If you are considering relocating to another country as a senior ex-pat, you may be concerned about Medicare for expats, whether coverage is available. Knowing this is an integral part of learning how to become an expat in your senior years.
If you are looking for a more general guide to Medicare, see our article on Medicare covered services.
Will Medicare Cover You if You Live in Another Country?
In general, Medicare will not cover care you receive in another country. However, there are occasions when you may wish to keep Medicare coverage even while living abroad. In this article, we’ll look at how to enroll from abroad, the different components of Medicare coverage available to ex-pats, and whether you’ll want to continue paying Medicare premiums or not.
Applying for Medicare from Abroad
Puerto Rico, the Virgin Islands, Guam, and American Samoa are territories of the United States. The Northern Mariana Islands is a commonwealth of the United States, as well. If you move to one of these areas, you are entitled to all Social Security benefits, including Medicare. Additionally, medical facilities in these areas will typically accept Medicare coverage. You can find out more information about coverage for these areas here.
You can apply for Social Security benefits if you are a U.S. citizen over the age of 65 before or after you move abroad. However, if you do not qualify for the premium-free Medicare Part A, you may not be eligible for any of the Medicare provisions if you live outside the United States and its territories.
If you are outside of the United States when you turn 65, you can request the enrollment forms from the U.S. embassy or consulate where you are located. You should also receive a letter from the Social Security Administration (SSA) letting you know you’ve entered the Initial Enrollment Period (IEP) along with a form you can use to request an enrollment packet. When you return your enrollment forms, use a reliable courier service and keep copies for your personal records as well.
If you are already receiving SSA or Railroad Retirement Board (RRB) benefits, you may be enrolled automatically in Medicare Part A when you turn 65 even if you are living abroad. You’ll need to submit the enrollment forms for Part B and subsequent parts if you wish to enroll in those.
If you are not able to enroll during your Initial Enrollment Period, you will need to wait to enroll during the General Enrollment Period (GEP), which may result in penalties or gaps in coverage.
Medicare Part A
If you qualify for premium-free Medicare Part A, you won’t pay for coverage. If you unenroll when you move abroad, you must pay back all the benefits you’ve received to the Social Security Administration (SSA). If this is your situation, it would be in your best interest to continue your enrollment even if the country that you live in does not accept Medicare. You aren’t paying monthly premiums, and you won’t have to repay previous benefits.
If you pay a premium for Medicare Part A, you’ll need to determine if the monthly expense is worth continuing. If you plan on returning to the U.S. at some point, you should keep your coverage. Otherwise, there may be a coverage delay if you do return to the U.S. and need to re-enroll, which could impact your treatment.
If you plan on making frequent trips to the U.S. even though you are living abroad, you may also wish to continue paying premiums for Part A. You’ll be able to take advantage of your visits to address any medical procedures or wellness checkups you may need to be done.
Medicare Part B
You may not want to continue your coverage under Medicare Part B if you live in another country, especially if you won’t be taking frequent trips to the U.S. To keep your coverage for Part B as an ex-pat, you must continue to pay monthly premiums. If you unenroll and then return to the U.S., you may be subject to premium penalties or have gaps in your coverage that could impact treatments.
Premium penalties and gaps in enrollment coverage occur if you reactivate your policy outside of the General Enrollment Period (GEP). This enrollment period begins on January 1 and ends on March 31 every year. Your Medicare coverage begins on July 1 after enrollment.
Special Enrollment Period for Medicare Part B
Under certain conditions, you may qualify for a Special Enrollment Period (SEP) for Medicare Part B if you live abroad.
If you or your spouse work in a foreign country for a company that provides you with health insurance, you can enroll in Part B without penalties up to eight months after you lose health insurance. If you or your spouse work in a country where you qualify for coverage under its national health system, you can delay enrollment as well.
If you volunteer for a tax-exempt non-profit organization in a country outside of the U.S., you may be eligible for a six-month Special Enrollment Period (SEP). You must volunteer at least 12 months and have health insurance coverage during your volunteer service period. Your SEP begins once you finish your term of service or when your health insurance policy ends, whichever comes first.
Medicare Part C / Medicare Advantage
If you have Medicare Advantage, you should stop paying premiums and unenroll before moving abroad because you must live within a specific service area to receive benefits. However, if you plan on being a snowbird or sunbird, you might find it advantageous to continue your coverage under Medicare Advantage, provided you maintain a permanent residence in the U.S. A snowbird is a term for someone who migrates to a sunnier location during the winter. A sunbird is a person who relocates to a milder climate during the summer.
Medicare Part D
You’ll need to make the same decision about your enrollment in Medicare Part D, the prescription coverage section of Medicare. You will be unable to use the plan as an ex-pat. However, if you are back and forth between your new country and the U.S., you may wish to continue paying the premiums for coverage.
Medicare for Expats Conclusion
Medicare coverage is not generally accepted outside the United States and its territories. Depending on your personal situation, you may wish to continue your enrollment of certain parts while living abroad.
Want to read more about expat life in other countries, specifically regarding elder care? Read the articles we wrote on being an expat in:
If you are planning to live abroad for a long period of time, looking for alternative insurance is probably your best bet.
6 comments
Medicare Advantage plans go beyond Original Medicare with better cost sharing for more services, a maximum out-of-pocket (MOOP), extra benefits, and additional support. Medicare Advantage plans operate similarly to Original Medicare, but the difference is that the government pays private insurance companies to offer the Advantage plans.
I am a US citizen live and work in China. Since I have insurance coverage from my employer, and I can live without using Medicare coverage for now (a few years), is there anyway to waive my Medicare premium? Thanks!
I’m a US citizen living and working in Canada. So I’m covered under Ontario’s health plan. Does this qualify me for a Special Enrollment Period where I won’t pay a penalty not enrolling in Part B if/when I ever want to enroll in Part B, assuming I don’t enroll in Part B when I enroll in Part A? I turn 65 next October.
Good question. Unfortunately I think you’ll have to play the phone game with Medicare in order to get that question answered.
I am a US citizen living in Greece. I was born DEC 30 1956, so I will be 65 DEC 30 2021.
Should I apply for Medicare if eligible? I do not receive SSA benefits yet.
Probably, yes. Contact Medicare as soon as possible.