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Medicare Portability About Us

Medicare Portability Task Force

US Citizens who worked in the US, or for US companies, paid into the Medicare system throughout their careers.  Once they begin receiving the Social Security they earned throughout their work lives, their benefit is automatically reduced for the cost of their Medicare.  But US Citizens residing outside the country are unable to use the Medicare they paid for, and continue to pay for, without often-costly travel back to the United States.  Many choose that option.  Others never receive the benefits for which they paid.  This has implications for fairness and cost to the Medicare system.

At its May 2021 global annual meeting, Democrats Abroad passed a resolution calling on the United States government to provide opportunity for American seniors living abroad to access Medicare services in their country of residence. 

An estimated 9 Million American Citizens live abroad and likely up to one-third are senior citizens. Additionally, the costs of providing medical care to aging Americans is rapidly escalating in the US, both as a percentage of GDP and in absolute dollars. Our costs for health care services are the highest in the world. Many US seniors who retire abroad live in countries with significantly lower cost of living, and health care.  

A mixed-bag current state

Today, Medicare does not provide any option for health care coverage except limited reimbursement for emergencies for US resident seniors while traveling abroad.  Those who reside abroad for more than 90 days are denied coverage.

Almost every US Citizen receiving Social Security has a Medicare deduction from their monthly benefit. And all who are eligible for Medicare and who worked in the US or for US-based employers paid into the Medicare system throughout their work lives. Yet depending on their country of residence, their opportunity for health insurance coverage abroad is vastly different across the population of expatriate seniors.

  • US Citizens who served in the military can access their retiree health care benefits wherever they reside through the Tricare Overseas Program.
  • Retirees from the federal government also have health care insurance that covers them wherever they choose to live. 

For the remaining US seniors abroad, the situation is not at all similar.

  • Some countries allow or even require US seniors to opt into their national health care at a cost, paid through local taxes or direct payment. This is an additional cost on top of what they must pay for Medicare services they are unable to use. 
  • But many countries do not offer national health care to expatriates, forcing many seniors to buy additional local or international insurance coverage at significant cost in addition to what they continue to pay for Medicare coverage they are unable to use. Because of the high cost of the additional insurance, many are forced to take the risk that an accident or medical emergency in their country of residence will require them to pay hospital and other costs out of their savings when Medicare would cover most costs if the accident or emergency occurred within the borders of the US.
  • Many Medicare beneficiaries choose to return to the US for serious health care needs, and many for routine health care and regular check-ups and medical tests.  Those American seniors have significant out-of-pocket travel costs, and the Medicare trust pays for their health care at significantly more costly US rates. 


Our goal is to end a serious inequity in how US Citizen seniors abroad are treated with regard to the Medicare benefit they paid for throughout their work lives, and continue to pay for through deductions from their Social Security benefit.  While different countries of residence present different situations for seniors, the cost of health care in nearly every one is significantly less than in the US, a potential savings that we believe will help the Medicare Trust Fund’s viability over time.

What you can do

  • Complete the Medicare Portability Survey when you receive it, and encourage other DA members who are in the target population to do the same. The more data we have, the easier it will be to convince Congress to act.
  • Contact your Congressional Representatives to ensure they are aware of this inequity and how critical it is to providing fairness and producing potentially significant savings for the Medicare Trust Fund.  Remind them that Democrats voting from abroad provided the margin of victory in multiple races in 2020 and 2018.  
  • Educate other seniors and individuals approaching Medicare age about this issue and ask them to join DA and complete a survey, and become part of the drive to change this unfair and unequal treatment of seniors who retire abroad.

Join DA’s Medicare Portability Task Force.  Send an email to [email protected]