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Ask Ms. Medicare

Can You Buy Into Medicare if You Live Overseas?

If you don't have enough work credits to qualify for Medicare, you can buy into Part A by paying full premiums only when you return to the United States.

Q. I’m a U.S. citizen, age 68, recently diagnosed with prostate cancer. As I’ve been living overseas for many years, I haven’t enough work credits to qualify for Medicare. Can I buy into Medicare Part A if I need to go to the U.S. for treatment?

A. You can buy into Part A (hospital insurance) by paying full premiums only if and when you return to the United States to live. You cannot buy into the program while your permanent address is in another country.

(In contrast, U.S. citizens who live overseas but have enough credits to qualify for Part A without paying a premium can sign up during their initial enrollment period around the time of their 65th birthday at the nearest U.S. Embassy or consulate.)

It doesn’t matter whether you’ve maintained an address and telephone number in this country, are on the electoral register, have family living here, return on regular visits, or keep regular links in any other way. Under Social Security rules, you must reside permanently within the United States or its territories to buy into Part A. A person cannot establish residency in two places at the same time, officials say.

What should you do when you return to live in the United States?

When you return, you’ll have an initial enrollment period (IEP) to buy into Part A and to enroll in Part B (doctors’ and other outpatient services), regardless of how long you’ve lived outside the United States or how many years have passed since you turned 65.

This IEP begins during the month of your return as a U.S. resident and expires at the end of the third month after the month of your return. (For example, if you return in July, your IEP expires Oct. 31.) If you don’t sign up within this time frame, you must wait until the next open enrollment period (January 1 to March 31).

To buy into Part A, you must also enroll in Part B. To sign up for both, call Social Security at 1-800-772-1213 to apply on the phone or to make an appointment at your local Social Security office. You must do so from within the United States after your return.

If you also wish to enroll in Part D (prescription drug coverage), the rules are different. Joining Part D is voluntary, but to be sure of avoiding a late penalty, you should sign up with a Part D drug plan during the special enrollment period that lasts two months from the day of your return to the United States. For more information on Part D, see our consumer guide “Medicare Prescription Drug Coverage: Your Questions Answered.”

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