FAQ Medicare Information for Expats with links to useful information

Members of Democrats Abroad have compiled this as a service. It’s not official advice. We aren’t employees of the Social Security Administration, the Centers for Medicare and Medicaid Services, nor are we insurance specialists or lawyers.

The information in this FAQ should be used only as a guide and not as an answer to questions specific to your situation, as those can have a number of variables.

Where available, we’ve linked to the relevant official government website. Please note that www.medicare.gov is the only official website for Medicare.

What is Medicare?

Medicare is a United States health-insurance program for Americans over the age of 65 or those under 65 with certain disabilities. It’s administered by the federal government.

With few exceptions, Medicare will cover members only when they’re in the United States.   For example, an exception would be if you lived in the United States but your closest hospital is in Canada or Mexico, Medicare would cover you under those circumstances

What is Medicaid?

Medicaid is a federal health-insurance program for low-income adults that’s administered by the individual states. Eligibility has income restrictions, and those vary from state to state. Some people who receive Medicare may also qualify for Medicaid.

What is CMS?

The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program, works in partnership with state governments to administer Medicaid and the Children's Health Insurance Program (CHIP), and sets and monitors health-insurance standards for the various programs.

Contacting Medicare: This is the link to live chat and for telephone assistance.  Because of staffing shortages and other COVID-related service problems, live chat may be difficult to access.

When can I sign up for Medicare?

You can sign up for Medicare on the first day of the month beginning three months before you turn 65 until three months after you turn 65. That’s known as your Initial Enrollment Period (IEP). Signing up after that can incur penalties and coverage restrictions. You can find your exact IEP here: when can I sign up for Medicare?

If you become eligible for Medicare starting in 2022 and so far have had difficulty getting through to Medicare on the phone, there is an extension until the end of 2022.

When does coverage start?

The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always starts on the first of the month.

If you qualify for Premium-free Part A:

Your Part A coverage starts the month you turn 65. If your birthday is on the first of the month, coverage starts the month before you turn 65.

Part B (and Premium-Part A if you don’t qualify for premium free): Coverage starts based on the month you sign up. This chart will help you determine your start date.

What are Medicare’s components?

Medicare Part A pays for many of your costs when your doctor has admitted you to the hospital (inpatient). It includes doctors, room, meals, treatment, tests, and medications. It also covers care in a skilled nursing facility (not the same as a nursing home), hospice care, and some home health care. Information on coverage specifics can be found here.

For most people, there is no premium for Part A.   But if you’re not eligible for premium-free Part A, here are the specifics.

Medicare Part B generally pays 80% of your doctor and clinician bills in a doctor’s or therapist’s office, or when you get treatment in a hospital as an outpatient. Part B pays 80% of what Medicare allows a participating doctor to charge you, not your doctor’s normal, much higher fee.

Part B has a monthly premium that under most circumstances is deducted from your Social Security payment before you see it show up in your bank account every month. If you’re 65, but not yet collecting Social Security benefits, you can still sign up for Medicare. Medicare will send you a bill for the premiums.   Medicare also has a fairly low annual deductible. Click here to find out more.

 Medicare Part C, aka Medicare Advantage is not really Medicare at all, but private insurance that replaces Medicare for those eligible for Medicare. For additional information click here.

Medicare D is also private insurance, but this component covers prescription medications you get at a pharmacy. If your doctor advises you to take aspirin or another pain reliever, for example, that would not be covered as a prescription drug unless it’s prescribed in a prescription-strength dose. There are other options for prescription coverage that might be better in your situation, especially as an expat. 

Within the United States you might find it more cost effective to purchase prescription medication with one of the coupon systems, such as GoodRx. But you need to do your homework first and check the availability and costs of your drugs, and whether the pharmacy you want to use accepts a particular coupon plan.

As an expat, your country of residence could have a significant impact on what you pay for prescriptions. Many countries have prescription drug prices that are far lower than in the US even if you don’t participate in that country’s national health system. So check out your local options and requirements.

Medigap or Medicare supplement insurance is private insurance that you pay for each month directly to an insurance company. Depending on the specific plan, it covers some or all of the costs not covered by Medicare Parts A and B. Supplement policies are designated by letters of the alphabet, and availability depends on the state in which you live. While not every insurance company offers every plan, each Plan A or Plan G for example offered by a company must be identical to every other Plan A or Plan G offered by others; premium prices differ from company to company.

Click here to learn how to sign up for Medicare when you have a US address

How to sign up when you don’t have a US address

If you don’t maintain a US address while living abroad, you’ll need to contact the Federal Benefits Office at the US Consulate that covers the country where you live for the enrollment forms. You should also contact the Social Security Administration to get a letter stating that you’ve entered your Initial Enrollment Period.   Documenting your IEP is crucial to avoiding late enrollment and other penalties. So even if you’re working with the federal benefits office in your country of residence, also get it in writing from the SSA. 

If you don’t sign up for Medicare Part B during your Initial Enrollment Period.

In general, there is a permanent monthly penalty for not signing up for Medicare Part B during your Initial Enrollment Period.

Exemptions to the sign-up penalty

You can only avoid the penalty  if you have “other creditable insurance.” This usually means someone who is still working at age 65 and has insurance through their employer or through a spouse’s employer. Under some circumstances it can also mean health insurance sponsored by a foreign government or foreign employer.   You’ll need to get specifics for your own circumstances by contacting Medicare and/or by speaking to the federal benefits people in your country of residence.

 Are you covered by Medicare when outside of the USA and territories?

No. Coverage is valid only in the United States with a few very limited exceptions. Democrats Abroad is currently working to make Medicare portable, so it can be used overseas. We have made some headway, but for the time being we have nothing specific to announce. Updates, when available, will be on our website.

Links to general articles about Medicare (paywalls might apply)

Top-5-things you need to know about Medicare enrollment

Medicare retirement costs

Elderly Medicare and Medicaid

Websites with useful information

Medicare if you live abroad temporarily

Medicare coverage when living abroad

Medicare for expats

How to handle Medicare when returning to the US after living overseas

If you notice any broken links, believe this contains inaccurate or outdated information, or you have a general question, please email [email protected].