Medicare Won't Cover You Abroad: What Expat Retirees Must Know
Roughly 750,000 Americans retire abroad each year, and the number keeps growing. But there's a critical healthcare gap that derails many expat retirement plans: Medicare does not work outside the United States.
If you're planning to retire in Portugal, Mexico, Thailand, or anywhere else, you need a healthcare plan before you leave. Here's exactly what you need to know.
The Medicare Reality Check
Medicare Parts A and B cover hospital and medical care only in the United States. With a few narrow exceptions, the moment you leave US territory, you're on your own.
The narrow exceptions (all rare):
- A US-flagged ship within 6 hours of a US port
- Emergency care in a Canadian or Mexican hospital closer to the US border than a US hospital
- Treatment on a cruise ship within 6 hours of a US port
What about Medicare Advantage? Almost all require in-network US providers. Some offer limited international emergency coverage, but it's rarely comprehensive.
The Awareness Gap
According to surveys, 55% of Americans nearing retirement don't know Medicare won't cover them abroad. Many discover this only after arriving in their new country.
Your Healthcare Options as an Expat Retiree
Option 1: Local National Health System
| Country | Public Health Access | Quality Notes |
|---|---|---|
| Portugal | Yes (SNS) after residency | Good urban care |
| Spain | Yes after registration | High quality |
| Costa Rica | Yes (CAJA) with residency | Good primary care |
| Mexico | Limited | Variable |
| Thailand | No public access | Excellent private care |
Option 2: Local Private Health Insurance
Typical costs (2026, age 65):
- Mexico: $150–$250/month
- Portugal: $200–$350/month
- Thailand: $180–$300/month
- Costa Rica: $220–$380/month
- Spain: $250–$400/month
Pros: Low cost, accepted at local hospitals. Cons: Doesn't cover you in the US; may exclude pre-existing conditions.
Option 3: International Health Insurance
Plans like Cigna Global, Aetna International, and GeoBlue provide worldwide coverage.
Typical costs (age 65):
- Worldwide including US: $3,500–$8,000/year
- Worldwide excluding US: $1,800–$4,500/year
Adding US coverage significantly increases premiums because US healthcare costs are the world's highest.
Option 4: FEHB for Federal Employees
If you're a federal employee or retiree, FEHB plans generally DO provide international coverage. You must have been enrolled for 5 years before retirement.
Country-Specific Considerations
Portugal: SNS free for legal residents. Good quality, English widely spoken in hospitals. Many expats carry a local private supplement ($150–$200/month).
Mexico: Excellent private hospitals in Puerto Vallarta, San Miguel, and Mexico City. Costs 40–60% below US prices.
Thailand: No public system for expats. World-class private hospitals (Bumrungrad in Bangkok). International coverage runs $180–$350/month.
Spain: Non-EU retirees must show proof of private health insurance for the Non-Lucrative Visa — it's a visa requirement.
Costa Rica: CAJA enrollment required for most residency categories ($50–$150/month income-based).
Should You Drop Medicare Part B?
Many expat retirees consider dropping Part B to save ~$185/month since it doesn't cover them abroad.
The risk: A 10% premium surcharge for every 12-month period you were unenrolled. At age 75 with a 10-year gap, that's a permanent 100% surcharge — for life.
General guidance: If there's any chance you'll return to the US, keep Part B.
Visa and Residency Healthcare Requirements
| Country/Visa | Health Insurance Requirement |
|---|---|
| Portugal D7 Visa | Required |
| Spain Non-Lucrative Visa | Required (mandatory private) |
| Thailand LTR Visa | Required ($50,000 coverage) |
| Panama Pensionado Visa | Not required (recommended) |
| Costa Rica Pensionado Visa | CAJA enrollment required |
Practical Checklist
6–12 months before departure:
- Decide whether to keep Medicare Part B
- Research destination country's healthcare system
- Get quotes from 3+ international health insurers
3–6 months before:
- Purchase international health insurance
- Stock 6-month supply of prescriptions
- Confirm visa insurance requirements
After arrival:
- Register with local health system if eligible
- Identify nearest English-speaking doctors
Plan Your Expat Healthcare Budget
Use the RetireStack Medicare vs. International Coverage Calculator to compare healthcare costs across countries and coverage types. See monthly premium estimates and a side-by-side comparison of keeping Medicare vs. switching to international coverage.