Many Americans choose to retire overseas — for the warmer weather, the lower cost of living or the new cultural experience. If that describes you, you might be wondering how living overseas affects your Medicare coverage, especially if you intend to move back to the United States at some point.
In this guide, we’ll explain how living overseas might affect your Medicare coverage and enrollment and the best ways to make sure you’re covered.
[Related:How Do I Know When I’m Eligible for Medicare?]
Do I Have to Sign Up for Medicare If I’m Living Abroad?
The short answer is no, you don’t have to have Medicare if you live abroad. And by “abroad” we mean outside of the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa or the Northern Mariana Islands.
And by “live” we mean reside in a foreign country, not just take an extended trip there. The Social Security Administration defines living abroad as living outside the U.S. for at least 30 consecutive days. Once you’re back on U.S. soil for 30 consecutive days, you are no longer considered to be living abroad.
American citizens living outside the U.S. are not required to sign up for Medicare, which makes sense since Medicare typically does not cover medical care rendered outside the country, explains Whitney Stidom, vice president of sales enablement with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
However, there are certain health care scenarios that may be covered while you’re traveling in a foreign country, such as an emergency hospital visit.
“This includes Medicare Advantage and Medicare Part D prescription drug plans. Some Medicare supplement plans may cover services outside of the U.S.,” Stidom adds.
Other exceptions include when you’re on a ship within six hours of a U.S. port or if you’re in a U.S. location but the nearest hospital that can treat you is in another country. For example, if you’re traveling to Alaska through Canada and a Canadian hospital is closer than the nearest U.S. hospital, that treatment would be covered under Medicare.
So, if you plan to remain abroad for the rest of your life, you can avoid enrolling in Medicare. However, “you should consider it if you plan to return to the U.S.,” Stidom notes. And if you’re traveling or residing abroad, you may want to consider enrolling in a travel insurance plan or Medicare supplement plan, also known as Medigap, to provide more comprehensive coverage in case of illness or emergency.
“Foreign emergency care is the only benefit Medicare supplement plans will help cover,” confirms Jack Glasker, designated partner at Affordable Healthcare Solutions, a father-son health insurance brokerage firm based in Westfield, New Jersey.
If you’re permanently living abroad, “it really depends on the country,” he adds, noting that “most advanced countries already offer citizens, regardless of income, universal and affordable health insurance.”
When comparing costs, Medicare may end up being more expensive than getting coverage from the country’s natural health system if you’re able to access that.
[READ Medigap vs. Medicare Advantage: Which Should You Buy?]
When Should I Sign Up for Medicare Coverage Abroad?
Consider signing up for Medicare during the seven-month initial enrollment period that starts three months before you turn 65 and lasts for three months after you turn 65.
You can delay signing up for Medicare if you meet any of the following criteria:
— You’re still working, and you have creditable health insurance coverage through your employer.
— You’re covered under the national health system of the country in which you’re residing.
— Your spouse works for an employer that provides creditable health insurance coverage for you, or they’re covered under the national health system of the country where you live and that provides coverage for you as well.
— Your reason for living abroad, such as volunteering with the Peace Corps or another approved organization, provides creditable health coverage.
U.S. citizens who are living abroad should receive a notice from the Social Security Administration about signing up for Medicare as they approach their 65th birthday, Stidom explains. You can also request enrollment forms from the U.S. embassy in the country where you’re living. Reach out to your nearest U.S. consulate for help getting the information and documents you need.
It’s important to pay attention to any notifications you receive from the SSA or the Centers for Medicare & Medicaid Services because if you delay signing up, you could be hit with late enrollment fees later on.
If you don’t sign up for Medicare during the initial enrollment period, you can sign up for Medicare during the general enrollment period between January 1 and March 31 each year. You may also qualify for a special enrollment period in some situations, such as retiring from a job that provided creditable health insurance.
Keep in mind that if you don’t sign up during the initial enrollment period but then move home, you’ll likely have to wait until the general enrollment period to sign up. That could mean you’ll be without health insurance for several months while also potentially incurring a penalty.
[READ: Navigating Medicare Deductibles and Premiums in 2025]
So, Should I Sign Up for Medicare Coverage Abroad When I Turn 65?
For most people, Medicare Part A, which covers hospitalization, is premium-free because you or your spouse paid into the system via Medicare taxes for 10 years or more while working.
So, if you qualify for premium-free Part A, “there’s no reason not to enroll,” Stidom says, even if you’re living abroad.
If you don’t qualify for premium-free Part A, you may be able to pay a monthly premium to get it, but you’ll most likely have to wait until you move back to the United States to enroll. In 2025, you’ll pay either $285 or $518 per month depending on how long you or your spouse worked and paid Medicare taxes. If you don’t qualify for premium-free Part A, you will have a three-month window after moving back to the U.S. to enroll without penalty.
But keep in mind that if you are buying Part A, you also have to sign up for Part B, which covers outpatient care and services. And if you don’t buy Part A when you first become eligible for Medicare, you may be charged a penalty if you enroll at a later date.
Medicare Part B is not premium-free, no matter how long you worked.
“Medicare Part B comes with a monthly premium that is typically taken from your Social Security payment,” Stidom says.
In 2025, the base premium for Part B is $185 per month.
“If you choose not to enroll in Part B while living abroad, you will need to provide documentation proving you were living outside of the U.S. in order to enroll upon your return and avoid a penalty for delaying enrollment in Part B,” Stidom adds.
This means you should hold onto the following items as proof of having lived overseas:
— Pay stubs
— Tax returns
— Medical statements
— Insurance benefit statements
— Records of doctor’s bills and any payments you made
Part B provides coverage when you travel to the U.S., even if you’re not living here full time. This can help prevent gaps in coverage or premium penalties if you go back and forth between your home abroad and the U.S.
It’s also worth noting that Medicare Advantage plans and Medicare Part D plans cover services only within a specific geographical area. If you’ve already signed up for either of these programs prior to moving abroad, you should unenroll to stop paying the premiums on those plans.
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Do I Have to Sign Up for Medicare If I Live Overseas? originally appeared on usnews.com
