Written by Steffan Grund · Insurance specialist (Versicherungsfachmann BWV) · Updated Facts checked: The short version: US public cover stops at the border, so cover where you live has to come from somewhere else.
| Question | Official answer | Source |
|---|---|---|
| Does Medicare pay abroad? | Generally no; only narrow exceptions (e.g. an emergency that begins in the US when a foreign hospital is closer) | Medicare.gov |
| Part B standard premium | USD 202.90 a month (higher with higher income) | Medicare.gov, 2026 |
| Part B late penalty | +10% for each full 12 months you could have had Part B but didn't; usually for as long as you have Part B | Medicare.gov |
| When can you re-enrol? | General Enrollment Period, 1 January–31 March; cover starts the month after you sign up | Medicare.gov |
| ACA Marketplace abroad? | Requirement: "Live in the United States"; plans cover US providers | HealthCare.gov |
| Federal penalty for no insurance | USD 0 for months after 31 December 2018 | IRS |
| Medigap abroad | Some plans: 80% of emergency care after USD 250, max. USD 50,000 lifetime, first 60 days of a trip | Medicare fact sheet |
| TRICARE For Life overseas | Requires Part B; TRICARE pays first | TRICARE |
| International cover for a US citizen in the US | Not covered under Care Expat World in any zone (USA = home country) | Insurer's terms |
No: Medicare generally does not pay for health care outside the United States, wherever you live. Medicare.gov lists only narrow exceptions: you are in the US when an emergency happens and a foreign hospital is closer than the nearest US one; you travel through Canada between Alaska and another state; or you live in the US and a foreign hospital is closer to your home. The Social Security Administration’s own staff manual puts it bluntly: beneficiaries "cannot use most Medicare benefits outside the United States".
Two more limits matter for retirees. Medicare drug plans (Part D) do not pay for prescriptions bought abroad. And Medicare Advantage plans may include some foreign emergency or travel benefits, but this varies by plan and is designed for trips, not for living in Lisbon or Chiang Mai. Your Medicare entitlement does not disappear when you move: it simply only pays when you are treated on US soil.
That leaves two separate jobs. The first is cover where you actually live, which comes from a local public system, a local private policy or a long-term international plan; our expat health insurance guide explains the types. The second is what you do about Medicare in the US, which is mainly a Part B question.
Keep Part B if there is a real chance you will return to the US for care or to live, and always if you rely on TRICARE For Life; drop it only if you are sure you will not need it, because the penalty is permanent. The trade-off is plain arithmetic. Keeping Part B in 2026 costs USD 202.90 a month, USD 2,434.80 a year, for a benefit you cannot use while abroad. Dropping it adds 10% of the standard premium for each full 12-month period you could have had it, and Medicare.gov says penalties are usually charged for as long as you have that coverage.
Part A is a different story. If you qualify for premium-free Part A (generally after at least 10 years of Medicare taxes), it costs nothing to keep. Only people who buy Part A (USD 311 or USD 565 a month in 2026) face a Part A decision; its penalty is 10%, paid for twice the number of years you did not sign up.
Method from Medicare.gov: 10% of the standard premium per full 12-month period without Part B, rounded to the nearest 10 cents (USD 202.90 + 20% = USD 243.50 in Medicare’s own example). Uses the 2026 standard premium unless you change it; real premiums change every year, and higher incomes pay more. Count only months after your Initial Enrollment Period in which you had no Special Enrollment Period. An estimate, not a Medicare decision.
You have five realistic building blocks, and you can combine two of them.
| Option | Where it pays | Age | Good for | Limits |
|---|---|---|---|---|
| Medicare (A + B) plus travel cover | US only (Medicare); trips (travel policy) | 65+ | People who return to the US for most care | No cover where you live; travel policies are for trips, not residence |
| Medigap foreign-travel benefit | Emergencies abroad, first 60 days of a trip | 65+ with Medigap C, D, F, G, M, N | Snowbirds and short stays | 80% after USD 250; USD 50,000 lifetime cap |
| Long-term international health insurance | Your chosen zone (Zone 1 = worldwide except USA, China, Singapore) | Care Expat World: start cover by 1 December of the year you turn 64 | Everyday and hospital care where you live, wherever you move next | Underwriting; the US is never covered for a US citizen |
| Local public system | That country only | Varies; health checks in some countries | Lower cost once you are a legal resident | Waiting lists, exclusions, residence rules; not open in every country |
| Employer or international group plan | Defined by the employer contract | While employed | Americans still working abroad | Ends with the job; check what follows at retirement |
Prices for the long-term option are on our international health insurance cost page and in the plan cards below; plan rules are on the Care Expat World page.
In six of the seven popular retirement countries we have researched, yes: a legally resident American can join or apply to the public system; Thailand is the exception. The details differ a lot, so read the country page before you count on it.
| Country | Public system | Can a US retiree join? | Cost and catch | Our country guide |
|---|---|---|---|---|
| Mexico | IMSS voluntary insurance (Seguro de Salud para la Familia) | Yes; the law does not distinguish by nationality (CURP and NSS needed) | 14,850 MXN a year at 50–59, 20,600 MXN at 60–69 (2026); listed pre-existing conditions excluded; waits up to 2 years for orthopaedic surgery | Mexico insurance |
| Costa Rica | CCSS ("la Caja") | Yes, and residents must register (GOV.UK) | Monthly premium based on income; no official rate for retirees found | Retire in Costa Rica |
| France | PUMa (Assurance Maladie) | Yes, after 3 months of stable residence, living there ≥ 6 months a year | US–France agreement has no health provisions; a contribution for non-working members is legislated but its amount awaits a decree | France insurance |
| Portugal | SNS | Yes, any legally resident foreigner can get a user number | Needs a valid residence permit, NIF and address; user fees only in hospital A&E without referral | Retire in Portugal |
| Thailand | Universal Coverage / Social Security | No: Universal Coverage is not for foreign residents (reported); Social Security needs a Thai job, which retirement visas forbid | Public hospitals may charge foreigners a higher price tier | Thailand insurance |
| Philippines | PhilHealth | Yes, foreigners with an ACR I-Card join as informal-economy members | 2024 charter: PHP 17,000 a year, PHP 15,000 for PRA retirees; confirm at enrolment | Philippines insurance |
| Panama | CSS voluntary group B2 ("ciudadanos extranjeros") | You can apply; acceptance depends on CSS medical exams | Minimum declared income B/.500 a month; you pay 100% of the exams; rate not found; older press reported a suspension | Panama visa |
Sources per row in our country fact sheets: IMSS (2026 fee table) and Mexico’s Social Security Law; GOV.UK Living in Costa Rica; service-public.fr and CLEISS; gov.pt; Thai Ministry of Public Health and reported practice; PhilHealth Circular 2017-0003 and 2024 Citizen’s Charter; CSS Panama. For a wider comparison see healthcare systems by country.
Visa rules are a separate question. Some retirement visas ask for insurance, some do not, and we make no claim that any consulate accepts a particular plan. See the Thailand, Philippines, Portugal and France visa guides, and best countries to retire for the bigger picture.
Because a US citizen’s home country is the USA, and Care Expat World covers the home country only when it is an EU or Schengen state, the plan never pays for a US citizen’s care in the US, in any zone. This is the single most misunderstood point for American buyers, so here it is in a table.
| Zone | Area | Care in the USA for a US citizen? | Care in the USA for, say, a British citizen? |
|---|---|---|---|
| Zone 1 | Worldwide except the USA, China and Singapore | No | Emergencies only, up to 42 days per trip (never for US citizens, whose home country is the USA) |
| Zone 2 | Adds China and Singapore, still without the USA | No | Emergencies only, up to 42 days per trip (never for US citizens, whose home country is the USA) |
| Zone 3 | Worldwide including the USA | No: the USA is the home country | Yes, inside the cover area |
Two consequences follow. First, an American abroad who buys Zone 3 pays more for a benefit the home-country rule cancels. Second, if you want cover for care in the US, Medicare (from 65) is the tool, which is another reason to think hard before dropping Part B. The insurer defines your home country as the one you declare where you hold citizenship or a permanent residence permit; dual US–EU citizens should ask the insurer how that applies before they apply. Our guide to international health insurance with home-country cover explains the rule in full.
With Medicare Parts A and B in force, a 2026 hospital stay costs a USD 1,736 deductible per benefit period, and doctor care costs a USD 283 yearly deductible plus usually 20%; without Part B, outpatient care has no Medicare cover at all. The official 2026 amounts:
| Item (2026) | What you pay with Original Medicare |
|---|---|
| Part A premium | USD 0 if you or your spouse paid Medicare taxes for at least 10 years; USD 311 or USD 565 a month if you buy Part A |
| Hospital stay, days 1–60 | USD 1,736 deductible per benefit period |
| Hospital, days 61–90 | USD 434 a day |
| Hospital, days 91–150 (lifetime reserve days) | USD 868 a day |
| Skilled nursing facility, days 21–100 | USD 217 a day |
| Part B premium | USD 202.90 a month, plus any late penalty |
| Part B deductible and coinsurance | USD 283 a year, then usually 20% of the Medicare-approved amount |
| Getting there if you are too ill to fly normally | Medical evacuation: USD 20,000–200,000 (US State Department) |
We found no official figure for what US hospitals charge people with no cover, so we do not quote one. The pattern is clear enough: coming home for a planned operation works best with Part B already active and a Medigap policy for the 20%; coming home for an emergency is often not possible at all, which is why cover where you live comes first. Care Expat World pays medically advised transport home, but it does not pay for treatment once you are in the US.
Generally no: HealthCare.gov lists "Live in the United States" as a requirement for Marketplace coverage and warns that Marketplace plans cover care from providers in the US. The same page says people who are US residents for tax purposes can get Marketplace coverage; whether that helps a particular citizen abroad is a question for the Marketplace, not something to assume. Either way, a Marketplace plan would not pay your doctor in Guadalajara.
The federal penalty is no longer a reason to keep one: the IRS says the individual shared responsibility payment was reduced to zero for months beginning after 31 December 2018. When you move back and live in the US again, the Marketplace is open to you on the usual terms; ask HealthCare.gov whether your move gives you a special enrolment window.
Military retirees keep TRICARE overseas, but TRICARE For Life requires Medicare Part B to stay eligible, even though Medicare itself pays nothing abroad. Overseas, TRICARE is the primary payer and you pay its annual deductible and cost-shares. For this group, dropping Part B would end TRICARE For Life, so the penalty calculator above is not the main issue.
The VA Foreign Medical Program is narrower: it pays only medically necessary care for a VA-rated service-connected disability, a condition associated with it that makes it worse, or care during Veteran Readiness and Employment. You may use any licensed provider abroad, but everything else needs other cover, such as a public system or an international plan.
Some Medigap plans pay 80% of emergency care abroad after a USD 250 deductible, up to USD 50,000 in your lifetime, for emergencies in the first 60 days of a trip. That is useful for a US-based retiree who travels, and not a solution for someone who lives abroad.
| Feature | Medigap foreign-travel emergency benefit |
|---|---|
| Plans that include it | C, D, F, G, M, N (and older E, H, I, J) |
| Deductible | USD 250 |
| Share paid | 80% of emergency care |
| Lifetime maximum | USD 50,000 |
| Time limit | Emergencies in the first 60 days of a trip |
| Use while living abroad | Not designed for it; routine and long-term care not included |
Source: Medicare fact sheet "Medicare coverage outside the United States".
Linda, 66, retiring to Portugal. She has premium-free Part A and Part B. She expects to live in Portugal for six years and then move near her children. Dropping Part B for 72 months saves 6 × USD 2,434.80 = USD 14,608.80 at 2026 premiums. The penalty would be 60%: USD 202.90 becomes USD 324.60 a month, USD 1,460.40 a year more, for as long as she has Part B. After about ten years back in the US the penalty has eaten the saving, and she also faces the January–March window. She keeps Part B and registers with the SNS as a legal resident (retire in Portugal).
Mike, 57, moving to Mexico. No Medicare until 65, and no Marketplace once he lives abroad. Mexico’s IMSS voluntary scheme costs 14,850 MXN a year at his age but excludes listed pre-existing conditions. He adds long-term international cover: Care Expat World Zone 1, Basic with a €3,600 deductible, at age 55–59 costs €200 a month (€2,400 a year); Comfort with €1,200 deductible is €505. Because he joins before 65, the contract has no end date. At 65 he will face the Part B decision too (retire in Mexico).
Carol, 62, moving to Thailand. Thailand has no public scheme for her, and her visa route decides the insurance rule (retire in Thailand). In Zone 1 at 60–64, Comfort with a €1,200 deductible costs €655 a month (€7,860 a year), Basic with €3,600 €325. When she visits Ohio, this plan does not cover her: the USA is her home country.
Bob, 72, a military retiree in the Philippines. He keeps Part B because TRICARE For Life requires it overseas; TRICARE pays first in the Philippines. He also considers PhilHealth (PHP 15,000 a year for PRA retirees in the 2024 charter). He is too old to join Care Expat World.
For comparison, Susan, 61, British, married to an American in Mexico. The UK has no reciprocal health agreement with Mexico, so no NHS or S1 cover applies (S1 works only in the EU, EEA and Switzerland; see the S1 form and filling the S1 gap). With Care Expat World her home country is the UK, which is not covered either; but with Zone 3 she would be covered in the USA when visiting her husband’s family, which he, as a US citizen, would not.
| Person | Medicare | Where they live | Main cover abroad | Monthly example |
|---|---|---|---|---|
| Linda, 66 | A + B kept | Portugal | SNS (legal resident) | Part B USD 202.90 |
| Mike, 57 | Not yet | Mexico | IMSS + international plan | €200 (Basic, 55–59) |
| Carol, 62 | Not yet | Thailand | International plan | €655 (Comfort, 60–64) |
| Bob, 72 | A + B (TRICARE condition) | Philippines | TRICARE For Life (+ PhilHealth option) | Part B USD 202.90 + TRICARE cost-shares |
Generally yes: US citizens can usually receive Social Security abroad, often by direct deposit, with Federal Benefits Units at US embassies to help. SSA restricts payments to a small number of countries, so check its list before you choose a destination. Remember that a Social Security payment reaching you abroad does not change Medicare: the benefit travels, the health cover does not.
| Age | What to do |
|---|---|
| 50–63 | Move abroad with long-term international cover plus the local public system where allowed; no Medicare yet |
| Year you turn 64 at the latest | Last calendar year to apply for Care Expat World (closed from the year you turn 65; see international health insurance age limits) |
| Around 65 | Medicare Initial Enrollment Period: take Part A; decide on Part B with the penalty in mind |
| Any year you move back | Re-enrol in Part B in January–March; cover starts the next month |
The plan featured on this site. We earn a referral commission if you take it out, at no extra cost to you (how we are paid); this is information, not personal advice. Lowest prices (Basic, €3,600 deductible): €140 at 50–54, €200 at 55–59, €325 at 60–64; €40 for ages 0–24.
Lowest price, for people who mainly want protection against large medical bills.
Per month, Zone 1. Lower price with a €3,600 deductible, higher with none.
Adds dental, check-ups, physiotherapy, psychotherapy and pregnancy cover to Basic.
Per month, Zone 1. Lower price with a €3,600 deductible, higher with none.
Highest refunds, including more psychotherapy and 80% for dentures.
Per month, Zone 1. Lower price with a €3,600 deductible, higher with none.
Prices are Zone 1 (worldwide except the USA, China and Singapore). A US citizen is not covered in the USA in any zone; every benefit and cap is listed on the Care Expat World plan details page. Already 65 or older in the year cover would start? This plan is closed to you; we are preparing a comparison of plans without an entry-age limit.
There is no single best plan. Under 65, the usual building blocks are a long-term international policy plus, where foreigners may join, the local public system. From 65, Medicare adds the Part B decision but still does not pay abroad. Compare the options table on this page against your age, health and where you will live.
No, apart from narrow exceptions. Medicare.gov says Medicare generally does not pay for care outside the US, and the SSA staff manual says beneficiaries "cannot use most Medicare benefits outside the United States". Your Medicare entitlement stays, but it pays only when you are treated in the US.
Keep it if you expect to come back to the US for care or to live, or if you have TRICARE For Life (which requires Part B overseas). Dropping it saves USD 202.90 a month in 2026 but adds 10% to your Part B premium for each full 12 months without it, usually for life, and you can only re-enrol from January to March.
Medicare.gov adds 10% of the standard premium for each full 12-month period you could have had Part B but did not. Its own example: a 2-year gap gives 20%, so the 2026 premium of USD 202.90 becomes USD 243.50 a month. The penalty is usually charged for as long as you have Part B.
Medicare.gov lists one only for people who volunteered in a foreign country with a qualifying organisation. We found no Special Enrollment Period for simply living abroad, so most returning retirees use the General Enrollment Period (1 January to 31 March) and pay the penalty.
The month after you sign up, and you can only sign up between 1 January and 31 March (General Enrollment Period). If you move back in May, the earliest Part B start is 1 February of the following year unless you qualify for a Special Enrollment Period.
Premium-free Part A (generally after at least 10 years of Medicare taxes) costs nothing to keep, so there is no reason to drop it. If you must buy Part A, it costs USD 311 or USD 565 a month in 2026, and its late penalty is 10% for twice the number of years you did not sign up.
HealthCare.gov lists "Live in the United States" as a Marketplace requirement and warns that Marketplace plans cover care from US providers. The same page mentions people who are US residents for tax purposes; if that might apply to you, ask the Marketplace before relying on it. Either way, a Marketplace plan does not pay for care in Mexico or Portugal.
Not at federal level. The IRS says the individual shared responsibility payment was reduced to zero for months beginning after 31 December 2018. If you keep a US address, ask your state whether it has its own rule; we did not research state mandates.
Only for travel emergencies. Medigap plans C, D, F, G, M and N (and older E, H, I, J) pay 80% of emergency care abroad after a USD 250 deductible, up to USD 50,000 in a lifetime, in the first 60 days of a trip. That is travel cover, not cover for living abroad.
Some plans include limited foreign emergency or travel benefits; Medicare.gov says this varies by plan. Advantage plans are tied to a US service area, so ask the plan in writing what happens to your enrolment if you move abroad.
Yes. TRICARE says: if you live overseas, you must have Medicare Part B to remain eligible for TRICARE For Life. Overseas, TRICARE pays first and you pay its yearly deductible and cost-shares. Dropping Part B to save money would end that cover.
Through the Foreign Medical Program, but only for a VA-rated service-connected disability, a condition that is associated with and makes it worse, or care during Veteran Readiness and Employment. You can use any licensed provider abroad. Other conditions need other cover.
Insurers price their plans by area of cover, and many sell a lower-priced zone without the USA. Care Expat World Zone 1 covers the world except the USA, China and Singapore; Zone 3 adds the USA at a higher price. For a US citizen, though, the USA is the home country.
No, in no zone. The binding terms cover the home country only if it is an EU or Schengen state; the US is neither. Trips to a country outside your zone are covered for emergencies only, up to 42 days per trip, but that rule does not reach your home country.
Possibly. Care Expat World’s terms define the home country as the one you declare, where you hold citizenship or a permanent residence permit, and home cover applies only to EU or Schengen home countries. How a dual US–EU citizen should declare is a question for the insurer before you apply.
At 60–64 there is no Medicare yet, and Marketplace plans need US residence. Care Expat World in Zone 1 costs €325–€800 a month at 60–64, depending on level and deductible; local public systems are an option in Mexico, Costa Rica, France, Portugal, the Philippines and Panama.
Not Care Expat World: you must cover must start by 1 December of the year you turn 64. Joined in time, the contract has no end date and no age at which cover stops. We are preparing a comparison of plans without an entry-age limit for people who are already 65.
Yes. Nothing in the Medicare or Care Expat World rules we read stops you holding both. Medicare would pay for care in the US, the international plan for care in your zone outside the US; neither covers the other’s territory for a US citizen.
Generally yes for US citizens. SSA pays into many countries by direct deposit and has Federal Benefits Units at US embassies, but it lists a few countries where it cannot send payments; check SSA’s list before you move. Receiving Social Security abroad does not make Medicare pay abroad.
SSA’s manual names Form CMS-1763, "Request for Cancellation of Medicare Part B", which SSA staff give to enrolled beneficiaries who move abroad. Before you sign it, work out the lifelong penalty with the calculator on this page; cancelling is easy, coming back is not.
From our country research: Mexico (IMSS voluntary insurance), Costa Rica (CCSS, mandatory for residents), France (PUMa after 3 months of stable residence), Portugal (SNS for legal residents), the Philippines (PhilHealth for foreigners with an ACR) and Panama (CSS voluntary group for foreigners, after medical exams). Thailand has no public scheme for retirees.
Not as visitors, and not always free as residents. A legally resident American can join France’s PUMa after 3 months of stable residence (a contribution for non-working members is legislated but its amount awaits a decree) and can get a Portuguese SNS user number with a residence permit, NIF and address. The US–France agreement has no health provisions, and Medicare generally pays nothing abroad.
With Medicare, a 2026 hospital stay costs the USD 1,736 Part A deductible per benefit period, then USD 434 a day from day 61. Doctor care costs the USD 283 Part B deductible plus usually 20%. Medical evacuation can cost USD 20,000–200,000 (US State Department). Without Part B, outpatient care is not covered.
No. Medicare.gov says Medicare drug plans do not cover prescriptions bought outside the US. Abroad, a local public system or an international plan with prescription cover pays instead.
Possibly, after underwriting. Care Expat World runs a health interview by video call; the insurer can accept you normally, add a surcharge, exclude a condition or decline. Local public systems differ too: Mexico’s IMSS voluntary scheme, for example, excludes listed pre-existing conditions.
For Medicare, yes: each person has their own Part A and Part B and their own penalty. For international insurance, each person is underwritten and priced by their own age band, and the 65 entry limit applies to each of you separately.
Medicare amounts are for 2026; 2027 amounts had not been published when we checked. This page is general information, not legal, tax or Medicare advice; Medicare and SSA decide your case.
Medicare stays at the US border. Apply for long-term international cover before the year you turn 65, and it stays with you wherever you settle next.
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