Can expats take their Medicare abroad?

Editor’s Note: Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in “Ask Phil, the Medicare Maven.” Send your questions to Phil.


Ask the Medicare Maven

Medicare rules and private insurance plans can affect people differently depending on where they live. To make sure the answers here are as accurate as possible, Phil is working with the State Health Insurance Assistance Program (SHIP). It is funded by the government but is otherwise independent and trains volunteers to provide consumer Medicare counseling in state and local offices around the country. The non-profit Medicare Rights Center is also providing on-going help.

Moeller is a research fellow at the Center on Aging & Work at Boston College and co-author of “How to Live to 100.” Follow him on Twitter @PhilMoeller or e-mail him at

David – Calif.: I live in the Philippines, mostly. My plan when I retired was to live in the Philippines, and to return to the United States periodically for any needed medical care. My Medicare Part D insurer is threatening to cut me off because I don’t really live in the United States. However, I am living now in Oakland because I have medical problems. So they stopped hassling me for the moment. But I intend to return to the Philippines within a year or so. What are expatriates like me supposed to do?

Phil Moeller: Realistically, you will need to develop your own network of health care providers in the Philippines and shoulder those costs. You can keep Medicare Part A and Medicare Part B while you live outside the United States, so long as you continue to pay your monthly Part B premium. So, you could come back here for treatment and have most hospital and doctor expenses covered.

However, drugs are trickier. To qualify for either a Part D drug plan or a Medicare Advantage plan (which can include drug coverage), you must live in that plan’s service area. Our clever experts at the Medicare Rights Center have a workaround, but you need to be able to plan for your U.S. needs in advance. This workaround rests on your right to qualify for a special enrollment period (SEP) for a Part D plan each time you move into a plan’s service area. So, every time you come back from the Philippines, call your Part D plan about a month in advance. Say that you are moving back to the United States and you need to use your SEP to re-enroll in the plan because you are moving back into its service area.

Donna – Mass.: I know you’ve written about the Medicare options for people who are at least 65 but still working and insured under their employer’s plans. But it’s still not clear to me. I work for a company that has more than 20 employees. Do I need to sign up for Medicare when I turn 65 or not? And do I automatically get Part A hospital coverage or must I elect to enroll in it?

Phil Moeller: Sorry if it’s still confusing. We’ve been conditioned so long about needing to get Medicare at age 65 that it’s a little scary when someone says you may not need to have it under certain circumstances. But this is one of those situations. If you are still covered by an employer’s policy and work for an organization employing more than 20 employees, you need not sign up for Medicare when you turn 65.

You can wait until your employer coverage ends and then you have an eight-month window to sign up. The only caveat here is that your employer’s plan needs to provide coverage that is considered “credible” under Medicare’s rules. But employer plans almost always meet this test.

While there is no need to sign up, there usually is no reason not to sign up for Part A hospital coverage if you feel more comfortable not waiting. If you’ve worked at least 40 quarters in jobs where you’ve paid Social Security taxes, you qualify for free Part A hospital coverage, so there’s no cost when you sign up. And if you are collecting Social Security benefits, you will automatically be enrolled in Part A when you turn 65.

If you’ve not yet begun taking Social Security, the major reason not to sign up for Part A is if you are contributing to a Health Savings Account (HSA) through your work. If you (or your employer) are contributing to an HSA, your contributions will be disqualified for any month you had Medicare Part A. This could result in owing ordinary income taxes on the deferred income, as well as IRS penalties for the disqualified HSA contributions.

Georgeanna – Fla.: If you do not qualify for Social Security, you do not qualify for Medicare? What does one do then?

Phil Moeller: In nearly all cases, you do qualify for Medicare. What I’m guessing you’re referring do is that people need a minimum amount of work in jobs covered by Social Security (see Donna’s question above) to qualify for free Medicare Part A hospital insurance. If you do not have a work history of 40 credits that qualifies you for premium-free Medicare Part A, ask Social Security to check to see if you may qualify under your spouse’s work history. If not, you can still get Medicare Part A, but you will have to pay for it, and the premiums can cost you more than $400 a month. If you qualify for Medicaid then your state may help you by paying the Part A premium. Some states call this the “buy-in” or the Medicare Savings Program.

Regardless of your Social Security work history, you will qualify for Medicare if you are 65 or older and a current U.S. resident, and either a U.S. citizen or have lived in the U.S. for five continuous years before you apply for Medicare. Also, even if you’re younger than 65, you can qualify for Medicare if you’ve been receiving Social Security disability payments for two or more years. If you have been diagnosed with either end-stage renal disease or amyotrophic lateral sclerosis (ALS), there are special rules to expedite your eligibility.