You have to be a U.S. citizen or permanent legal resident to qualify for Medicare, but you don't have to live here.
Most people know that Medicare usually does not follow them when they take a vacation in a foreign country. The only real exceptions are if you have a Medigap plan that covers a portion of medically-necessary emergency care outside of the United States. But do you lose Medicare if you move out of the country entirely? The basic answer is no, you don't lose Medicare when you move to another country.
Do I have to live in the U.S. to get Medicare?
You have to be a U.S. citizen or permanent legal resident to get Medicare Parts A and B, but you do not have to live in the United States.
The rules are different, though, for Medicare Part C (Medicare Advantage) and Medicare Part D (prescription drug coverage). These plans are provided by private insurers and most require members to live within the plan's service area for at least 6 months out of the year. See an individual plan's details for guidelines.
Medicare Supplement Insurance plans, more commonly known as Medigap, only require you to be a U.S. resident at the time you joined the plan. As long as you keep paying your premiums, you may keep your Medigap plan – even if you move to another country. Of course, you won't be able to use it, but you'll have it if you decide to return to the U.S.
What happens to Your Medicare coverage if you move to another country?
If you're enrolled in Medicare and move to another country, you won't be disenrolled unless you request it or renounce your American citizenship. (Remember, Medicare eligibility requires being either a U.S. citizen or permanent legal resident.) However, you won't be able to use Medicare Part A or Part B to pay for overseas healthcare – even if you're paying monthly premiums.
But the question of whether to keep your Medicare coverage isn't as easy to answer. There are many variables to consider, such as whether you get premium-free Part A or plan to visit the United States occasionally. It's important to remember that the Medicare program changes every year. It's always a good idea to check Medicare.gov or call 1-800-MEDICARE to find answers for your unique situation.
Do you get premium-free Medicare Part A?
Since the only qualification to get Medicare Part A premium-free is you or your spouse paying Medicare taxes for 10 years, nearly everyone qualifies. And since it's free, our advice is usually to sign up for Medicare Part A as soon as you're eligible. The only exception is if you contribute to a Health Savings Account (HSA) and wish to continue doing so after you turn 65.
Even though you won't be able to use your Medicare Part A benefits while living in another country, it costs you nothing to keep it. And if you ever come back to the U.S. – either to live or to visit – you may need that coverage. Dropping Part A when you move could result in expensive coverage gaps.
If you return to the United States and don't qualify for a Special Enrollment Period, you'll have to wait for the General Enrollment Period to sign up for Parts A and B (Original Medicare). General Enrollment occurs every year between January 1 and March 31, with coverage beginning on July 1.
Most people have to pay the Medicare Part B premium, which changes every year. In 2024, the standard Part B premium is 174.40.
Why would you keep Medicare if you move to another country?
If there is any chance you'll move back to the United States or if you plan to spend a portion of the year here, you probably want to keep your Medicare coverage. This protects you from coverage gaps and potentially high late enrollment penalties.
- The Medicare Part A late penalty is 10% for twice the number of years that you could have had Part A but did not. So, for every full 12-month period that passes without having Part A, you pay a 10% penalty for 24 months.
- Medicare Part B's late enrollment penalty is 10% for every year you could have had Part B but delayed. So, 12 months = 10%, 24 months = 20%, and so on.
- The Medicare Part D late enrollment penalty accrues monthly. You'll pay 1% of the national base beneficiary premium for every month you did not have creditable drug coverage, rounded to the nearest dime. So, 1 month = 1%, 2 months = 2%, and so on. The base beneficiary premium is $34.70 in 2024.
Very few people owe the Part A penalty, because very few people pay the Medicare Part A premium.
You pay the Parts B and D late enrollment penalties for the entire time you have Medicare.
Do you have medical insurance or other coverage?
Whether you have to pay the Medicare Part B late enrollment penalty depends on whether you qualify for a Special Enrollment Period (SEP). For the purposes of this article, this typically means having creditable coverage, i.e. benefits and costs that are comparable to Medicare.
If you have group health insurance through an employer (yours or your spouse's) or national health system (which most developed countries offer), you have creditable coverage. Your coverage is also considered creditable if you're covered as a volunteer with an organization like the Peace Corps. In each of these scenarios, you should qualify for an 8-month Special Enrollment Period once said coverage ends.
Your SEP begins either the month after employment ends OR the month after your coverage ends (whichever comes first). If you sign up for Medicare Part B during your SEP, you will not have to pay the late enrollment penalty.
Waiting to apply for Medicare until you return to the United States (unless it's within that 8-month window) means you'll likely owe the late fees. In addition, you'll have to wait for General Enrollment, which could result in a significant coverage gap.
Is your health insurance creditable?
Not all health insurance qualifies as creditable coverage, especially after you turn 65. Examples include:
- TRICARE or CHAMPVA: You may keep this coverage only if you have Medicare Part B (unless you or your spouse is an active-duty service member).
- Not actively employed: If you have health insurance through an employer but are no longer actively employed, then you do not have creditable coverage. The same is true if the coverage is courtesy of your spouse's employer. Once the covered person is no longer actively employed, coverage ceases to be creditable.
- COBRA: If you have coverage under COBRA, you are not actively employed and therefore it is not considered creditable. You may decide to keep your COBRA plan, though, if it provides health insurance for dependents. However, you must still sign up for Part B if you want to avoid lifelong late penalties.
If you had creditable coverage, you'll need to prove it once you sign up for Medicare. Save everything you can – tax returns, medical statements, notices from your insurance company, pay stubs, etc.
Did you turn 65 while living in another country?
Everything is a little bit different if you weren't yet 65 when you moved to another country.
If you live in a foreign country, SSA should send you a letter when you enter your Initial Enrollment Period (IEP). Enrollment may be automatic if you were already receiving Railroad Retirement Board (RRB) or Social Security benefits before you turned 65.
Those who qualify for premium-free Part A may enroll in Medicare while living in another country. The Social Security Administration (SSA) provides a list of foreign offices that can assist you. Find it on SSA.gov here.
If ALL of the following apply, you cannot sign up for Medicare Part B until after you return to the United States:
- You are a U.S. citizen
- You're over age 65
- You are not eligible for Social Security
- You were living in foreign country on your 65th birthday
You'll have 3 months to sign up for Medicare once you move back to the U.S.
What happens with Medicare Part D?
If you had a Medicare Part D prescription drug plan before moving abroad, contact your plan to set your disenrollment date.
Once you move back to the U.S., you should qualify for a 2-month SEP. If you join a new Part D plan during that 2-month period, you won't owe the late enrollment penalty. However, if you owed late fees before, those will still apply – you just won't accrue any additional penalties.
When should you sign up for Medicare?
If you're living in the United States when you turn 65, you should sign up for Medicare during your Initial Enrollment Period. This begins 3 months before your 65th birthday and lasts for a full 7 months. So, if you turn 65 in April, your IEP begins on January 1 and ends July 31.
Even if you know you'll have other coverage once you move abroad, you should at least sign up for Part A (assuming it's free). Part B coverage is also recommended if you don't think you'll have creditable coverage abroad and plan to return to the States occasionally or move back permanently.
Those who qualify for a Special Enrollment Period should act within those timelines. Failure to do so could land you with late fees and coverage gaps.