Medicare When You Live Abroad: Coverage and Timing

Medicare living abroad comes down to one fact and one decision. The fact: Medicare almost never pays for care outside the United States. The decision: whether to sign up for Part B, and pay its monthly premium, while you live somewhere it does not cover you, or delay and accept a penalty that can last the rest of your life if you ever come back. This guide sets out what Medicare.gov and the Social Security Administration (SSA) say, so you can make that call with the real numbers in front of you.

The short version

• Medicare generally does not cover health care outside the 50 states, DC, Puerto Rico, the US Virgin Islands, Guam, the Northern Mariana Islands and American Samoa. In most cases you pay all costs abroad.
• The exceptions are narrow: certain emergencies near the US border, travel through Canada between Alaska and another state, a foreign hospital closer to your US home, and some care on cruise ships near a US port.
• Part A is premium-free for most people who worked 10 years with Medicare taxes, and it is there to use whenever you are back in the US.
• Part B costs $202.90 a month in 2026 (standard premium). If you delay without qualifying for a Special Enrollment Period, the penalty is 10% for each full 12-month period you could have had it, usually for as long as you have Part B.
• Your Initial Enrollment Period lasts seven months around your 65th birthday. After that, the General Enrollment Period runs January 1 to March 31 each year.
• Medicare drug plans do not cover prescriptions you buy outside the US.

What Medicare covers outside the US

Medicare.gov is blunt: Medicare usually does not cover health care while you are outside the US, and in most cases you pay all of the costs. In rare cases it may pay for inpatient hospital, doctor and ambulance services in a foreign country, if one of these applies:

• You are in the US when a medical emergency happens, and a foreign hospital is closer than the nearest US hospital that can treat you.
• You are traveling through Canada between Alaska and another state, without unreasonable delay and by the most direct route, when an emergency happens, and the Canadian hospital is closer.
• You live in the US and a foreign hospital is closer to your home than the nearest US hospital that can treat your condition, emergency or not.

Part B can also pay for medically necessary care on a cruise ship if the doctor is allowed to practice on board and the ship is in a US port or no more than six hours from one.

Notice who these exceptions are for. They describe people who live in the US and cross a border. If you live in São Paulo, Florianópolis or Salvador, none of them covers your routine care, your hospital stays or your prescriptions. Medicare.gov also notes that Medicare drug plans do not cover drugs bought outside the US, and that foreign hospitals do not have to file Medicare claims.

Part A: usually free, and there when you return

Most people qualify for premium-free Part A after 10 years of work with Medicare taxes, theirs or a spouse's. Part A only pays for care in the US, but because there is no premium, most people sign up for Part A at 65 even if they live abroad. One exception to know about: if you contribute to a Health Savings Account, enrolling in Part A ends your ability to contribute, so check that before you enroll.

Part B: the real decision

Part B covers doctors, outpatient care and other medical services, but only in the US. For people abroad, the trade-off is paying a monthly premium for coverage you cannot use where you live, against the penalty for joining late: if you sign up later, you pay a premium 10% higher for each 12-month period you could have been enrolled but were not.

Medicare.gov's own example uses 2026 figures. If you waited two full years without a Special Enrollment Period, your penalty is 20%. The standard premium of $202.90 plus $40.58 gives $243.48, which Medicare rounds to $243.50 a month in 2026. The penalty is not a one-time fee. It is added to every monthly premium for as long as you have Part B. Higher-income enrollees also pay an income-related surcharge on top of the standard premium.

How to think about it:

• If you are sure you will never return to the US for care, paying Part B for years abroad buys coverage you will not use.
• If there is a real chance you will move back, or come back for treatment later in life, the penalty grows each year you wait. Ten years abroad means a 100% penalty: double the standard premium, for life.
• There is no special enrollment period simply for living abroad. If you skip Part B at 65 and later move back, you sign up during the General Enrollment Period (January 1 to March 31), and coverage starts the month after you sign up.

This is a personal financial decision, and worth reviewing with SSA and a financial or tax professional who knows your plans.

The enrollment periods

Initial Enrollment Period. Seven months: the three months before the month you turn 65, the month itself and the three months after. Sign up before your birthday month and Part B starts the month you turn 65. Sign up during or after it and Part B starts the following month.

General Enrollment Period. January 1 to March 31 every year, with coverage starting the month after you sign up, and a penalty if one applies.

Special Enrollment Periods. The ones that come up most for people abroad:

• Job-based coverage. If you or your spouse have group health coverage from current employment, you can delay Part B and sign up within eight months after the job or the coverage ends. COBRA and retiree coverage do not count. Coverage from a foreign employer may not qualify, so ask SSA before you rely on it.
• Volunteering in a foreign country. If you volunteer abroad with a tax-exempt organization and have health coverage there, you get a six-month window after the volunteering, the organization's status or that coverage ends.
• Exceptional conditions. Medicare lists other situations, such as being misinformed by an employer or health plan, which you request through SSA.

Part D and Medigap

Part D (drug plans). Medicare drug plans do not pay for drugs bought abroad, and you must live in a plan's US service area to join one. When you move back, ask SSA or Medicare about the window to join a plan so you do not run into the Part D penalty, which is 1% of the national base premium for each month without creditable coverage.

Medigap. Medicare.gov says some Medicare Supplement (Medigap) policies may cover emergency care during travel outside the US. That helps people who live in the US and travel. It does not replace health coverage in the country where you live.

What people abroad actually do

Most Americans who retire abroad rely on the public system where they become legal residents, on private local insurance, on international health plans, or on a mix. Our guides to health insurance abroad and public vs private healthcare explain how those options work. Whatever you choose, put health coverage in your cost of living budget as its own line, because Medicare will not fill the gap.

Questions to ask SSA before you decide

Call SSA from abroad at +1-410-965-0160, or contact the Federal Benefits Unit that serves your country, usually at a US embassy.

1. When does my Initial Enrollment Period start and end?
2. If I enroll in Part A only, how do I decline Part B, and how do I confirm that in writing?
3. If I already have Part B, how do I cancel it, and when does the last premium come out?
4. Does my current employer or my spouse's employer coverage qualify for the eight-month Special Enrollment Period?
5. What would my penalty be if I enrolled during a future General Enrollment Period?

If you also receive Social Security abroad, see our guide to Social Security payments while living abroad, which covers how benefits are paid and what you must report.

Common questions

Does Medicare cover me if I live abroad? In almost all cases, no. Medicare generally does not pay for care outside the US. The few exceptions are for border emergencies, travel through Canada and certain cruise ship care.

Should I keep Part A if I live abroad? Most people do, because Part A is premium-free for anyone with enough work credits and covers hospital care whenever you are back in the US. Check first if you contribute to a Health Savings Account.

How much is the Part B late enrollment penalty? 10% of the standard premium for each full 12-month period you could have had Part B but did not, usually for as long as you have Part B. The 2026 standard premium is $202.90 a month.

Is there a Special Enrollment Period for people who lived abroad? Not for living abroad alone. There is one for people who volunteered abroad with a tax-exempt organization, and one for job-based coverage from current employment. Otherwise you use the January to March General Enrollment Period.

Will Medicare pay for prescriptions I buy overseas? No. Medicare.gov states that Medicare drug plans do not cover prescription drugs you buy outside the US.