Medicare abroad: why it won't pay overseas, and whether to keep Part B

Medicare is a stateside-only plan. Retire abroad and it won't pay your doctor in Lisbon or Chiang Mai, but the choices you make about it now still follow you if you ever come home.

The short version

• Medicare generally doesn't pay for care outside the US. There are three narrow hospital exceptions and a rule for cruise ships near a US port [3].
• Part A is usually free, so there's no reason to drop it. Part B costs $202.90 a month in 2026 for most people [2].
• Drop Part B and you may pay a penalty for life if you sign up later: 10% more for each full 12-month period you could have had it [1].
• You can't join a Part D drug plan or Medicare Advantage while you live abroad, because you must live in the US to join [4]. Joining within 63 days of moving back avoids the Part D penalty [4].
• You'll need local or international health insurance wherever you live. Many retirement visas require it.

What Medicare covers outside the US (almost nothing)

Medicare's own fact sheet on coverage outside the United States (April 2026) lists the only times it pays for inpatient care in a foreign hospital [3]:

1. You're in the US when a medical emergency happens, and a foreign hospital is closer than the nearest US hospital that can treat you.
2. You're traveling through Canada between Alaska and another state, without unreasonable delay, when an emergency happens and a Canadian hospital is closer.
3. You live in the US and a foreign hospital is closer to your home than the nearest US hospital that can treat you.

On a cruise ship, care can be covered only if the ship is in a US port or within six hours of one [3]. Part D drug plans can't cover drugs you buy outside the US [3].

Notice the pattern: every exception assumes you live in the States. None of them helps someone who lives in Mexico, Spain or Thailand. Once you've moved, your day-to-day care comes from the local system or private insurance, and Uncle Sam isn't picking up the tab.

What about Medigap?

Medigap Plans C, D, F, G, M and N (and older E, H, I and J plans) include foreign travel emergency coverage. It pays 80% of billed charges for emergency care abroad after a $250 yearly deductible, up to $50,000 over your lifetime, and only for emergencies that begin in the first 60 days of a trip [3]. That's fine for a two-week vacation in Italy. It's not a plan for living abroad, and you generally need to live in the US to buy Medigap in the first place.

The four parts of Medicare when you live abroad

Should you keep Part B?

This is the big one. Part B is the only part you pay real money for, and while you live abroad it gives you exactly nothing. But dropping it, or never signing up, can come back to bite you later.

The late-enrollment penalty

If you don't sign up for Part B when you're first eligible, and you don't qualify for a Special Enrollment Period, your premium rises 10% for each full 12-month period you could have had Part B but didn't. In most cases you pay that penalty for as long as you have Part B [1][4].

Medicare's own example: two years late means a 20% penalty. For 2026, that's $202.90 plus $40.58, or about $243.50 a month [1].

Here's the fine print that trips people up: living abroad doesn't, by itself, give you a Special Enrollment Period. Medicare.gov does describe a narrow case: if you first become eligible the month you return to the US to live, and you enroll within three months of that return, you don't pay a penalty [5]. That generally helps people who weren't eligible before, not US citizens who turned 65 abroad and chose to skip Part B.

A worked example

Say you turn 65 in Portugal in 2026, skip Part B, and move back to the US seven years later. That's seven full 12-month periods, so a 70% penalty. At the 2026 rate, the premium would be about $345 a month instead of $202.90, for life. The penalty is a percentage, so it grows each time the standard premium rises. That's real sticker shock on a fixed income.

Signing up late

If you skipped Part B, you can sign up only during the General Enrollment Period, January 1 to March 31 each year [5], and coverage starts the month after you sign up. That can leave a gap of several months after you move back, which is a lousy time to be uninsured.

How to decide

Keeping Part B tends to make sense if:

• you expect to move back to the US, or spend long stretches there
• you want US treatment for a serious illness later
• your Social Security benefit pays the premium automatically and the cost is manageable

Dropping or skipping Part B can make sense if:

• you're sure you'll stay abroad for good
• you have strong local coverage, such as a public system you pay into
• the premium is a real strain, especially with an income-related surcharge

There's no one-size-fits-all answer. Free counseling from a State Health Insurance Assistance Program (SHIP) is available to people with Medicare, and Medicare's package for people abroad points to it [4].

Part D and Medicare Advantage

You can't join a Part D drug plan while you live outside the US [4]. When you move back and have no other creditable drug coverage, join within 63 days to avoid a late penalty [4]. The Part D penalty is 1% of the national base beneficiary premium ($38.99 in 2026) for each month without creditable coverage, and it lasts as long as you have drug coverage [1]. Medicare Advantage also requires you to live in the US and have both Part A and Part B [4].

Practical steps before and after you move

1. Decide on Part B before you turn 65 or before you leave. Medicare's letter to people abroad gives you a window to sign up if you plan to return [4].
2. Keep Part A. It's free for most people and keeps you in the system.
3. If you drop Part B, contact Social Security. Ending Part B is done through SSA, not your doctor or insurer, and it usually needs a form and an interview.
4. Pay premiums from abroad. If you get Social Security, the Part B premium is normally taken from your benefit. If not, you'll get a bill every three months [4]. Medicare.gov lists the ways to pay.
5. Buy health insurance for where you live. Look at the local public system, private local insurance and international plans. Our guide to health insurance between countries compares them.
6. When you move back, join Part D within 63 days and use the General Enrollment Period for Part B if you dropped it.
7. Use your US embassy or consulate for enrollment questions abroad. Medicare.gov says people with premium-free Part A who live abroad can enroll through the nearest Social Security office, US embassy or consulate [5].

You can compare how other retirees handled the Part B question in our community groups for Americans abroad.

One heads-up for mixed couples: if your spouse is Australian, their Medicare is a completely different program, and our sister site ExpatCooee explains how Australia's Medicare works when you live abroad.

Sources

1. Medicare.gov: Avoid late enrollment penalties
2. Medicare.gov: Medicare costs (2026)
3. Medicare.gov fact sheet: Medicare coverage outside the United States (CMS 11037, April 2026)
4. Medicare.gov: Welcome to Medicare package for people living outside the US
5. Medicare.gov: I'm outside the US

Keep reading

• Social Security abroad: payments and restrictions
• Retiring abroad: the main retirement visas for Americans
• Moving back to the US: taxes, health insurance and credit
• Health insurance between countries