Must I Enroll in Medicare if I Live Abroad?

Key takeaways

  • If you don’t get premium-free Part A, you can’t enroll in Part A or Part B while living outside of the United States.

  • You may not be able to enroll in Part B overseas if you are a U.S. citizen, aged 65 or older, not eligible for Social Security, and you were living in a foreign country when you turned 65.

  • If you do qualify, you can choose to 1) enroll and pay premiums for Part B monthly but not be able to fully access Medicare benefits outside the U.S., or 2) delay enrollment until your return to the U.S., but this may lead to permanent Part B late enrollment penalties and gaps in coverage.

  • The decision mainly depends on whether you want to return to the U.S. or plan on living abroad permanently.

  • Compare costs. Consider different options for covering medical emergencies and medical costs when living overseas, like private insurance.

Do I have to enroll in Medicare if I live overseas?

You are not typically required to enroll in Medicare overseas, as it is primarily a U.S. government health insurance program that can be used in:

  • The 50 states

  • District of Columbia

  • Puerto Rico

  • The U.S. Virgin Islands

  • Guam

  • American Samoa

  • The Northern Mariana Islands.

The choice of whether to enroll or decline hinges on several factors, including your intentions regarding returning to the United States, your employment or retirement status or volunteer commitments abroad, and the potential financial consequences of delaying enrollment. You have to carefully evaluate these aspects to make an informed decision about your Medicare coverage.

If you are living abroad when you first become eligible for Medicare, you can sometimes delay enrollment without penalties until you return to the United States. However, you need to understand the enrollment rules and deadlines of Medicare plans if you plan to move back to the U.S. in the future.

How to decide whether to enroll in Medicare if I move abroad?

Since Part A often comes with no premium cost for most individuals, it is advisable to maintain Part A even if you are relocating abroad since it’s essentially free. However, if you don’t qualify for premium-free Part A, your ability to enroll in Medicare may be limited to residing within the U.S.

To retain Part B coverage, you must pay the monthly Part B premium. Keeping Part B could be beneficial if you have plans to return to the U.S. in the future or frequently visit, as maintaining premium payments while abroad ensures that Medicare will cover your healthcare needs during your U.S. visits, and you won’t have premium penalties or coverage gaps.

Failure to maintain Part B coverage while living abroad can result in a substantial gap in health insurance when you return to the U.S. You may need to wait until the General Enrollment Period (GEP), which occurs from January 1 through March 31 each year, to enroll, You coverage will start the first day of the month after you sign up.

What if I don’t qualify for a premium-free Part A and live abroad?

If you or your spouse haven’t paid Medicare taxes for a minimum of 40 quarters, making you ineligible for premium-free Part A, you cannot enroll in Parts A and B while residing outside of the United States.

In this particular scenario, you have the option to delay your Medicare enrollment until your return without being subjected to late enrollment penalties, regardless of the duration of your time abroad or how many years have passed since you turned 65.

When you return to the States, your special enrollment period begins during the month of your return and extends for a maximum of 2 months following that month. Coverage under Medicare begins on the first day of the month after you complete the enrollment process.

What if I’m retired, live abroad, and want to enroll in Medicare?

If you qualify for Medicare and neither you nor your spouse are employed, you typically have the option to enroll in Medicare while residing outside the United States.

You can either pay monthly Medicare Part B premiums for coverage that is not usable outside the U.S., or you can defer enrollment until your return to the United States, which may subject you to permanent Part B late enrollment penalties.

Your decision will depend on whether you intend to live abroad temporarily or on a long-term basis. If your plan is to become a permanent expatriate, you won’t need to worry about enrolling and facing late enrollment penalties. Nevertheless, some individuals opt to return to the U.S. if their health deteriorates. In such cases, you will incur permanent Part B penalties.

If you choose to enroll in Part B while living abroad, you can initiate the process by reaching out to the nearest Social Security office, U.S. embassy, or consulate in your country of residence.

What if I’m working abroad and want to sign up for Medicare?

If you reside and work in another country, you can postpone enrolling in Medicare Part B and avoid its associated premiums without incurring a late enrollment penalty if you have healthcare coverage through any of the following:

  • Your employer, for which either you or your spouse actively work, that offers group health insurance for one or both of you.

  • The national health system of the country where you currently live, regardless of whether you or your spouse are employed by an organization or are self-employed. This postponement applies as long as one of you is still in the workforce and does not apply if both of you have retired.

  • An organization that sponsors the voluntary service you provide abroad, such as the Peace Corps.

Once you or your spouse end employment or lose your health care coverage, you become eligible for a unique 8-month Special Enrollment Period (SEP) during which you can enroll in Medicare without a late enrollment penalty. However, if you are in a volunteering capacity, the special enrollment period is only 6 months.

If you stop working or volunteering but remain abroad beyond this specified period, you must decide whether to enroll in Part B and pay premiums for coverage that can’t be used, or postpone enrollment until your return to the United States, subsequently facing permanent late enrollment penalties.

Will I be automatically enrolled in Medicare if I live overseas?

Automatic enrollment in Medicare Parts A & B is not available for individuals residing overseas. If you wish to enroll in Parts A and B while abroad, you can start the enrollment process by visiting the closest U.S. embassy or consulate located in foreign countries.

If you reside in Puerto Rico, you are automatically enrolled in Medicare Part A upon becoming eligible, but you must actively enroll in Part B.

People who qualify for Part A without paying premiums can enroll in Medicare on their own while living overseas. The Social Security Administration (SSA) provides a directory of international offices to aid in this procedure.

However, if the following conditions all apply to you, you won’t be able to enroll in Medicare Part B until you come back to the United States: You are a U.S. citizen, aged 65 or older, not eligible for Social Security, and you were living in a foreign country when you turned 65. Upon your return to the U.S., you will have a 3-month opportunity to sign up for Medicare.

Do you have to live in the U.S. to be eligible for Medicare?

In most cases, you must be a U.S. citizen or a legal permanent resident (green card holder) who has lived in the United States continuously for at least 5 years to be eligible for Medicare. However, there are some exceptions to this rule:

  • Specific categories of non-citizens, such as refugees and asylees, who may be eligible for Medicare sooner.

  • People with ESRD, regardless of their citizenship status or how long they’ve lived in the U.S. if they meet certain criteria.

  • Individuals with ALS, also known as Lou Gehrig’s disease, can be eligible for Medicare as soon as they are approved for Social Security Disability Insurance (SSDI) benefits, regardless of their citizenship or residency status.

Can dual citizens sign up for Medicare?

Yes, dual citizens of the United States can be eligible for Medicare if they meet the other eligibility criteria, such as age or disability status, and have the necessary legal residency or citizenship status in the United States, as mentioned above.

Can you enroll in Medicare if you’ve never worked in the U.S.?

Your eligibility for Medicare begins at age 65 (or earlier in certain situations) if you are a U.S. citizen (or the aforementioned qualified non-citizen or non-resident), regardless of your work history.

However, your work history becomes relevant if you wish to enroll in Medicare without paying a monthly premium for Part A and without being obligated to enroll in Part B.

A common method for individuals who haven’t accumulated the required 10 years of work credits to qualify for premium-free Medicare Part A is to rely on their spouse’s (or former spouse’s) work history to meet this requirement.

What if I return to the U.S. and want to enroll in Medicare?

If you are eligible for Medicare, you can enroll during specific enrollment periods when you come back to the U.S.

If you were eligible for Medicare but didn’t enroll while living abroad, you can enroll during your Initial Enrollment Period (IEP). Your IEP for Medicare Part A and Part B typically starts 3 months before your 65th birthday, includes your birthday month, and extends for 3 months after your birthday month. If you’re enrolling due to a disability, your Initial Enrollment Period begins during your 22nd month of receiving disability benefits.

Those who miss their Initial Enrollment Period and do not have creditable coverage can enroll during the General Enrollment Period (GEP).  The GEP occurs from January 1 to March 31 each year. Beware that there may be a late enrollment penalty for Part B if you didn’t have qualifying health coverage while abroad.

If you or your spouse had employer-sponsored group health care coverage through work while living abroad, you may qualify for a Special Enrollment Period (SEP). This allows you to enroll in Medicare without penalties when the employment or group health coverage ends.

What are the Special Enrollment Periods for those living abroad?

Special enrollment periods for Medicare beneficiaries living abroad can vary, depending on the part of Medicare:

Part A

If you do not qualify for premium-free Part A, you have a 2-month special enrollment period that begins after your return to the United States. If you do qualify for premium-free Part A, you can sign up at any time without incurring penalties.

Part B

If you or your spouse stops working and you have health care insurance in the country where you reside, you have an 8-month special enrollment period. If you have insurance through a volunteer organization and stop volunteering, your special enrollment period is 6 months. This enrollment period applies even if you haven’t returned to the United States.

Part C and Part D Medicare plans

After you return to the U.S., you have a 2-month special enrollment period for Medicare Part C (a Medicare Advantage plan) or Part D prescription drug coverage.

How does my Medicare work if I live abroad?

When you live abroad, your Medicare coverage is still in place, but it has limited scope. Original Medicare (Part A and Part B) primarily provides emergency coverage and medically necessary care while living overseas. Routine care and non-emergencies are generally not covered. If you have Medicare Advantage or Part D plans, they may not provide coverage abroad. You must continue paying Part B premiums if you want to keep it while overseas. If you move back to the U.S., you may have a special enrollment period for Part B.

Consider alternative health insurance options for comprehensive care while living abroad, such as international health insurance, national health insurance, local private health insurance, travel health insurance, etc.

Does Medicare cover you when living overseas?

Original Medicare (Part A and Part B) generally does not provide coverage for healthcare services received outside the United States, with a few exceptions. These exceptions are primarily for emergency situations or for Medicare beneficiaries who are in the United States when a medical emergency occurs.

Medicare Part A (Hospital Insurance):

Part A may cover medically necessary inpatient hospital care in a foreign country only in these limited situations:

  • You are in the United States when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your condition.

  • You are traveling through Canada without unreasonable delay between Alaska and another U.S. state, and a Canadian hospital is closer than the nearest U.S. hospital that can treat your condition.

Medicare Part B (Medical Insurance):

Medicare Part B provides more limited coverage abroad compared to Part A.

Part B may cover medically necessary doctor’s services, medical services, and outpatient services received as a result of a medical emergency while traveling abroad. This coverage is usually limited to services needed to diagnose or treat the emergency condition.

Medigap plans (Medicare Supplement) and Medicare Advantage plans

These plans may have different rules regarding coverage outside the United States. Some plans may offer limited or additional coverage for health care and emergency services abroad, but you gotta check with your specific Medicare plan for details.

A Medicare Advantage plan may also require you to live in the plan’s service area for at least 6 months annually.

Medicare Part D

Medicare Part D (prescription drug plan) typically does not cover prescription drugs purchased outside the United States. This means that if you are traveling or living abroad and need prescription medications, you will likely need to pay for them out of pocket.

While some Part D plans may have limited coverage for medications obtained at foreign pharmacies in certain medical emergencies, coverage for drugs purchased abroad is generally not comprehensive.

Also, most Part D plans require members to reside within the plan’s service area for at least 6 months annually. Check with your health insurance plan for specific rules.

What happens to your Social Security if you move to another country?

In most cases, if you are eligible for Social Security benefits in the United States, you can receive those benefits while living in another country. This includes retirement, disability, survivors, and spousal benefits.

It’s usually best to have your Social Security payments deposited directly into a bank account in the United States.

If you are currently receiving Social Security or Railroad Retirement Board benefits, the premiums for Part B are deducted automatically from these benefits.

Bear in mind that some countries have restrictions on receiving Social Security benefits while residing there. For example, if you are a U.S. citizen and move to Cuba or North Korea, you may not be able to receive Social Security payments.

Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.

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