Does Medicare cover you abroad? It does not. There is a small set of exceptions, narrow enough to ignore when you are planning a move, and the benefit you paid into for forty years stops working the moment the plane lands.
The Part B decision
That leaves a choice nobody enjoys, and it has no clean answer.
Keep paying the Part B premium and you protect coverage for visits home, while paying for everything abroad privately on top. You are buying two systems and using one.
Drop it and you face permanent late-enrolment penalties if you ever move back. The penalty is not a one-off; it is added to the premium for as long as you hold the coverage.
Either way, routine medicine abroad becomes a private purchase, and the question changes from “is healthcare cheaper there” to “what does a private purchase actually cost in that country”.
What that purchase costs
Americans pay $1,472 a year out of pocket even with Medicare. Here is what residents pay in the countries Americans most often move to.
| Country | Out of pocket / year | Total health spending / person | Share |
|---|---|---|---|
| Thailand | $106 | $1,067 | 9.9% |
| Mexico | $564 | $1,368 | 41.2% |
| Portugal | $1,371 | $4,679 | 29.3% |
| Spain | $1,029 | $4,935 | 20.9% |
| Colombia | $250 | $1,709 | 14.6% |
| Costa Rica | $465 | $1,928 | 24.1% |
| Panama | $1,342 | $3,318 | 40.5% |
| Malaysia | $535 | $1,441 | 37.1% |
| Philippines | $249 | $560 | 44.4% |
| Greece | $1,185 | $3,454 | 34.3% |
| Italy | $1,151 | $4,866 | 23.6% |
| France | $622 | $6,719 | 9.3% |
Read the two numbers together
A low out-of-pocket figure can mean the system covers people well. It can also mean the system is small and people simply do not get treatment. That is why total spending per person matters: it is the ceiling on what the system can do at all.
Out-of-pocket cost is what a normal year costs you. Total spending is what is available when a year goes wrong.
The cost that stays out of every spreadsheet
For anything major, a large share of American retirees abroad come home for treatment — sometimes because the depth is not there, sometimes to be near family, sometimes because the specialist they trust is in Cleveland.
That decision carries a bill: last-minute flights, often two because somebody travels with you, accommodation near the hospital, and American prices at the other end. It appears in no country comparison and it is the line that most often turns a workable plan into an unworkable one.
Sources
Medicare coverage rules from medicare.gov. Out-of-pocket and total health expenditure per capita, PPP adjusted, from the World Bank.