Medicare for a Permanent Move Abroad: Your Key Decisions Before You Go

You've made the hardest decision — where to go. Now there are a few more to make, and one of them is genuinely complicated. If you're moving permanently, the Part B keep-or-drop question is actually a real question. Most sites say "talk to an advisor." This page gives you the math to decide for yourself.

Figures on this page reflect 2026 Medicare rates published by CMS. Premiums and deductibles change annually — verify current amounts at medicare.gov before making decisions.

Kelly Milligan, founder of Expat Retire Guide

By Kelly Milligan

Updated June 6, 2026 · Published April 26, 2026

Do You Lose Medicare If You Move Out of the Country?

No — you don't lose your Medicare. Moving abroad doesn't end your eligibility: Part A stays with you (it's premium-free for most people — keep it), and you can keep paying for Part B too.

The catch isn't losing Medicare — it's that Medicare barely covers you outside the US. So the real question is whether to keep paying $202.90/month for Part B coverage you can't use abroad. That's what this page is about — the Part B math is below.

Part A: Keep It — This Is a Non-Decision

Part A is free for most people (if you paid into Social Security for 10+ years). It covers hospital stays when you're back in the US visiting family, emergency repatriation care, and any extended US stay. There's no premium to save by dropping it. Keep it.

Part B: The Actual Math

Part B costs $202.90/month at standard income in 2026 — $2,435/year — and covers almost nothing outside the US. For a permanent move, paying for ten years of coverage you won't use adds up to more than $24,000. That's real money. But dropping it and coming back carries a permanent penalty. Here's how to think through it.

Late enrollment penalty

Drop for 3 years, then return +$61/month forever

Drop for 5 years, then return +$101/month forever

Drop for 10 years, then return +$203/month forever

Drop for 20 years, then return +$406/month forever

The break-even: premiums saved vs. penalty paid

The penalty is permanent, but so are the savings while you're abroad. The break-even consistently lands around 10 years after you return — regardless of how long you were away. The ratio is constant because the penalty scales proportionally with the savings.

Abroad for 5 years, return at 70

Premiums saved while abroad $12,174

Permanent penalty on return +$101/month ($1,218/year)

If you return at 70 and live to 80, the penalty costs roughly what you saved. Live to 85, you're $6,000 in the hole on the trade.

Abroad for 10 years, return at 75

Premiums saved while abroad $24,348

Permanent penalty on return +$203/month ($2,435/year)

If you return at 75 and live to 85, the penalty roughly zeroes out the savings. If you live longer, it's a losing trade. If you return later, less time for the penalty to compound.

Decision framework

Keep Part B

Under 70 — keep it for now

The penalty math doesn't favor dropping Part B if you're under 70 and might return at some point. The break-even still lands in a range where you could realistically be affected by it. The uncertainty cost is high.

Evaluate

70+ and genuinely permanent — run your numbers using the break-even examples above

If you're 72 and certain you're not returning to live in the US, dropping Part B might make financial sense. Use the break-even logic above: if you returned at 80 and lived to 90, would the penalty cost more than you saved? At those ages and amounts, the math gets closer. Run it against your specific situation.

Keep Part B

Visiting the US regularly — keep it

If you'll be back for weeks or months each year — family, doctors, seasonal — Part B will get used. At $202.90/month, a single specialist visit without it can cost $300–500 out of pocket. The math favors keeping it.

Medigap: Get It Before You Go — Even If You Plan to Drop Part B Later

Medigap covers the gaps in Original Medicare — the 20% Part B leaves on every bill, the Part A deductible, and more. Plan G, the most popular option, also covers 80% of emergency care abroad up to $50,000 lifetime.

Here's the critical timing issue: you can only buy Medigap without medical underwriting during your guaranteed issue window — 6 months from when you first enrolled in Part B. After that, most states allow insurers to deny your application or charge more based on your health history.

Buy Medigap before departure, even if you plan to drop Part B eventually

If you're considering dropping Part B after establishing yourself abroad, buy Medigap first — during the guaranteed issue window — to protect your first few years of transition. You need active Part B for Medigap to stay in force, so dropping Part B eventually means losing Medigap. But having it during years one through three gives you real US coverage for visits home, plus the foreign emergency benefit, while you figure out your long-term plans.

Full Medigap guide: plans, timing, and what coverage actually looks like →

Part D: Drop It Carefully, Not Automatically

Part D covers prescription drugs in the US — and covers nothing outside it. For a permanent move, keeping it indefinitely doesn't make sense. But dropping it has consequences:

Part D penalty

1% per month — permanent and compounding

The late enrollment penalty for Part D is 1% of the national base beneficiary premium for every month you went without creditable drug coverage. It's calculated differently from the Part B penalty — it's based on the national average plan premium, not your specific plan — and it compounds over time.

If you're truly never coming back, the accumulated savings from dropping Part D will likely exceed the penalty cost at some point. If there's any realistic chance you return — or if you have ongoing prescriptions you want covered during US visits — dropping it is riskier than it looks.

International Insurance: Not a Gap-Filler — Your Primary Coverage

For a permanent move, international health insurance isn't filling a gap in Medicare. Medicare is filling a gap for your occasional US visits. Your IPMI plan is your health insurance — full stop. Here's what that means for the plan you choose:

Look for

Full IPMI — inpatient and outpatient

You want a plan that covers both inpatient hospital stays and outpatient care — GP visits, specialist appointments, diagnostics, ongoing prescriptions. Travel insurance only covers emergencies. Nomad plans are designed for people who move frequently, not retirees with a fixed address.

Look for

Direct billing networks in your country

Direct billing means the insurer pays the hospital or clinic directly, so you're not fronting thousands of dollars and waiting for reimbursement. In Portugal, Spain, and most of Western Europe, top IPMI plans have robust direct billing networks.

Avoid

Plans with age-out cutoffs

Some international plans stop accepting new members above a certain age (often 70 or 75) or stop renewing coverage at age 80. If you're planning a permanent move, you need a plan that will still be available to you at 80. Confirm renewal guarantees before you buy.

Your Pre-Departure Checklist

Step 1

Buy Medigap during your guaranteed issue window

Plan G before departure. If you're turning 65, this window opens at Part B enrollment and lasts 6 months. It's your only guaranteed shot at coverage without underwriting.

Step 2

Decide on Part B using the break-even framework above

Under 70: keep it. Visiting the US regularly: keep it. 70+ and genuinely permanent: run your specific numbers. Whatever you decide, document your time abroad carefully in case the abroad exception applies when you return.

Step 3

Switch off Medicare Advantage if you're on it

The 6-month service area rule can auto-disenroll you from an Advantage plan on the plan's timeline. Switch to Original Medicare before you go, on yours. Use the Annual Enrollment Period (October 15–December 7) or a qualifying SEP.

Step 4

Get IPMI quotes — compare full coverage annual plans

For a permanent move, you want a full annual IPMI plan from a provider with no age-out cutoffs and direct billing in your destination country. IMG Global, Cigna Global, and Allianz Care are well-established options for US retirees.

Step 5

Notify Social Security of your address change

Your Social Security benefits continue abroad — but you need to keep your address current with SSA. You can do this at ssa.gov or by calling 1-800-772-1213. This also ensures your Part B premium billing stays correct if you're keeping it.

Common Questions

If I drop Part B and come back to the US in 10 years, what happens?

You can re-enroll in Part B during the General Enrollment Period (January 1–March 31 each year), with coverage starting July 1. The late enrollment penalty — 10% per 12-month period you went without Part B — attaches permanently. If you were gone for 10 years, that's a 100% permanent surcharge on the base premium. At 2026 rates, your Part B premium would be $405.80/month instead of $202.90 — forever. You should also expect a Medigap coverage gap when you return: without active Part B, you can't hold Medigap, and re-applying after years abroad means medical underwriting in most states.

Can I keep Medigap if I drop Part B?

No — not in any meaningful sense. Medigap is designed to cover the gaps in Original Medicare's Part B coverage. If you don't have Part B, Medigap has nothing to supplement. Insurers generally require active Part B enrollment for the policy to remain in force. This is why the order of operations matters: if you're considering dropping Part B for a permanent move, buy Medigap now, during your guaranteed issue window, to protect your US coverage during any transition period. If you later decide to drop Part B, you'll lose Medigap — but at least you'll have had it during the vulnerable early years abroad.

What about Part D — should I drop it if I'm leaving permanently?

Probably, eventually — but it's worth thinking through. The Part D late enrollment penalty is 1% per month (12% per year, compounding) for every month you're without creditable prescription drug coverage after first becoming eligible. If you're genuinely never returning, accumulated savings will eventually exceed the penalty cost. But if there's any chance you return — or if you have ongoing prescriptions you want covered during US visits — dropping it creates real risk. A middle-ground option: keep Part D until you're certain you're not coming back, then drop it with eyes open.

I'm turning 65 and moving permanently right away. What do I do?

Enroll in Part B during your Initial Enrollment Period (the 7-month window around your 65th birthday), buy Medigap during the guaranteed issue window that opens with Part B enrollment, and then make your Part B keep-or-drop decision after you're established abroad. The IEP is not the time to make the permanent decision — it's the time to protect your options. Once you're outside the US and certain about your plans, you can re-evaluate. Dropping Part B before you've ever enrolled means you'd face the full late enrollment penalty on any future re-enrollment, with no abroad exception available to you.

Is there a way to avoid the Part B penalty if I move abroad and come back years later?

There's one exception: if you were living outside the US when you first became eligible for Medicare (typically age 65) and weren't receiving Social Security at the time, you may qualify for a penalty-free enrollment window when you return and re-establish US residency. The window is only 3 months, and you'll need documentation — passport stamps, foreign lease agreements, utility bills, foreign tax records. This exception doesn't apply if you were enrolled in Part B and later dropped it. Don't count on it, but document your time abroad carefully in case it turns out you qualify.

Do you lose Medicare if you move out of the country?

No. Moving abroad doesn't cancel your Medicare eligibility — Part A stays (premium-free for most people, keep it) and you can keep Part B. What changes is coverage: Medicare pays for almost nothing outside the US, so the real question is whether to keep paying the Part B premium for coverage you can't use, weighed against the permanent 10%-per-year late-enrollment penalty if you drop it and re-enroll later. The break-even math is in the Part B section above.

Sources

2026 Medicare Parts B Premiums and Deductibles — CMS: Part B standard premium ($202.90/month) used in all calculations on this page.
Medicare Costs — medicare.gov: Late enrollment penalties for Part B (10% per 12-month period, permanent) and Part D (1% per month, permanent).
Compare Medigap Plan Benefits — medicare.gov: Plan G benefits, including 80% foreign travel emergency coverage up to $50,000 lifetime.
Medicare Coverage for Those Who Live Permanently Outside the United States — Medicare Interactive: Part B disenrollment options, the abroad exception to the late enrollment penalty, and re-enrollment windows.
Medicare Advantage and Part D for Those Who Live Abroad — Medicare Interactive: The 6-month service area rule and disenrollment mechanics.

Next: Find your primary coverage abroad

Medicare is your backup for US visits. International health insurance is your health coverage. Compare full annual IPMI plans from providers that work well for US retirees living abroad permanently.

Compare Full IPMI Plans for Permanent Expats