Medicare Eligibility If You Live Overseas or Are Moving Back to the U.S.

 

Whether you currently live overseas, or you’re returning to the U.S. after living outside of the country, you may be wondering whether you qualify for Medicare and how to sign up. Typically, U.S. citizens and legal permanent residents of at least five continuous years are eligible for Medicare when they turn 65 or at any age through disability. You can also get Medicare before 65 if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease). However, eligibility and enrollment works differently if you first become eligible while you’re out of the country.

Here’s an overview of different situations, including what to do if you become eligible for Medicare while abroad and how to sign up for Medicare if you’re moving back to the U.S. Please note that Medicare considers the U.S. to include the 50 states, the District of Columbia (Washington, D.C.), Puerto Rico, Guam, American Samoa, the U.S. Virgin Islands, and the Northern Mariana Islands.

Are you an American living abroad and turning 65?

If you’re an American citizen living abroad when you turn 65 and first become eligible for Medicare, you may not be able to enroll in Original Medicare, Part A and Part B, until you return to the United States. You must be a U.S. resident to sign up for Part A and/or Part B.

In certain situations, you can delay enrollment in Part A and/or B without a late-enrollment penalty if you’re living out of the country when you first become eligible for Medicare. See below for more information on Special Enrollment Periods.

Are you already enrolled in Medicare and moving out of the country?

If you signed up for Medicare while you were living in the U.S., and then later moved overseas, Medicare won’t cover your medical expenses outside of the country in most cases. You may want to contact Social Security in this case to disenroll from Part B, since you’ll otherwise be paying a monthly premium for coverage you can’t use. You can call Social Security at 1-800-772-1213 (TTY users, call 1-800-325-0778); Monday through Friday, from 7AM to 7PM.

At the same time, keep in mind that you may have to pay a late-enrollment penalty for Part B if you ever do move back to the U.S. and decide you want this coverage later. This comes in the form of a 10% higher premium for every full 12-month period that you were eligible for Part B and went without it. You may also owe a late-enrollment penalty for Part A if you haven’t worked enough quarters to get it without a premium and go without it any time after you’re first eligible.

Are you a citizen of a different country who just moved to the U.S.?

Most people qualify for Medicare when they turn 65. However, even if you’re 65 years or older, you may not be eligible for Medicare until you’re either a United States citizen or a permanent resident who has lived in the country for at least five continuous years.

If you meet the citizenship and residency requirements for eligibility, you can also qualify for Medicare at any age if you’ve been receiving Social Security Administration (SSA) or Railroad Retirement Board (RRB) disability benefits for two years or if you have end-stage renal disease or amyotrophic lateral sclerosis.

If you have questions about whether you qualify for benefits, you can contact Medicare or the Social Security Administration; contact information is at the end of this article.

Are you a returning U.S. citizen?

If you didn’t sign up for Medicare because you were out of the country, you may be able to enroll in Part A and Part B after you return to the country and establish residency. As mentioned, you must be either a U.S. citizen or permanent legal resident of at least five continuous years to be eligible. In addition, you must be either 65 or older, collecting disability benefits for two years, or have end-stage renal disease or amyotrophic lateral sclerosis. There are different enrollment periods and options depending on your situation.

Generally, if you return to the U.S. after living abroad, you can sign up for Medicare Part A and/or Part B during the General Enrollment Period (January 1 through March 31). You might have to pay a late-enrollment penalty. But, in some cases, you might qualify for a Special Enrollment Period (see below for some examples of qualifying situations).

Special Enrollment Periods

If you turned 65 while living overseas and you didn’t sign up for Medicare when you were first eligible, you may qualify for a Special Enrollment Period that starts when you return to the U.S. and lasts three months. You generally don’t need to pay a late-enrollment penalty if you enroll during this three-month period.

You may also qualify for a Special Enrollment Period if you were living overseas and covered by an employer-based health plan. You can sign up for Medicare Part A and/or Part B anytime as long as either you or your spouse is working and covered through health coverage based on current employment. If your employment or group coverage ends, your Special Enrollment Period begins after you or your spouse stops working or the group health insurance based on current employment ends (whichever occurs first). This Special Enrollment Period lasts for eight months. Note that COBRA and employer retirement health plans don’t typically qualify you for a Special Enrollment Period because this coverage isn’t based on current employment.

You might also be eligible for a Special Enrollment Period if you were a volunteer serving outside the U.S. for at least 12 months on behalf of a tax-exempt organization and had health insurance coverage for the duration of the service. Your six-month Special Enrollment Period begins when one of the following happens:

  • Your volunteer service outside of the U.S. ends.
  • The volunteer organization loses its tax-exempt status.
  • Your health plan that was providing coverage overseas ends.

Usually, you don’t pay a late-enrollment penalty if you sign up during a Special Enrollment Period.

Enrolling in Medicare after you return to the U.S.

Once you return to the U.S. and establish residency in the country, you may be eligible for Medicare Part A and/or Part B if you meet the above-mentioned citizenship and legal permanent residency requirements. You can sign up through the Social Security Administration:

If you worked for a railroad, contact the Railroad Retirement Board (RRB) to enroll in Medicare. You can call 1-877-772-5772, Monday through Friday, from 9AM to 3:30PM, to speak to an RRB representative.  TTY users, call 1-312-751-4701.

Signing up for a Medicare Advantage or Prescription Drug Plan after moving to the U.S.

If you already have Original Medicare and you move back to the U.S., you can do either of these during the two-month period after the month you return:

  • Enroll in a stand-alone Medicare Part D Prescription Drug Plan that works alongside your Original Medicare, Part A and Part B, coverage.
  • Switch to a Medicare Advantage plan. If you do this, you get your Medicare Part A and Part B benefits through a private insurance company that contracts with Medicare. Most Medicare Advantage plans include prescription drug coverage, and many of them offer extra benefits beyond Original Medicare.

With either of these choices, you may need to continue paying your Medicare Part B premium, in addition to any premium required by your plan. 

If you’d like more information about the Medicare options available to you, you can start browsing plan options in your area with the plan finder tool on this page. Or, for more personalized assistance with your Medicare needs, contact eHealth today to speak with a licensed insurance agent.

To learn about Medicare plans you may be eligible for, you can:

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