Health insurance when you retire abroad

For Americans retiring abroad, health insurance is often the most confusing part of the move. The short version: Medicare mostly stops at the U.S. border, so you'll need another way to pay for care where you live. But there are good reasons to think carefully before dropping Medicare entirely.

What Medicare covers abroad

In general, Medicare doesn't pay for care outside the United States. There are a few narrow exceptions, such as certain emergencies near the U.S. border, but you shouldn't count on Medicare for routine or even serious care abroad.

If you have a Medicare supplement (Medigap) plan C, D, F, G, M or N, it includes a limited foreign travel emergency benefit: 80% of emergency care during the first 60 days of a trip, after a $250 deductible, up to $50,000 over your lifetime. That's helpful for travel, not for living abroad. Most Medicare Advantage plans offer little or no coverage outside the U.S.

Should you keep Part B?

Part A is free for most people, so there's usually no reason to drop it. Part B has a monthly premium, and many retirees abroad ask whether to keep paying it.

The trade-off is the late-enrollment penalty. If you drop Part B and sign up again later, for example because you move back or want to come home for treatment, your premium can go up 10% for each full year you went without it, for life, and you can generally re-enroll only during the yearly window from January through March. People who expect to return to the U.S. for care, or might move back someday, often keep Part B as insurance against that. Others decide the premium isn't worth it. It's a personal decision worth making deliberately.

Your main coverage abroad

Most retirees abroad combine two things:

• International or expat health insurance, which covers care in your new country and often other countries too. Some plans include or exclude the U.S. Prices rise with age, and some insurers limit new applicants above a certain age or exclude pre-existing conditions for a period.
• The local health system. Many countries let legal residents join their public system, sometimes after a waiting period or for a contribution based on income. Others rely on private care that's far less expensive than in the U.S. Quality and access vary a lot by country and region.

Visas often require insurance

Many residency visas for retirees ask for proof of health insurance that meets specific requirements, at least for your first years. Check what your destination requires before you choose a plan.

Prescriptions and ongoing care

Before you move, confirm that your regular medications are available in your destination, sometimes under different names, and how they're prescribed there. Bring a supply and your medical records, and look for a doctor early.

A practical plan

Decide whether you'll keep Part B, choose coverage that meets your visa's requirements, learn how the local system works for residents, and keep some savings for care you might need while coverage starts.

This is general information. Medicare rules, insurance products and visa requirements change, so confirm details with Medicare, insurers and the destination's official sources.