Medicare and moving abroad from the US

What stays and what stops when you leave the US

Part B costs $202.90 a month in 2026 and pays for almost nothing outside the US. That is the figure behind a decision most people on Medicare face before they leave: keep paying for cover that will not work where you live, or stop and risk a penalty and a gap if you ever come back.

Medicare is a US program. Federal regulation allows one narrow exception to the rule that it does not pay for services furnished outside the United States, and the State Department tells travellers plainly that Medicare does not cover medical costs outside the United States.

What will pay for care where you live is a separate question. This article is about the other one: what to do with your Medicare in the meantime, because its premiums, penalties and sign-up windows keep running on US rules, and where it meets a visa's insurance requirement. [H3] [P2]

What Medicare pays for outside the US

The main exception is a hospital stay. Part A may pay for inpatient care in a foreign hospital, and Part B for doctor and ambulance services immediately before and during it, in three situations.

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

All three assume you are in the US or live there, so someone who has moved abroad fits none of them.

Where Medicare does pay, you owe the usual deductibles and coinsurance. Foreign hospitals aren't required to file claims, so you may pay first and send Medicare an itemised bill. Dialysis outside those cases, drugs bought outside the US and return ambulance trips home are not covered. [H1] [H2] [H3]

The premiums that keep running

Ten years of Medicare taxes, paid by you or a spouse, generally make Part A premium-free. If you don't qualify, you can buy it for $311 or $565 a month in 2026, depending on work history, and you must also have Part B. You can generally drop Part A only if you pay a premium for it, so a premium-free Part A stays with you at no cost.

Part B is the part that costs money while you are away. The standard premium is $202.90 a month in 2026, or more depending on income, and it is due every month even if you use no services. The yearly deductible is $283. The amount changes each year, so for budgeting plan on more than $210 a month. Social Security, where you sign up, can withhold premiums from benefit payments. Not published; ask Social Security how premiums are paid from abroad.

Part B pays for almost nothing outside the US, yet it is what helps pay for doctors and outpatient care when you are back. That trade-off drives the next two sections. [H4] [P1]

Dropping or delaying Part B

Send a request to drop Part B on 5 April and coverage ends on 31 May. It stops at the end of the month after you file, and you pay for every month you still have it. You usually send a signed request in writing to Social Security. If you were enrolled automatically, keeping the card means you agree to keep Part B.

Dropping it means you may pay all the costs of care Part B would have covered, including a US hospital stay. If you change your mind, you may have to wait for the General Enrollment Period, 1 January to 31 March each year, with coverage starting the month after you sign up.

Then comes the penalty. Without a Special Enrollment Period, the Part B premium rises 10% for each full 12 months you could have had Part B and didn't, and you pay it for as long as you have Part B. Two years of waiting means 20%, or $243.50 a month in 2026 instead of $202.90. The same applies if you never sign up after your seven-month Initial Enrollment Period around your 65th birthday. [H5] [H6] [H7] [P1]

The special enrollment period that doesn't cover living abroad

Eight months is how long you have to sign up for Part B without a penalty once the job or group coverage you held through your own or a spouse's current job ends. COBRA and retiree coverage don't count, and missing the window doesn't create a second one.

A Special Enrollment Period also exists for losing Medicaid, a declared disaster, wrong information from a plan or employer, TRICARE, and "other exceptional conditions" that you ask Social Security about. The only one that mentions another country is for volunteers serving abroad with a tax-exempt organisation while holding health insurance that works outside the US.

Living abroad is not on that list, and neither is holding international private insurance. Not published; ask Social Security whether a move abroad could count as an exceptional condition, and whether group coverage from a non-US employer counts. Put both questions before a deadline passes. [H5] [H8]

Drug plans, Advantage plans and Medigap

Medicare drug plans can't cover drugs you buy outside the US. Part D has its own penalty: 1% of the national base premium ($38.99 in 2026) for each month you go without a drug plan or creditable drug coverage once you are eligible, triggered by a gap of 63 days or more. It stays as long as you have drug coverage. Creditable coverage is cover expected to pay at least as much as Part D, such as some employer plans.

A Medicare Advantage plan must follow Medicare's rules for coverage outside the US but may cover more, so ask it. If you move outside its service area, you can switch plans or return to Original Medicare, and otherwise you'll be moved to Original Medicare when the plan drops you. Not published; ask the plan how it treats an address abroad. When you move back to the US after living abroad, you get two full months after that month to join an Advantage or drug plan.

Medigap is the other product that mentions foreign care. Most plans pay 80% of billed charges for certain emergency care outside the US, after a $250 yearly deductible, up to a $50,000 lifetime limit. The care must begin in the first 60 days of a trip, and only if Medicare doesn't otherwise cover it. It is written for trips, and an insurer would have to say whether it applies to someone who lives abroad.

You need Parts A and B to buy Medigap. Your one-time six-month Medigap Open Enrollment starts the month you have Part B and are 65 or older; after it, you may be refused a policy or pay more. Dropping Part B can therefore affect a policy you might want later, and an insurer can tell you whether an existing policy continues without it. [H1] [H2] [H6] [H9] [H10] [H11]

When a visa asks for private insurance

Spain's non-lucrative residence visa asks for public or private health insurance from an insurer authorised in Spain, covering all the risks of Spain's public system, with no co-payment or coverage limit. The Spanish Consulate in Washington does not accept travel insurance. See the Spain guide and the Portugal and Spain comparison.

Portugal's documentation list for residence visas includes valid travel insurance covering necessary medical expenses, including urgent medical assistance and possible repatriation. It may be waived under a bilateral or international agreement on medical assistance; Brazil and the United Kingdom are the examples named, not the United States. See the Portugal guide.

Neither list mentions Medicare, and it doesn't fit either one. Medicare doesn't pay for care in either country, and a Medigap travel benefit with its 60 days and $50,000 limit reads like a different product from the Spanish wording. The consulate decides what it accepts. For the same question from a Canadian angle, see health cover when you retire abroad from Canada. [V1] [V2] [H1] [P2]

Before you cancel anything

Start with Social Security: whether your Part A is premium-free, what Part B costs at your income, and whether employer coverage could give you a penalty-free Special Enrollment Period. Your Part D or Advantage plan can say what it does with an overseas address, and a Medigap insurer what happens if you drop Part B. The visa checklist of the consulate that serves you settles the last piece.

Whether a penalty or a Special Enrollment Period applies depends on your income, work history and dates, and Social Security or 1-800-MEDICARE can check them against your record. Retirement accounts raise their own questions; see taking a US 401(k) or IRA abroad. [H5] [H7] [H11]