Expats who delay Medicare Part B enrollment while living abroad face a 10% premium penalty for every 12-month period they were eligible but not enrolled. These penalties are permanent and lifelong. Additionally, a 1% per month penalty applies to Part D (drug coverage) if you go without it.
In most situations, Medicare won't pay for health care or supplies you get outside the U.S. The term “outside the U.S.” means anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
Deciding whether to maintain coverage
It's important to understand that Medicare typically doesn't provide coverage for healthcare expenses incurred overseas. This means you may need to enroll in private insurance or your country of residence's public healthcare system (if eligible).
If you have moved outside the United States permanently, you should decide whether to keep Medicare Parts A and B. Remember, you can have Medicare while you live abroad, but it will usually not cover the care you receive. Most people qualify for premium-free Part A, meaning you will pay nothing for coverage.
You may get disenrolled from your Medicare Advantage plan and returned to original Medicare if you travel outside the U.S. for more than six months. Medicare Advantage coverage and rules vary from plan to plan—so be sure to check with your plan provider before traveling outside the country.
Here are some of the biggest Medicare mistakes to avoid:
Establish an Irrevocable Trust
Cash, property, and investments can be transferred into an irrevocable trust. By doing so, these assets would be removed from Medicaid's calculation. However, this trust would need to be established at least five years before applying for Medicaid to avoid lookback scrutiny.
Because the US requires all Americans to file US taxes globally, many expats are also required to pay US social security tax and Medicare Tax.
U.S. Medicare does not provide medical cover when you have been living outside the country for more than six months. You will need to purchase an international health plan to cover your medical expenses abroad, instead.
If you earned Social Security benefits, you can visit or live in most foreign countries and still receive payments. Look up the country on the Payments Abroad Screening Tool to find out if you can collect your Social Security payments or survivor benefits.
If you live in a foreign country when you turn 65 and first qualify for Medicare, you can sign up by requesting enrollment forms from the United States Embassy or Consulate in the country where you currently live.
Medicare does not pay for medical services you receive outside the United States.
Does Medicare check your bank account? Medicare examines your bank accounts and other assets when you seek financial help with Medicare costs. However, eligibility criteria and verification procedures differ by state of residence. In certain states, there are no asset limits for Medicare savings programs.
To avoid the Medicaid 5-Year Lookback Period effectively, you must transfer your assets into the irrevocable trust (also called a Medicaid Trust) well before you apply for Medicaid benefits —preferably, at least 5 years and one day before. Keep in mind that not just any irrevocable trust will do.
Generally, you're first eligible to sign up for Part A and Part B starting 3 months before you turn 65 and ending 3 months after the month you turn 65. (You may be eligible for Medicare earlier, if you get disability benefits from Social Security or the Railroad Retirement Board.)
Vermont, Utah and Minnesota topped the Commonwealth Fund's Medicare performance scorecard in 2025, whereas Kentucky, Mississippi and Louisiana struggled the most.
If you want to drop your Part B coverage while you are out of the country, you must notify the Social Security Administration. Your Part B benefits — and premiums — will continue for one more month after the month you notify Social Security that you wish to cancel.
Top 5 most popular countries for expats right now
Your monthly Social Security payments continue regardless of your new citizenship status or residence in a foreign country. However, while your entitlement remains, your tax obligations regarding these payments can become more complicated once you become a non-resident alien (NRA).