Medicare coverage outside the U.S. is limited and depends on where you are and what type of care you need

Medicare generally does not pay for medical care you receive outside the United States, with a few narrow exceptions. If you are a U.S. citizen or permanent resident enrolled in Original Medicare (Parts A and B), you are covered only in the U.S., its territories, and possessions. Medicare Advantage plans (Part C) and prescription drug plans (Part D) follow the same rule — coverage stops at the border.

The exceptions are small and specific. Medicare will pay for emergency care in Canada or Mexico if you are traveling directly between two parts of the U.S. and the emergency happens during that trip. Medicare also covers dialysis at facilities outside the U.S. if you are a permanent resident of that country. Beyond these cases, you pay out of pocket for any medical care abroad.

If you spend months or years outside the U.S., you need to understand how that affects your coverage and what happens to your enrollment. The rules differ depending on whether you are traveling temporarily, living abroad, or moving permanently.

Key Takeaways

  • Medicare does not cover routine or emergency medical care outside the United States except in narrow cases involving travel between U.S. states through Canada or Mexico.
  • If you are out of the country for more than six months, you may lose your Part B coverage and face a penalty when you return.
  • You can keep your Medicare enrollment while living abroad, but you will pay for all medical care yourself unless you meet the dialysis exception.
  • Travel insurance and expatriate health plans exist specifically to cover medical care outside the U.S., and you should research these before you leave.
  • You must contact Social Security or Medicare before you move abroad to understand how your specific situation affects your coverage and enrollment.

The three exceptions where Medicare does pay overseas

Medicare covers emergency care in Canada or Mexico if you are a U.S. resident traveling directly between two parts of the U.S. and the emergency occurs during that trip. This means you are driving or flying from one state to another and become ill or injured in Canada or Mexico on the way. The care must be emergency care — not planned treatment — and you must be able to show you were in transit. This exception does not cover a vacation to Mexico or a planned trip to Canada.

The second exception is dialysis. If you are a permanent resident of a country outside the U.S. and need dialysis, Medicare will pay for treatment at a Medicare-approved facility in that country. You must have established permanent residency there, not just be living there temporarily. You will need to work with the dialysis facility to confirm it is approved by Medicare before you rely on this coverage.

The third exception is limited to U.S. citizens who are crew members on ships or aircraft. If you work on a U.S.-registered ship or aircraft, Medicare may cover some care. This is rare and applies to very few people; if this describes your situation, contact Medicare directly at 1-800-MEDICARE to learn what is covered.

What happens to your Medicare if you leave the country for six months or longer

If you are outside the U.S. for more than six consecutive months, you may lose your Part B coverage. This is automatic — Medicare does not send a warning or ask permission. When you return to the U.S., you will have to re-enroll in Part B, and you may owe a late enrollment penalty for each year you were not enrolled. The penalty is 10 percent of the standard Part B premium for each 12-month period you were not enrolled, and it is permanent — you will pay it for as long as you have Medicare.

Part A (hospital insurance) is not affected by time spent outside the U.S., so you will not lose it or face a penalty. However, you cannot use Part A for any care outside the country, so it provides no protection while you are abroad.

If you have a Medicare Advantage plan (Part C), the rules vary by plan. Some plans will terminate your enrollment if you are out of the country for more than six months. Others allow you to keep the plan but will not cover any care outside the U.S. You must contact your specific plan before you leave to find out what happens to your enrollment.

Keeping your Medicare enrollment while living abroad

You can remain enrolled in Medicare while living outside the U.S., and you do not have to do anything special to keep your enrollment active. You will continue to pay your premiums (either through payroll deduction, your bank account, or by check), and your coverage will remain in effect. However, you cannot use that coverage for any medical care outside the U.S. unless you meet one of the three exceptions listed above.

If you are living abroad and need medical care, you will pay the full cost yourself. This is true even for routine care like doctor visits, prescriptions, or hospital stays. Some countries have public health systems that residents can access; you may be able to use those systems, but Medicare will not reimburse you for the cost.

You must continue to pay your Medicare premiums while you are abroad. If you stop paying, your coverage will end, and you will face a late enrollment penalty if you try to re-enroll when you return to the U.S. If paying premiums while abroad is difficult, contact Social Security to discuss your options.

Travel insurance and other coverage options for time outside the U.S.

Because Medicare does not cover care outside the U.S., you should purchase supplemental coverage before you leave. Travel insurance is available for short trips (usually up to one year) and covers emergency medical care, evacuation, and sometimes routine care depending on the plan. Prices vary widely based on your age, how long you are traveling, and what is covered. You can purchase travel insurance through private insurers, and many policies can be bought online before you depart.

If you are moving abroad permanently or for several years, travel insurance is not practical. Instead, look into expatriate health insurance plans, which are designed for people living outside their home country for extended periods. These plans cover routine care, emergency care, and sometimes dental and vision care. They are more expensive than travel insurance but provide broader coverage. You can research expatriate plans through international insurance brokers or by contacting insurers that specialize in expat coverage.

Some countries have reciprocal agreements with the U.S. that allow Medicare beneficiaries to access public health care. These are rare and limited. If you are moving to a specific country, contact that country's health ministry or your nearest U.S. embassy to ask whether such an agreement exists.

What to do before you move or travel abroad

Contact Social Security or Medicare at least two months before you leave the U.S. Explain where you are going, how long you will be there, and whether you plan to return. A representative can tell you exactly how your specific situation affects your Medicare enrollment, premiums, and coverage. They can also discuss whether you should keep your enrollment or make changes before you leave.

Get a copy of your Medicare card and any other insurance documents before you leave. If you need to see a doctor while abroad, you may need proof of your U.S. residency or citizenship. Carry copies of important medical records, a list of your current medications, and the names and dosages of any medications you take regularly. If you use prescription medications, ask your doctor whether you can obtain a larger supply before you leave, or research how to refill prescriptions in the country where you will be.

Research the health care system in the country where you will be. Find out whether you need to register with a local doctor, how to access emergency care, and what the costs are. If you are moving to a country with a public health system, learn whether you are may be able to access to use it and what paperwork you need to complete.

Returning to the U.S. and re-enrolling in Medicare

If you were outside the U.S. for more than six months and lost your Part B coverage, you must re-enroll when you return. You have a special enrollment period of two months after you return to the U.S. During this time, you can enroll in Part B without a late enrollment penalty, but only if you enroll within that two-month window. If you miss this important date, you will owe a penalty.

To re-enroll, contact Social Security or visit Medicare.gov. You will need to provide proof that you have returned to the U.S. and are now a resident. This can be a lease, a utility bill, or a state ID. The process usually takes a few weeks, so plan ahead if you know you will be returning on a specific date.

If you have a Medicare Advantage plan that terminated while you were abroad, you will need to choose a new plan when you return. You can enroll in a new Medicare Advantage plan or switch to Original Medicare (Parts A and B) with a Medigap supplemental plan. You have 60 days after you lose your Medicare Advantage coverage to enroll in a Medigap plan without being denied for pre-existing conditions.

Frequently Asked Questions

Can I use my Medicare if I am visiting family in another country for a month?

No, Medicare does not cover any care you receive outside the U.S., even for a short visit. If you become ill or injured during your trip, you will pay the full cost. You should purchase travel insurance before you leave to cover emergency medical care while you are abroad.

What if I have an emergency while traveling through Canada to get to another U.S. state?

Medicare will cover emergency care in Canada if you are traveling directly between two U.S. states and the emergency happens during that trip. You must be able to show that you were in transit, not vacationing. The care must be emergency care, not planned treatment. Keep receipts and documentation of your travel dates in case you need to prove this to Medicare.

If I move to another country, do I have to keep paying Medicare premiums?

Yes, you must continue to pay your Part B and Part D premiums if you want to keep your coverage active. If you stop paying, your coverage will end. If you later return to the U.S. and try to re-enroll, you will owe a late enrollment penalty. Contact Social Security before you move to discuss payment options if paying from abroad is difficult.

Will my prescription drug plan (Part D) work in other countries?

No, Part D does not cover prescriptions filled outside the U.S. If you take regular medications, ask your doctor for a larger supply before you leave, or research how to obtain prescriptions in the country where you will be. Some countries allow you to fill U.S. prescriptions at local pharmacies, but Medicare will not pay for them.

What should I do if I am a U.S. citizen living permanently in another country?

Contact Social Security or Medicare before you move to understand how your enrollment is affected. You can keep your Medicare enrollment while living abroad, but it will not cover any care outside the U.S. unless you meet the dialysis exception. You should purchase expatriate health insurance to cover medical care in your new country. You must continue to pay your Medicare premiums to keep your enrollment active.