What Medicare Covers Outside the United States, and What Local Insurance Costs
Medicare's own page says it usually does not cover health care outside the United States.
Picture a couple named Ramona and Wallace, 68 and 70, who are weighing a move to Mexico. On the kitchen table are a Medicare card each, a calculator and a pad. Their question is short. "If we go, what pays the doctor?"
Wallace read the Medicare website aloud.
What Medicare covers abroad
Medicare's own page says it usually does not cover health care outside the United States. It lists three narrow cases for hospital and doctor costs in a foreign hospital: an emergency in the United States where the foreign hospital is closer, travel through Canada between Alaska and another state, and living in the United States with a foreign hospital closer to home. A person who lives abroad is outside all three. Part D does not cover drugs bought abroad.
Two more things turned up. A Medicare Advantage plan must disenroll a member who has left its service area for more than six months. Several Medigap plans (the plan letters vary, and some are closed to people new to Medicare) pay 80% of foreign emergency care on a trip, after a US$250 yearly deductible, up to plan limits. That benefit is for trips, and we did not read the rules for people who live abroad full time.
The Part B question
"So do we pay for Part B and never use it?" Wallace asked.
| Part B, 2026 | Amount |
|---|---|
| Standard premium | US$202.90 a month (US$2,434.80 a year) |
| Deductible | US$283 |
| Penalty for waiting | 10% for each full 12 months, for as long as the person holds Part B |
| Medicare's own example: 24 months late | 20%, so US$243.48 a month |
| Three years late (30%, our arithmetic) | US$263.77 a month |
The penalty page lists no exception for living abroad. Exceptions need a Special Enrollment Period, for example current employer coverage. Enrolling while abroad and whether to keep Part B are questions for Medicare, or a paid professional. Ramona wrote one question on the pad: "Ask Medicare before we decide."
Local options, as reported
| Place | Reported cost | How firm |
|---|---|---|
| Spain, public care by paid agreement | €60 a month under 65; €157 a month at 65 or older (€1,884 a year) | Ministry page, undated; may predate 2026 |
| Spain, residence visa | Needs private or public insurance with no deductible, no copayment and no waiting period; travel insurance is not accepted | Consulate page, read October 2026 |
| Mexico, public social security institute | Voluntary family plan from 1 March 2026: MXN 20,600 a year at ages 60 to 69, MXN 21,500 at 70 to 79 | Institute page, 2026 |
| Costa Rica, public scheme | Foreign residents are reported to pay a share of declared income; ask the office for the percentage | One undated law-firm page |
The Mexican plan comes to about MXN 1,717 a month at 60 to 69. Whether a foreign resident can enroll and how existing conditions are handled are questions for the office, or a paid professional. For Portugal and Panama, ask the insurer or the office for the price. In Portugal a foreign national can get a user number at a public health unit, but the government portal ePortugal says it does not promise that public care pays the costs.
You could…
- Ask Medicare, in writing or by phone, what enrolling or delaying means for someone living abroad.
- Ask the consulate of your chosen country which insurance the residence visa accepts.
- Get a written quote from a local insurer for your age and any existing conditions.
Which did you choose for health cover abroad, and what did it cost? Tell us the year and the country, and a reader at their own kitchen table may be glad of it.
Figures are estimates for planning, based on public data. Rules change, so each figure shows the year it applies to; ask the official office before you act.
Sources: Medicare.gov pages on travel outside the US and on costs and avoiding penalties; the Centers for Medicare and Medicaid Services booklet "Choosing a Medigap Policy" (March 2026); Title 42 of the Code of Federal Regulations, section 422.74; Spain's health ministry and the Consulate of Spain in Los Angeles; Mexico's social security institute; ePortugal; a Costa Rica law firm's page.
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