U.S. residents who live outside the U.S. have additional considerations when enrolling in Medicare. U.S. territories such as Puerto Rico, the Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands are not considered as residing “outside the US.” Whether you choose to enroll in Medicare during your initial enrollment period or delay enrollment is influenced by several factors including how long you plan on working or volunteering outside the U.S., whether you plan to return to the U.S. (intermittently or permanently), and the costs related to delaying enrollment.
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. The Social Security Administration (SSA) should also send you a letter explaining that you have entered your Initial Enrollment Period (IEP), along with a form to request an enrollment packet. It’s a good idea to keep copies of any forms that you complete. If possible, it’s also best to send paperwork via certified mail to ensure their delivery.
Since most Americans do not pay for Part A, it is generally recommended to enroll in Part A, whether or not you elect Part B. You can keep both Medicare Part A and Part B while you live abroad, however, Medicare will not provide coverage for your healthcare outside of the U.S. Additionally, you will have to continue to pay your Part B premiums and applicable IRMAA surcharges while living abroad. If you do not anticipate returning to the U.S. at some point and/or won’t be traveling back and forth to the U.S., it’s important to consider whether the cost of maintaining Medicare Part B coverage has value to you. If you do anticipate traveling to or returning to the U.S. after Medicare enrollment, you may want to consider keeping your Part B coverage active. In doing so, you won’t be subject to a Late Enrollment Penalty, which is applied if you delay enrollment in Part B.
It’s also important to note that if you do not enroll in Medicare during your IEP or keep Part B when you are residing outside the United States, you may have to wait until the General Enrollment Period (January 1- March 31 annually) to sign up for Part B coverage, which could result in gaps in coverage.
Further, suppose you designate an address outside the U.S. as your primary address with Social Security. In that case, you cannot enroll in a stand-alone drug plan or a Medicare Advantage plan until you return to the U.S. Separate arrangements will need to be made for coverage overseas as Medicare does not provide coverage outside of the U.S. However, if you designate a U.S. address with Social Security as your primary residence (you reside outside the U.S. some of the year), you may be able to fully enroll in a Part D drug plan and a supplemental plan or a Medicare Advantage plan.
Some important caveats to consider:
- If you have a Medicare Advantage or Medicare Part D plan before you move abroad, you must 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. You will be entitled to a special enrollment period which lasts from the month before you move until two months afterward to re-enroll in these coverages when you return to the U.S. For example, if you move back to the U.S. in April, your SEP is March through the end of June.
- If you don’t enroll in a Medicare Supplemental (“Medigap”) plan during your IEP and before moving abroad, you will have to go through medical underwriting to enroll in this coverage, unless you are returning to a state that permits guaranteed enrollment in a Medigap plan at any time. (link to article) If that does not apply to you, or you do not pass medical underwriting for a Medigap plan, your other option when you return to the U.S. is to enroll in a Medicare Advantage plan to cap out-of-pocket medical expenses.
- If you have active Part A and Part B coverage but have never enrolled in a Part D prescription drug plan or a Medicare Advantage plan, you are entitled to a SEP when you return to the U.S. This SEP begins the month before you move and lasts until two months afterward for a stand-alone Part D prescription drug plan or a Medicare Advantage plan with drug coverage.
Last updated on January 25th, 2023
