En español | Medicare has different enrollment rules for Americans who live outside the United States, depending on whether they work or are retired.
If you are retired and neither you nor your spouse works while abroad:
In this situation, 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 late penalties.
(There is one exception to this Catch-22 rule. Some people don’t qualify for Medicare Part A benefits without paying monthly premiums for them because they or their spouses haven’t contributed enough in payroll taxes at work. In this situation, you cannot sign up for Part A or Part B outside the United States. Therefore, in this specific circumstance, you can delay Medicare enrollment until your return, without being subject to 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 expires at the end of the third month following. Coverage begins on the first day of the month after you enroll.)
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 website, at https://www.ssa.gov/foreign/.
Part D drug coverage has different rules. 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 penalties. If you miss the two-month deadline, though, you must wait until the next annual open enrollment period, which runs from Oct. 15 to Dec. 7, with coverage beginning Jan. 1 — and then you will receive permanent late penalties, based on how many months elapsed between your return to the United States and when you begin receiving Part D coverage.
If you or your spouse is working while abroad:
You can delay Medicare enrollment in Part B (and avoid its premiums) if you have health care coverage from:
When you (or your spouse) stop working or lose your coverage from any of the above situations, you will be entitled to a special enrollment period of up to eight months to sign up for Medicare without risking late penalties. So if you stop working but don’t return to the United States within that time frame, you’ll confront the same dilemma that nonworking 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.
The rules for Part D drug coverage are the same as those noted in the information provided above for nonworking Americans abroad.