Should I keep Medicare if I live abroad?

Honest answer: it depends. The math turns on how long you'll be abroad, whether you have foreign or expat insurance, your age, and whether you'd take a permanent Late Enrollment Penalty hit if you ever come back.

For most people in their 60s and 70s with stable foreign coverage and a likely permanent move, dropping Part B saves $202.90/month in 2026 ($2,434.80/year) — real money. But the 10% per 12 months penalty is permanent. Drop for 5 years and re-enroll, your Part B premium is 50% higher for life.

This is exactly the call I'd take to SHIP (free) or a fee-only financial planner. Don't decide based on what a friend on a Facebook group did.

If you dropped Part B (or never enrolled) and now want it back, you re-enroll during the General Enrollment Period: January 1 through March 31 each year. Coverage starts the month after you enroll.

The Late Enrollment Penalty is 10% of the standard premium for every 12 months you went without Part B when you were eligible. It's permanent — you pay it for as long as you have Part B. Three years off = 30% extra. Ten years off = 100% extra (your premium doubles).

There's no Special Enrollment Period for moving back to the US. The SEPs are for people who had employer coverage, not for people who lived abroad.

Medicare pays for foreign hospital care in three specific situations under 42 CFR 424.122:

1. You're in the US and have a medical emergency, but the closest hospital that can treat you is in Canada or Mexico.

2. You're traveling through Canada by the most direct route between Alaska and another US state without unreasonable delay, and you have an emergency where a Canadian hospital is closer than any US hospital.

3. You live in the US, but a foreign hospital is closer to your home than the nearest US hospital that could treat your condition (whether it's an emergency or not).

These are narrow. They don't help you if you live in Mexico year-round and want routine care. They help if you're, say, in Buffalo and the closest trauma center is in Ontario.

Medigap plans C, D, F, G, M, and N include a foreign travel emergency benefit. The structure is:

- $250 deductible
- 80% coverage of approved costs after the deductible
- 60-day cap per trip
- $50,000 lifetime limit

It's emergency-only. It won't pay for a planned surgery in Thailand or routine care in Portugal. And it's tied to having Part B — if you drop Part B, your Medigap usually goes too.

Medicare Advantage plans are different. Some MA plans include emergency coverage abroad, but networks are US-only. If you're a full-time expat, MA is rarely useful.

If you spend meaningful time in the US — say, summers in Maine and winters in Costa Rica — keeping Part B usually makes sense. The premium ($202.90/month in 2026) buys you coverage every time you're back on US soil.

Medicare doesn't care where you live for premium purposes. It cares where the care is delivered. As long as you're physically in the US (50 states, DC, Puerto Rico, Guam, USVI, American Samoa, Northern Mariana Islands) when you get the service, Part B pays normally.

The main thing: keep a US address on file with SSA and Medicare so bills, premium notices, and Medicare Summary Notices reach you. A trusted family member's address works.

If you dropped Part B and you're moving back, the worst path is waiting until after you arrive. By then you've missed your re-enrollment window and you're stuck waiting for the next General Enrollment Period (January 1 – March 31), then waiting until the following month for coverage.

Better path: re-enroll during the next General Enrollment Period that lands at least 1–2 months before your return date. You'll have Part B in hand the day you land.

While you're at it, look at Medigap. Some states require Medigap insurers to offer coverage to anyone who enrolls in Part B regardless of health (guaranteed issue). Most states don't. Check with your state's insurance department before you assume Medigap will be available.

If you're in the US trying to sort Medicare out for a parent overseas, you'll hit two recurring problems: the time zones and the documentation.

First, get an SSA Form 1696 (Appointment of Representative) signed if your parent wants you handling things directly with SSA. Without it, SSA can't talk to you about their record.

Second, use the SSA Federal Benefits Unit at the US Embassy nearest your parent. They can do a lot remotely and they understand the international rules cold.

Third, for non-Medicare emergencies, Overseas Citizens Services at 1-888-407-4747 is the right starting point.

For Medicare-specific decisions (keep or drop Part B, Medigap timing), SHIP at 1-877-839-2675 is free and unbiased.

Expat cases are the most situation-specific Medicare cases I ever worked. Dual citizenship, totalization agreements, host-country national health systems, foreign employer coverage, federal employee retirees with FEHB, military retirees with TRICARE for Life — each combination changes the math.

If none of the situations above match, here's where to start:

1. SHIP (1-877-839-2675) for free, unbiased Medicare counseling.
2. SSA Federal Benefits Unit at the US Embassy nearest you for SSA and Medicare premium questions.
3. A fee-only fiduciary financial planner (not commission-based) for the keep-or-drop decision if there's serious money at stake.

Don't take this from a Facebook expat group. The rules are too specific and the penalties are too permanent.