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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.”

How do you prove that you’re now a resident in the United States?

Social Security officials say that you don’t have to reside in the United States for any minimum period of time to be considered a resident. But if they have any doubts about your residency, you’d have to show evidence, which might include any (though not all) of the following:

  • Proof of employment or a record of regular volunteer activity.
  • Proof of U.S. home ownership, a rental lease, or rent payment record.
  • Income tax or property tax forms or receipts.
  • Utility bills addressed to you.
  • U.S. driver’s license.
  • Records showing dates of regular medical treatment or services received from a social agency.
  • Evidence of regular involvement in social programs such as vocational rehabilitation, Meals on Wheels or services received from a social agency.

If you are applying for Medicare benefits very shortly after returning home, before you’ve had time to establish any of those signs of residence, it might help to show more immediate evidence—for example, that you arrived back in the country on a one-way ticket, had shipped home personal possessions, had retired from or terminated employment overseas, etc.

When will your Medicare coverage start?

Under Social Security rules, coverage for Part A and Part B begins according to when you enroll. Here’s an example:

If you return to live in this country in June, then this is the first month of eligibility in your four-month initial enrollment period. If you sign up in June, your coverage begins July 1. If you sign up in July, coverage begins two months later on September 1. If you sign up in August, coverage begins three months later on November 1. If you sign up in September, coverage begins three months later on December 1. But if you fail to sign up by September 30, the last day of your IEP, you must wait until the next open enrollment period (January 1 to March 31), and your coverage will begin the following July 1.

How long does it take to process the application? Social Security officials say that barring impediments (such as issues over your date of birth or lack of evidence establishing residency), it can be processed overnight. If such issues arise, they must be resolved before your application is accepted.

If you sign up for Part D drug coverage within the two-month special enrollment period that starts on the day of your return, your coverage begins the first day of the month after you enroll in a Part D drug plan. You don’t have to offer evidence of residency, but you must join a plan that serves the area in which you live. Once this enrollment period has expired, you would have to wait until the next annual enrollment period (Nov. 15 to Dec. 31) to sign up, with coverage beginning Jan. 1. In this case, you’d probably pay a late penalty.

Patricia Barry is a senior editor at the AARP Bulletin.

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