Medicare Coverage Outside the U.S.: Travel, Expats & International Retirement

Medicare is a U.S. program and — with three narrow exceptions — it stops at the border. That's a meaningful gap for the roughly 20% of retirees who travel internationally each year and an even sharper challenge for the growing number considering retirement abroad. Here's what the coverage actually is, what Medigap fills, and the Part B decision that can haunt you if you get it wrong.

The fundamental rule: Medicare doesn't cover care outside the U.S.

Social Security Act §1862(a)(4) explicitly excludes payment for items or services "not provided within the United States." This isn't a gap you can fill by appealing or by choosing a different Medicare plan — it's a statutory exclusion that applies to Original Medicare (Parts A and B).¹

What counts as "the United States" for Medicare purposes: the 50 states, Washington D.C., Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. If you're a retiree living in Puerto Rico or getting care at a hospital in Guam, Medicare applies normally.¹

Ships are also covered — but only within the territorial waters (within 3 nautical miles) adjoining U.S. land. A cruise ship anchored in a Bahamian port is outside coverage. The same ship in the port of Miami is covered.

The three exceptions that actually cover care abroad

There are three narrow situations where Original Medicare will pay for foreign hospital care. All three are narrower than most people expect.¹

Exception 1: Canadian hospital on the Alaska route

If you're traveling by the most direct route between Alaska and another U.S. state, and a medical emergency occurs, Medicare covers care at a Canadian hospital if it's closer to you than the nearest adequate U.S. hospital. This covers road travel through British Columbia and the Yukon — not a flight to Toronto on vacation.

Exception 2: Canadian or Mexican hospital closer to your U.S. home

If you live in the continental United States near the Canadian or Mexican border and the closest hospital that can treat your condition is across the border, Medicare may cover that care — even without an emergency, as long as you're traveling to or from the U.S. This is a genuine exception for some border-community residents in Texas, Arizona, New Mexico, California, Michigan, and northern border states.

Exception 3: U.S. ship emergency in international waters

If you're aboard a U.S. ship in international waters (more than 3 nautical miles from shore) and a medical emergency occurs, Medicare covers care — but only if the ship is not more than 6 hours away from a U.S. port.

For practical purposes: if you're traveling to Italy, Greece, Japan, Mexico City, or anywhere outside the territorial edge cases above, Medicare pays nothing for your care. This is true whether the care is emergency or elective.

Medigap's foreign travel emergency benefit

This is the main coverage bridge for international travelers. Six of the ten standardized Medigap plan letters include a foreign travel emergency benefit: Plans C, D, F, G, M, and N.² Plans A, B, K, L, High-Deductible Plan F, and High-Deductible Plan G do not include it.

For most new enrollees (those who became Medicare-eligible in 2020 or later), Plans C and F are no longer available. That means Plan G and Plan N are the practical options if you want foreign travel emergency coverage with a Medigap policy.

The benefit terms are standardized by federal law — every insurer offering these plans must provide the same coverage:

• Deductible: $250 calendar-year deductible (applies once per year regardless of number of trips)²
• Coinsurance: Medigap pays 80% of billed charges after the deductible; you pay 20%
• Lifetime maximum: $50,000 per beneficiary²
• Trip limitation: Care must begin within the first 60 days of your departure from the U.S.
• Emergency only: The benefit applies only to emergency care — generally defined as care that, if delayed, would cause death or serious deterioration of health
• Medevac is not covered: Medical evacuation transport back to the United States is not included. A medevac flight can cost $50,000–$150,000+; you need separate travel insurance for this.

What Medigap foreign travel emergency does NOT cover

• Non-emergency care abroad (elective procedures, routine checkups, specialist visits)
• Emergency care after day 60 of a trip
• Emergency care if you've used the lifetime $50,000 maximum
• Medical evacuation flights
• Prescription drugs while abroad (Part D doesn't cover foreign prescriptions)

Medicare Advantage and foreign coverage

Medicare Advantage plans (Part C) vary considerably in their foreign coverage offerings. Some plans include an emergency and/or urgent care benefit abroad — often with a flat copay per visit and a trip limitation. There is no standardized federal requirement for MA plans to cover foreign emergencies the way Medigap is standardized.

If you have Medicare Advantage and travel internationally, you should:

1. Read your plan's Evidence of Coverage (EOC) document specifically for "international," "foreign," or "outside the U.S." provisions
2. Confirm whether the benefit is emergency-only or includes urgent care
3. Note the per-visit copay, annual limit, and trip restrictions
4. Understand that MA plans can change their supplemental benefits each year at AEP (Oct 15–Dec 7)

For frequent international travelers, the variability in MA foreign coverage — combined with the one-way door risk of switching to MA and losing guaranteed Medigap access — is a reason many retirees who travel extensively prefer Original Medicare + Medigap Plan G.

The Part B decision for long-term expats

Retiring abroad full-time creates a fundamentally different question than travel: do you keep paying Part B premiums while living outside the U.S.?

The standard Part B premium in 2026 is $202.90/month ($2,434.80/year).³ If you're living in Portugal or Costa Rica and not using U.S. healthcare, that can feel like paying for coverage you never use. But the decision to disenroll has permanent consequences.

What happens if you disenroll from Part B while abroad

• You stop paying premiums immediately — but the coverage stops too, including any Medigap policy you had (Medigap requires active Part B enrollment)
• You can re-enroll during the General Enrollment Period (January 1–March 31 each year), with coverage starting July 1
• You pay a permanent late enrollment penalty: 10% of the standard Part B premium for each full 12-month period you were disenrolled — added permanently to your premium for life³
• A 5-year gap abroad means a permanent 50% premium surcharge when you re-enroll, on top of whatever the base rate is by then

Special Enrollment Period for returning expats

If you move outside the U.S. before becoming Medicare-eligible (before 65) and later return to live permanently in the U.S., you have a Special Enrollment Period to enroll in Medicare — generally within 2–3 months of establishing a permanent U.S. residence. This avoids the penalty for the period you were living abroad without U.S. health coverage.

However, this SEP generally applies to people who never had Medicare while abroad, not those who had Medicare, disenrolled, and then returned. The rules for the latter group are more complex, and the penalty may still apply to the gap period.

Part B abroad: the maintain-vs-let-lapse calculator

This calculator models the cost of maintaining Part B premiums while living abroad versus disenrolling and facing the late enrollment penalty when you return. It is a simplification — your actual decision depends on factors this tool can't model (IRMAA, your foreign healthcare costs, the year you return). Use it as a starting point.

Part D abroad: similar rules, simpler decision

Medicare Part D also doesn't cover prescription drugs purchased outside the U.S. If you're retired abroad, you'll pay out-of-pocket for medications locally (often at a fraction of U.S. prices in many countries). Most expats find that disenrolling from Part D while abroad makes sense — but the same late enrollment penalty logic applies.

Part D LEP: 1% of the "national base beneficiary premium" (approximately $38.99/month in 2026) for each full month you were without creditable coverage, added permanently. A 5-year gap = 60 months × 1% = 60% penalty on the base premium — roughly $23/month permanent surcharge on top of your plan premium.⁴

Exception: if you maintain creditable drug coverage abroad (qualifying foreign formulary — rare but possible for some expats with foreign employer-sponsored plans or government health programs), the Part D penalty period may not accrue. Document this carefully.

IRMAA doesn't care where you live

If you maintain Medicare Part B while living abroad and have U.S. income — pension, Social Security, RMDs, rental income, investment income — IRMAA surcharges apply based on that income exactly as they would for a U.S.-based retiree. Your MAGI is calculated from your U.S. tax return regardless of your country of residence.

There's a planning nuance here for expats with both U.S. and foreign income: the Foreign Earned Income Exclusion (FEIE, $132,900 in 2026 per IRS Rev. Proc. 2025-67) excludes earned income from U.S. tax — but excluded foreign earned income also reduces your MAGI and therefore your IRMAA exposure. Investment income, pension income, and RMDs remain fully taxable and IRMAA-counted regardless of where you live.

Travel insurance vs. Medigap: what to buy

For retirees who travel internationally a few weeks or months per year and have Medigap Plan G or N, the foreign travel emergency benefit often covers routine emergency needs. The gap is the $50,000 lifetime maximum and the absence of medevac coverage.

Consider adding a separate international travel medical insurance policy if:

• You're taking a trip longer than 60 days (the Medigap benefit expires at day 60)
• You've already partially or fully used your $50,000 Medigap lifetime maximum
• You're traveling to a country with very high healthcare costs (Japan, Switzerland, Norway)
• You want medevac coverage — evacuation flights to the U.S. can cost $50,000–$200,000
• You have Medicare Advantage and your plan's foreign benefit is limited or uncertain

Annual international travel insurance policies for retirees typically cost $300–$1,500/year depending on age, coverage limits, and pre-existing condition terms. A dedicated medical evacuation plan (e.g., Medjet, Global Rescue) costs $300–$500/year and covers just the transport — a complement to, not substitute for, medical coverage.

What if you're already abroad and haven't enrolled in Medicare?

If you're past 65, living abroad, and haven't enrolled in Medicare Part B, your situation depends on whether you're near the initial enrollment window:

• Still within your Initial Enrollment Period (IEP): You have a 7-month window (3 months before your 65th birthday month, your birthday month, and 3 months after). Enroll during this window, even from abroad, and there's no penalty.
• Outside your IEP, living abroad: You can enroll during the GEP (Jan 1–March 31), but will likely owe the late enrollment penalty for the months you were eligible and not enrolled — unless you had creditable employer coverage during that period.
• Planning to return to the U.S.: Work with an advisor and/or Social Security to understand the SEP that may apply when you establish a permanent U.S. residence.

Related guides

• Medigap Plan G vs. Plan N vs. High-Deductible G — which plan to choose and how the foreign travel benefit compares across the options
• Medigap Guaranteed Issue Rights — the one-time 6-month window to enroll without underwriting, and what happens if you miss it
• What Counts as Income for IRMAA? — how U.S. income flows into IRMAA whether you live in Tampa or Tuscany
• Retiring Before 65: Health Insurance Until Medicare — the ACA and COBRA options if you're retiring internationally before Medicare eligibility
• Roth Conversions and IRMAA — how to use a low-income period abroad to convert IRA assets tax-efficiently