enrolment rules change with visa type.
- Local private insurance. Cheap and reasonable in Mexico, Thailand, the Philippines, and Malaysia at 65; age caps (often 70–75 for new policies) and exclusions for pre-existing conditions are the catch. PhilHealth in the Philippines accepts foreign residents but covers a fraction of private hospital bills.
- International private medical insurance. Plans from large global insurers cover you anywhere except, usually, the U.S.; adding U.S. coverage roughly doubles the premium. Premiums are age-rated and rise sharply after 70. The site’s overview is at international insurance for Americans.
- Self-pay. Realistic for routine care in low-cost countries — a specialist consultation for $30–60, an MRI for $200–400 — and not realistic for cancer treatment, cardiac surgery, or six weeks in ICU.
Health premiums abroad are a medical expense for U.S. tax purposes (deductible above 7.5% of AGI if you itemise), and some national-system contributions are creditable as foreign taxes only if they are structured as income taxes rather than insurance premiums — usually they are not. The broader retiree tax picture is in U.S. taxes for retirees abroad.
Mistakes expats make with Medicare
- Assuming a Medigap foreign-travel benefit covers living abroad. It covers the first 60 days of a trip, after which you are uninsured — and the plan itself lapses without a U.S. address.
- Dropping Part B by accident — the premium bounces when a U.S. bank account closes, and after three missed quarterly bills Medicare terminates coverage.
- Expecting a special enrolment period on return. There is none for residence abroad; plan around January–March.
- Forgetting IRMAA. A large IRA withdrawal, Roth conversion, or home sale two years before you turn 65 raises the Part B premium for a year even while you live abroad.
- Not enrolling in Part A at 65 because “Medicare does not work abroad.” Part A is free and has no downside.
- Buying an international plan at 65 that ends at 75 and finding no insurer will take you at 76.
Frequently asked questions
Does Medicare cover me if I live in the Philippines, Mexico, or Portugal?
No. Medicare covers care only inside the U.S. and its territories, with narrow exceptions for emergencies near the Canadian and Mexican borders and on ships within six hours of a U.S. port. Local care abroad must be covered by a national health system, local or international private insurance, or self-pay.
Should I keep paying for Medicare Part B while living abroad?
Keep it if there is a realistic chance you will return to the U.S. for care or to live: the late-enrolment penalty is a permanent 10% of the premium for every 12 months you went without it, and the break-even after re-enrolling is only about ten years. Drop it only if you are settled abroad with durable local coverage and a return is genuinely unlikely.
How much is the Medicare Part B penalty if I drop it for five years and come back?
About 50% added to the standard premium for the rest of your life. At the 2026 standard premium of roughly $203 a month, that is about $100 a month, or $1,200 a year, on top of the regular premium.
Is living abroad a special enrolment period for Medicare?
No. Residence outside the U.S. is not a special enrolment period. Unless you had qualifying employer group coverage, you must wait for the General Enrolment Period (January 1 to March 31), with coverage starting the month after you enrol and the penalty applied.
Should I enrol in Medicare Part A if I live abroad?
Yes, if you qualify premium-free (40 quarters of Medicare taxes). It costs nothing, carries no penalty, and gives you hospital coverage if you ever return. Enrolling in Part A does not require Part B.
Can I keep my Medicare Advantage or Medigap plan when I move abroad?
No. Both require a U.S. residence within the plan’s area. Disenrol from Advantage when you move so you revert to Original Medicare; a Medigap plan will lapse. If you later re-enrol in Part B, you get a new six-month guaranteed-issue Medigap window.
Sources and references
Medicare.gov — Travel (health care outside the U.S.) · Medicare.gov — Medicare costs (current Part B premium and IRMAA) · Medicare.gov — When coverage starts and enrolment periods · Medicare.gov — Avoid late-enrolment penalties · SSA — Sign up for Medicare · SSA — Federal Benefits Units abroad · CMS newsroom — annual Part B premium announcements · IRS Publication 502, Medical and Dental Expenses.