Medicare coverage stops at the U.S. border for most services

Original Medicare (Parts A and B) does not cover medical care outside the United States, except in very narrow circumstances. If you receive treatment in another country, you will pay the full cost out of pocket — Medicare will not reimburse you. This applies whether you are traveling for vacation, living abroad temporarily, or have moved permanently.

The only exceptions are limited: care in Canada or Mexico if you are traveling directly to or from Alaska, and dialysis care in certain countries if you have arranged it in advance with Medicare. For almost all other situations overseas, you have no Medicare coverage.

Medicare Advantage plans (Part C) follow the same rule as Original Medicare — they do not cover care outside the U.S., with rare exceptions. Supplemental insurance (Medigap) also does not cover overseas care unless you buy a specific rider, and even then coverage is usually capped at a low amount.

Key Takeaways

  • Original Medicare and Medicare Advantage do not pay for medical care outside the United States, with only narrow exceptions for travel to Canada or Mexico from Alaska.
  • You will pay the full cost of any overseas medical care yourself; Medicare will not reimburse you later.
  • If you plan to live abroad, you must decide whether to keep Medicare or drop it, because you cannot use it and will still pay premiums.
  • Travel insurance that covers medical emergencies overseas is separate from Medicare and must be purchased before you leave the U.S.
  • Prescription medications obtained overseas are not covered by Medicare Part D, though you can fill prescriptions in other countries at your own cost.

The narrow exceptions: Canada, Mexico, and dialysis

If you are traveling directly between the continental U.S. and Alaska, and you need emergency care in Canada or Mexico along the way, Original Medicare will cover it. This applies only to emergency inpatient hospital care — not outpatient visits, not routine care, and not if you detoured to seek treatment. You must be traveling directly to or from Alaska for the exception to explore.

Dialysis is the only non-emergency service with an exception. If you have end-stage renal disease and arrange dialysis care in advance with Medicare in certain countries (primarily Canada and Mexico), Medicare may cover it. You must contact your Medicare contractor before you travel to set this up; showing up and expecting coverage will not work.

These exceptions are genuinely rare. For almost everyone, overseas care means paying out of pocket.

What happens to your Medicare if you move abroad

You can keep your Medicare enrollment even if you move outside the U.S. permanently. However, you cannot use it for care in your new country, and you will still pay your monthly premiums (Part B and Part D premiums continue). This is a poor financial choice for most people who move abroad long-term.

If you move abroad and want to drop Medicare, you can do so by contacting Social Security. Dropping Part B and Part D stops your premiums, but dropping Part A (hospital insurance) is harder — you must have worked long enough to be may have access to to it, and once you drop it, you cannot get it back without penalties if you return to the U.S. later. Before you drop any part of Medicare, speak with Social Security about the long-term consequences.

If you are a U.S. citizen living abroad, you can still enroll in Medicare when you turn 65, even if you are not in the U.S. at the time. You will need to contact Social Security or the nearest U.S. embassy or consulate.

Travel insurance versus Medicare coverage

Travel insurance that covers medical emergencies is a separate product from Medicare and is not part of your Medicare plan. You must purchase it before you leave the U.S. These policies cover emergency medical care, emergency dental, and sometimes evacuation to a hospital in the U.S. or a nearby country.

Travel medical insurance is usually inexpensive for short trips (a week or two of coverage might cost $20 to $50) but becomes more expensive for longer stays. Policies vary widely in what they cover, what they exclude, and what the deductible is. Read the policy details carefully — some exclude pre-existing conditions, some have age limits, and some will not cover care related to high-risk activities.

If you travel overseas regularly, an annual travel insurance policy is usually cheaper than buying coverage for each trip separately. Some credit cards and homeowners' insurance policies include travel medical coverage; check your existing policies before you buy.

Prescription medications and Part D overseas

Medicare Part D (prescription drug coverage) does not cover medications you obtain outside the U.S. If you fill a prescription in another country, you pay the full cost yourself, and Part D will not reimburse you.

You can bring a 90-day supply of medications into the U.S. for personal use if you have a valid prescription. If you are moving abroad and want to take medications with you, check the laws of your destination country — some countries restrict or ban certain medications, and some require a local prescription even if you have a U.S. one.

If you are traveling for a short time, ask your U.S. doctor for a 90-day prescription before you leave. If you are moving abroad long-term, you will need to find a local doctor and obtain prescriptions under that country's system.

Medicare Advantage and supplemental insurance abroad

Medicare Advantage plans do not cover care outside the U.S., with the same narrow exceptions as Original Medicare (emergency care in Canada or Mexico if traveling to or from Alaska). If you have a Medicare Advantage plan and travel or move abroad, you lose coverage the moment you leave the U.S.

Medigap (supplemental insurance) also does not cover overseas care in most plans. However, some Medigap plans offer a rider called Plan G with foreign travel emergency coverage, which covers up to 80 percent of emergency care in a foreign country, up to a maximum of $250 per day and $50,000 lifetime. This rider costs extra and must be added when you first enroll in the Medigap plan; you cannot add it later. Even with this rider, coverage is limited and does not include routine or planned care.

Planning ahead if you travel or move overseas

If you know you will be traveling or moving abroad, start planning at least two months before you leave. Contact Medicare at 1-800-MEDICARE to understand what coverage you will and will not have. If you are moving permanently, contact Social Security to discuss whether to keep or drop your Medicare enrollment.

For travel, research travel medical insurance options and purchase a policy before you leave the U.S. — you cannot buy it once you are already overseas. Check your destination country's healthcare system and whether you can register as a resident or temporary visitor; some countries offer public healthcare to residents, and some require private insurance.

If you take prescription medications, ask your U.S. doctor for a written prescription (not just a printout from the pharmacy) and research whether your medications are legal and available in your destination country. Bring copies of your medical records and a list of your current medications in case you need to see a local doctor.

Frequently Asked Questions

Can I use Medicare if I am on a cruise ship?

No. Once the ship leaves U.S. waters, Medicare coverage ends. If you need medical care on a ship, you will pay the ship's medical facility directly. Cruise lines often require travel insurance that covers medical care at sea; check your cruise documents. Some travel insurance policies exclude ship-based care, so read the fine print.

What if I have a medical emergency overseas and need to be flown back to the U.S.?

Medicare does not cover the cost of medical evacuation or transport. Travel insurance with evacuation coverage will pay for this, which is why it is important to have before you leave. Without it, evacuation can cost $100,000 or more and will be your responsibility.

Do I have to drop Medicare if I move abroad for a few years?

No, you can keep it, but you will pay premiums for coverage you cannot use. If you plan to return to the U.S. within a few years, keeping Part A may make sense to avoid penalties later. Dropping Part B and Part D while abroad and re-enrolling when you return is an option, but you may face late-enrollment penalties. Contact Social Security to discuss your specific situation.

Can I get a refund of Medicare premiums if I am not using it overseas?

No. Medicare premiums are not refundable. If you drop your coverage, your premiums stop, but you cannot recover what you already paid. This is another reason to think carefully before moving abroad about whether to keep or drop Medicare.

What if I am a U.S. citizen living abroad — can I still enroll in Medicare at 65?

Yes. You can enroll in Medicare even if you are outside the U.S. Contact Social Security or the nearest U.S. embassy or consulate. However, remember that you cannot use Medicare for care in your country of residence, so enrollment may not be useful unless you plan to return to the U.S. regularly.