For Americans 65 and older who move abroad, Medicare is an easy decision to make by default. Either the premiums keep running for coverage that barely works overseas, or Part B is dropped without anyone doing the math on coming back.
Both can be the right answer. Neither should be an accident.
What Medicare covers abroad
The general rule is simple: Medicare usually does not cover health care outside the United States. The published exceptions are narrow. They mostly involve a foreign hospital being closer than the nearest U.S. hospital, for someone in the U.S. or traveling between Alaska and another state. Medicare drug plans do not cover prescriptions bought abroad. Some Medigap policies cover emergency care during foreign travel.
For someone actually living in Europe, Medicare is largely unusable day to day.
The cost of dropping Part B
- 2026 standard Part B premium: $202.90 a month
- Late enrollment penalty: 10% added for each full 12-month period you could have had Part B and did not
- How long it lasts: usually for as long as you have Part B, which for most people means for life
Drop Part B for five years, come back, and you would typically pay a 50% surcharge on every future premium.
Part A and Part D work differently
Part A. Most people pay no premium because they have at least 40 quarters of covered work. For them, keeping Part A costs nothing.
Part D. This detail is easy to miss. CMS guidance does not count days when you did not live in the service area of any Part D plan, and it lists living abroad among those circumstances. In practice, months spent living abroad do not build up a Part D penalty the way missed Part B months do.
No special pass for returning expats
It is easy to assume there is a special enrollment period for people moving back. In general, there is not.
- The employment-based special enrollment period turns on current employment with group coverage, not on where you lived
- The exceptional-circumstance periods added in 2023 do not include residence abroad
- A statutory period does exist for certain international volunteers serving through a tax-exempt organization
Whether a foreign employer’s group plan qualifies is not clearly addressed in the guidance. I would not assume it does.
What covers you in Europe instead
Access to public systems depends on the country, and Portugal and Spain work differently.
Portugal. A foreign national with legal residence can obtain an SNS user number and access care on terms equivalent to nationals.
Spain. Economically inactive residents typically use the convenio especial, a paid subscription. As published by the Ministry of Health:
- €60 a month under 65, and €157 a month at 65 and over
- At least one continuous year of residence in Spain first
- Outpatient prescriptions are paid in full by the patient. For a retiree on regular medication, that is the key term
Visa-stage insurance is a separate requirement, set by immigration rules. Spain’s non-lucrative residence route requires comprehensive health insurance from an insurer authorized in Spain. Portugal requires travel insurance covering medical expenses and repatriation for the residence visa.
How I frame the decision
The Medicare question has two halves that interact: what covers care where you live, and what happens to Medicare in the meantime. The second half depends on:
- How likely you are to move back to the U.S., and when
- Whether your Part A is premium-free
- Whether any employment-based enrollment period will be available to you
- Your age, your health, and the quality of cover in your new country
Put the Part B premium, the potential penalty and your realistic odds of return on one page. The answer is usually clearer than it first appears.
Important disclosures
Medicare and health coverage rules depend on your age, work history and circumstances. Confirm your options with Medicare, the Social Security Administration and a licensed insurance professional. This is not a recommendation to purchase, keep or drop any insurance product.
Educational information only. This article is for general educational and informational purposes only. It is not personalized tax, legal, immigration, investment, financial planning, insurance, accounting or estate planning advice, and it cannot account for every reader’s citizenship, residence, domicile, tax status, objectives or jurisdiction. Consult appropriately qualified U.S. and local professionals before making decisions or taking action.
No professional relationship. Reading this article, contacting me or submitting a form does not create an advisory, fiduciary or other professional relationship. A professional relationship is created only through a separate written agreement.
Investments. Investing involves risk, including possible loss of principal. Past performance does not guarantee future results. Examples, figures, rates of return, withdrawal rates, exchange rates and scenarios are educational only, and actual outcomes may differ. Nothing here is an offer to sell or a solicitation of an offer to buy a security, a recommendation to buy, sell, hold or exchange an investment or insurance product, or a promise of performance or results. Investment advisory services, where referenced, are offered only through an appropriately registered investment adviser under a separate written client agreement.
Tax, legal and immigration rules change. These rules are complex, fact dependent and subject to change. Deadlines, thresholds, tax rates, treaty provisions and reporting obligations may change after publication. Figures are as of September 2026. This site does not provide tax preparation, immigration filing or legal representation.
Third-party links. Links to other websites, including US Expat and government sources, are provided for convenience. I do not control and am not responsible for their content, and a link is not an endorsement.
Accuracy and availability. I aim to provide reliable content but cannot guarantee that it is complete, current or error free. Services referenced may not be available in every jurisdiction. Confirm current information with a qualified professional before acting.
A longer version with full sources appears on US Expat: Health Cover Abroad: What Medicare Does Not Do.