Decisions about Medicare enrollment can be complicated if you live outside the United States. Living outside the U.S. means you do not live in the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands. Although Medicare does not typically cover medical costs you receive when you live abroad, you still need to choose whether to enroll in Medicare when you become eligible or to turn down enrollment. This requires considering:

  • Whether you plan to return to the U.S.
  • Whether you are working or volunteering outside the U.S.
  • The potential costs of delayed enrollment

If you are 65 or older and qualify for Medicare, you can enroll in Medicare Parts A and B, also known as Original Medicare, either before or after you leave the U.S. Remember, though, that Medicare will typically not cover any medical care you receive outside the U.S. Since most people pay no premium for Part A coverage, it is usually best to keep Part A, even if you are moving abroad, because it is free. If you do not qualify for premium-free Part A, you may only be able to enroll in Medicare if you live in the U.S. To have Part B coverage, you must pay the monthly Part B premium. You may want to keep Part B if you plan to move back to the U.S. in the future or visit frequently. This is because paying the premium to keep Part B when abroad will ensure that Medicare will cover your care whenever you travel to the U.S., and that you will not face premium penalties or gaps in coverage.

If you fail to pay for Part B while abroad, when you move back to the U.S. you may go months without health coverage. This is because you may have to wait until the General Enrollment Period (GEP), which runs January 1 through March 31 each year, with coverage starting the first of the month after the month you enroll.

If you have a Medicare Advantage or Medicare Part D plan before you move abroad, you should disenroll and stop paying these premiums when you move because these plans require that you live in their service area in order to be enrolled.

Note that this information only applies if you are living abroad; it does not apply if you are simply taking a trip. If you have specific questions, contact the Social Security Administration (800-772-1213) or the Consulate or Embassy in your country of residence before making any final decisions about Medicare enrollment.