En español | Generally, yes. Even though Medicare doesn’t typically cover care you receive outside of the United States and its territories, you may turn 65 while living abroad.
Whether you can — or should — enroll in Medicare while living outside the country depends on your answers to a few questions:
If you’re eligible for Medicare and neither you nor your spouse is working, you usually can enroll in Medicare while living outside the U.S. But you have a difficult decision to make: Either pay monthly Medicare Part B premiums for coverage you can’t use outside the United States, or delay enrollment until you return to the U.S. and then become liable for permanent Part B late enrollment penalties.
Your decision may hinge on whether you plan to live out of the country for a short while or long term. If you plan to be an expatriate permanently, you won’t need to worry about signing up and late enrollment penalties.
But some people do decide to return home if their health takes a turn for the worse. If that happens, be aware that you will face permanent Part B penalties.
If you decide to sign up for Part B while abroad, you can do so by contacting the nearest U.S. embassy or consulate in the country where you live. You can find contact information on the Social Security Administration’s international webpage.
You can delay enrollment in Medicare Part B and avoid its premiums without a late enrollment penalty if you have health care coverage from any of the following:
When you or your spouse stops working or loses your coverage, you’ll be eligible for an eight-month special enrollment period (SEP) to sign up for Medicare without having to pay a late enrollment penalty. But if you’re volunteering, the special enrollment period is only six months long.
If you stop working or volunteering but don’t return to the United States within that time, you’ll have the same dilemma that non-working people abroad face: Either sign up for Part B and pay premiums for coverage you can’t use or delay enrollment until your return to the U.S. and then become liable for permanent late penalties.
People who aren’t eligible for premium-free Part A because they or their spouse has not paid Medicare taxes at work for at least 40 quarters cannot sign up for Part A or Part B outside of the United States. So in this specific circumstance, you can delay Medicare enrollment until your return without facing late penalties, regardless of how long you lived outside the U.S. or how many years have passed since you turned 65.
Your special enrollment period begins during the month of your return as a U.S. resident and lasts for up to two months afterward. Coverage begins on the first day of the month after you enroll.
Part D prescription drug coverage has different rules, whether you’re working or not. If you enroll in a Part D drug plan within two months of returning to the United States, your coverage will start on the first day of the month after you enroll and you will not be liable for late enrollment penalties.
If you miss the two-month deadline, you must wait until the next annual open enrollment period, which runs Oct. 15 to Dec. 7 with coverage beginning Jan. 1. Then you will end up with a permanent Part D late enrollment penalty based on how many months elapsed between your return to the United States and when you begin receiving Part D coverage.
Each special enrollment period for Medicare beneficiaries living abroad is different. Don’t let the deadlines trip you up:
Both Medicare supplement insurance, commonly called Medigap, and Medicare Advantage, also known as Part C, are tied to enrolling in Part B and living in the United States. Your six-month Medigap open enrollment period, when you can’t be rejected or charged more for any policy sold in your area because of health problems, generally begins the first day of the month you have Part B. You’ll also have at least one opportunity, probably more, throughout a year to enroll in an Advantage plan if that is your preference.
Updated June 17, 2022
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