Does Medicare cover you abroad? Almost never. Yet the part people keep paying for, Part B, costs $202.90 a month in 2026, which is $2,434.80 a year, usually taken straight out of the Social Security check. Against the average retired worker’s benefit of $2,086 a month, that’s close to a tenth of the income, spent on coverage that switches on only when you’re back in the US.
So everyone who moves abroad after 65 faces the same choice. Keep paying for a benefit that works on visits home. Or drop it, and pay a penalty for life if you ever move back.
Both doors have an exact price. Plenty of people choose one by never deciding.
Does Medicare cover you abroad? What the rules say
Medicare’s own coverage page is short about it: Medicare usually doesn’t cover health care outside the US. “The US” means the 50 states, DC, Puerto Rico, the US Virgin Islands, Guam, the Northern Mariana Islands and American Samoa. Everywhere else is outside.
The exceptions are narrow, and they’re written for travelers:
- You’re in the US when an emergency happens, and a foreign hospital is closer than the nearest US hospital that can treat you.
- You’re driving through Canada by the most direct route between Alaska and another state, and a Canadian hospital is the closest.
- You live in the US and a foreign hospital happens to be closer to your home than the nearest US one.
- You’re on a cruise ship in a US port, or within six hours of one.
None of these is a plan for living in Lisbon or Mérida. Medicare drug plans don’t cover prescriptions bought outside the US either. Medigap policies may cover emergency care while you travel, but that’s travel.
In Spain, where I live, the public system’s buy-in for a resident over 65 is €157 a month, about $179, once you’ve been registered for a year. That’s less than Part B, and it works here. Part B doesn’t.
What you’re actually paying for
Part B abroad buys one thing: coverage that starts working when you land in the US. For someone who flies home for surgery or spends summers with family, that’s real. It just isn’t what most people think they’re paying for.
Part A is a separate decision, and an easy one. About 99% of beneficiaries pay no Part A premium, because they have at least 40 quarters of Medicare-covered work, their own or a spouse’s. It costs nothing to keep. It won’t help in a hospital abroad, though it will if you fly home for treatment (the 2026 hospital deductible is $1,736 per benefit period).
One more wrinkle. Higher incomes pay more for Part B: single filers above $109,000 of modified adjusted gross income and joint filers above $218,000 start at $284.10 a month in 2026. That changes the size of both doors below, not which one is cheaper.
The arithmetic of keeping it or dropping it
Door one: keep it. You pay $2,434.80 a year, every year, and the premium rises most Januaries. It went from $185.00 in 2025 to $202.90 in 2026, an increase of $17.90.
Door two: drop it, or never take it. You pay nothing while you’re away. But the late enrollment penalty is an extra 10% for each full year you could have had Part B and didn’t, and for most people it lasts as long as they have Part B. Medicare’s own example: two years late adds $40.58, for a monthly premium of about $243.50 in 2026.
Here’s what that looks like at today’s premium:
| Years abroad without Part B | Premiums you’d have paid | Penalty when you return | Extra you pay per year, for life |
|---|---|---|---|
| 5 | $12,174 | +50% ($101.45 a month) | $1,217.40 |
| 10 | $24,348 | +100% ($202.90 a month) | $2,434.80 |
| 15 | $36,522 | +150% ($304.35 a month) | $3,652.20 |
| 20 | $48,696 | +200% ($405.80 a month) | $4,869.60 |
Divide the second column by the fourth. Every row gives the same answer: ten years.
That’s the whole decision. It doesn’t matter how long you were away. If you expect to live more than about ten years after moving back, dropping Part B is the more expensive door. If you never move back, dropping it costs nothing at all.
And inflation doesn’t rescue you. The penalty is a percentage of the standard premium, so it rises with it. A 100% surcharge in 2026 is still a 100% surcharge in 2036.
Which door you’re already standing at
The default depends on when you leave, and it catches people in both directions.
If you had Part B before you moved, nothing happens. The premium keeps coming out of your check, month after month, for coverage that doesn’t work where you live. It’s easy to miss for years.
If you turn 65 while already abroad, the opposite happens. Social Security’s operating manual and the section next to it on automatic enrollment are blunt: the law excludes people living outside the US from automatic enrollment. You’re told about Part B and advised that if you want it, you must file a request.
No card arrives. The clock starts anyway.
Back home, none of this is a decision. You turn 65, you’re enrolled, the card comes. Crossing the border turns an automatic process into a form you have to know exists.
The rule that runs backwards
This is the part I’d want to know first.
Are you on the penalty clock at all? That depends on Part A, not Part B. Under that same manual section, someone living abroad can enroll in Part B only if they’re eligible for Part A.
If you qualify for premium-free Part A, you could have enrolled from abroad all along. So your initial enrollment period ran around your 65th birthday, and every full year since then is another 10%.
If you’re a US citizen over 65 living abroad and don’t qualify for premium-free Part A, on your own record or a spouse’s, you can’t enroll from abroad at all. Because that door is shut, the manual reopens it when you come back: the month you return to live in the US counts as the fourth month of a fresh initial enrollment period. Sign up then and there’s no penalty for the years away.
Read those two in order. The American who worked 40 quarters and earned free hospital cover is the one on the clock. The one who didn’t gets a clean start on return.
It doesn’t look like anyone designed it. It falls out of a rule that Part B is only sold to people eligible for Part A, or who live in the US. It’s still the rule, and it lands hardest on the people who paid in longest.
Three things returning retirees count on, and can’t
“I’ll get a Special Enrollment Period when I move back.” Retirees don’t. The list covers people who worked past 65 with employer coverage, certain TRICARE beneficiaries, people hit by a declared emergency or disaster, people misled by an employer or health plan, people leaving incarceration, and people losing Medicaid. And people who volunteered abroad: at least 12 months with a tax-exempt organization, with health coverage the whole time. Volunteer in Guatemala and you’re protected. Retire in Guatemala and you aren’t.
“I’ll use the exceptional-conditions period.” CMS says in writing that it won’t be granted for forgetfulness or lack of knowledge. Choosing to live abroad isn’t a condition outside your control.
“I’ll sign up the day I land.” Without a special period you wait for the General Enrollment Period, January 1 to March 31, and coverage starts the month after you sign up. Come home in April, sign up in January, and you’re covered from February 1. That’s ten months with nothing underneath you, and with a new diagnosis that gap can matter more than the penalty.
How I’d decide
- Ask whether you’ll ever live in the US again. Not visit. Live. For a parent, a grandchild, a diagnosis. If the honest answer is “maybe,” the arithmetic tilts toward keeping Part B fast. Ten years of life after a return isn’t a long bet at 65.
- Check which group you’re in. Your quarters of coverage are on your Social Security statement, in your online account. Forty is the number.
- Price your own premium. $202.90 is the standard; yours may be higher.
- Price what replaces it abroad. A private policy, or the public system where you’ll live. See expat health insurance age limits and public healthcare for foreign residents.
- Write the decision down, with the date. The expensive mistakes here are rarely the wrong choice. They’re three years of a premium nobody noticed, or eight years of a clock nobody mentioned.
If you’re already weighing the move home, moving back to the US covers the rest of that list.
This is journalism, not advice. I’m not a broker or an agent, I don’t have an arrangement with any insurer, and a decision this size is worth checking against your own record with Social Security, which handles Part B enrollment.
