Does Medicare Cover You Abroad? 2026 Rules

Medicare usually does not cover health care outside the United States. CMS publishes four exceptions, all tied to U.S. territory or a Canadian border crossing, and drug plans do not cover prescriptions bought abroad. Part B still adds 10% for each full 12-month period of delayed enrolment, in most cases for life.

The general rule, and its four exceptions

Medicare usually does not cover health care outside the United States. The exceptions published by the Centers for Medicare & Medicaid Services number four, not the three that are usually listed:

• a medical emergency occurring in the U.S. where the foreign hospital is closer than the nearest U.S. hospital able to treat the condition;
• travel through Canada without unreasonable delay by the most direct route between Alaska and another U.S. state, where a Canadian hospital is closer;
• living in the U.S. where the foreign hospital is closer to the person’s home than the nearest U.S. hospital able to treat the condition, whether or not there is an emergency;
• services on board a ship within U.S. territorial waters.

The shipboard item is frequently misdescribed as a foreign-care exception. It is not. Under 42 CFR §411.9 it is a rule deeming shipboard services to have been furnished inside the United States, and the window is six hours before arrival at, or six hours after departure from, a U.S. port. Medicare drug plans do not cover prescriptions bought outside the U.S.; Medigap policies may cover emergency care during foreign travel.

The penalties, and where they differ

The Part B late enrolment penalty adds 10% to the premium for each full 12-month period in which a person could have had Part B and did not. CMS describes such penalties as usually charged for as long as the person has that coverage, which for most people means for life. The Social Security Administration puts the same point to expatriates directly in its own publication for people paid abroad.

Part A is different in practice for most people: roughly 99% of beneficiaries pay no Part A premium because they have at least 40 quarters of Medicare-covered employment. For those who must buy it, the 2026 premium is $565 a month, or $311 with 30 to 39 quarters, and the penalty runs for twice the number of years missed.

Part D is different in a way that matters specifically abroad. The penalty is 1% of the national base beneficiary premium — $38.99 for 2026 — for each full uncovered month. But CMS’s own creditable-coverage guidance for 2026 instructs that days on which the individual did not live in the service area of any Part D plan are not counted, and lists living in a foreign country among those circumstances. Months spent living abroad therefore do not accrue a Part D penalty in the way that months without Part B accrue a Part B penalty. This asymmetry is real and is rarely stated.

On enrolment periods, the rule is narrower than hope suggests. The special enrolment period for group health plan coverage turns on current employment status, not on residence. The five special enrolment periods created for exceptional conditions with effect from 1 January 2023 — disaster or emergency, plan or employer error, formerly incarcerated individuals, termination of Medicaid, and other exceptional conditions case by case — do not include residence abroad. A statutory special enrolment period does exist for international volunteers serving at least twelve months through a tax-exempt sponsoring organisation while holding health insurance for the duration of that service. Whether a foreign employer’s group plan qualifies for the employment-based period is not addressed in the guidance available; it should not be assumed.

What is specific to Americans abroad

Access to European public systems is not automatic on legal residence, and the two most common destinations work differently.

In Portugal, the government’s own migrant health page states that any foreign person with legal residence in Portugal can obtain an SNS user number, and the health regulator confirms that foreign citizens with an updated registration access care on terms equivalent to nationals, paying the same user charges — while noting that registration does not mean the SNS assumes all costs.

In Spain, the equivalent route for economically inactive residents is the convenio especial, a paid subscription under Real Decreto 576/2013. The Ministry of Health sets the monthly cost at €60 under 65 and €157 at 65 and over, requires proof of at least one continuous year of effective residence in Spain immediately before the application, and provides that outpatient pharmacy, outpatient orthoprosthetic provision, dietary products and non-urgent medical transport carry a 100% patient contribution. For a retiree on regular medication, that pharmacy exclusion is the material term.

Visa-stage insurance requirements are set by immigration rather than health rules. Spain’s non-lucrative residence authorisation, now governed by Real Decreto 1155/2024, requires public or private health insurance contracted with an insurer authorised to operate in Spain; the consular guidance adds that the insurance must cover all risks insured by Spain’s public health system, and sets financial means at 400% of IPREM for the applicant plus 100% per accompanying dependant. Neither the ministry page nor the consular page states a prohibition on co-payments, which is often asserted. Portugal’s requirement attaches to the residence visa generally: Article 52.º(1)(f) of Lei n.º 23/2007 requires valid travel insurance, and Decreto Regulamentar n.º 84/2007 specifies cover for necessary medical expenses including urgent medical assistance and possible repatriation. No monetary minimum appears in the regulation.

Payment of Social Security itself follows separate rules. U.S. citizens may generally continue to receive payments while outside the United States; the Treasury prohibits payments to persons residing in Cuba or North Korea, and payments generally cannot be sent to Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan or Uzbekistan, subject to exceptions.

The shape of the decision

For scale, the World Health Organization’s expenditure database puts current health spending per person in 2022 at $12,586 in the United States, $2,949 in Spain and $2,601 in Portugal. That gap explains why cover abroad is often cheaper; it does not answer the question the rules pose, which is a different one.

That question has two halves that are usually considered separately and interact: what covers care in the country of residence, and what happens to Medicare in the meantime. The second half depends on facts no general article can supply — whether a return to the United States is likely and when, whether Part A is premium-free, whether any employment-based enrolment period is available, and how the Part D treatment of months abroad applies to a particular history.

Sources

1. Centers for Medicare & Medicaid Services — Medicare.gov, Travel outside the U.S. (the four exceptions; Part D drugs abroad; Medigap) — https://www.medicare.gov/coverage/travel-outside-the-u.s. — checked 2 August 2026
2. Electronic Code of Federal Regulations — 42 CFR §411.9, Services furnished outside the United States (shipboard six-hour rule) — https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-411/subpart-A/section-411.9 — checked 2 August 2026
3. Centers for Medicare & Medicaid Services — 2026 Medicare Parts A & B Premiums and Deductibles (fact sheet) — https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles — checked 2 August 2026
4. Centers for Medicare & Medicaid Services — CY 2026 Creditable Coverage Period Determinations and the Part D Late Enrollment Penalty, Chapter 4 (months lived in a foreign country are not counted) — https://www.cms.gov/files/document/cy-2026-final-chapter-4-guidance.pdf — checked 2 August 2026
5. Centers for Medicare & Medicaid Services — Medicare.gov, Avoid late enrollment penalties — https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties — checked 2 August 2026
6. Social Security Administration — Your Payments While You Are Outside the United States, Publication No. 05-10137 — https://www.ssa.gov/pubs/EN-05-10137.pdf — checked 2 August 2026
7. Ministerio de Sanidad (Spain) — Convenio especial de prestación de asistencia sanitaria (€60/€157; one-year residence; pharmacy exclusion) — https://www.sanidad.gob.es/servCiudadanos/internacional/convenioEspecial.htm — checked 2 August 2026
8. Ministerio de Inclusión, Seguridad Social y Migraciones (Spain) — Hoja 6, Autorización inicial de residencia temporal no lucrativa — https://www.inclusion.gob.es/en/web/migraciones/w/autorizacion-inicial-de-residencia-temporal-no-lucrativa — checked 2 August 2026
9. Governo de Portugal — Migrantes: cuidados de saúde em Portugal (SNS user number for legal residents) — https://www.gov.pt/guias/migrantes-cuidados-de-saude-em-portugal — checked 2 August 2026
10. Decreto Regulamentar n.º 84/2007, art. 12.º(e), and Lei n.º 23/2007, art. 52.º(1)(f) (travel insurance requirement for a Portuguese residence visa) — https://www.iefp.pt/documents/10181/11691207/Decreto_Regulamentar_84_2007_DR_212_2007_Serie_I.pdf — checked 2 August 2026
11. World Health Organization — Global Health Expenditure Database, current health expenditure per capita (2022) — https://www.who.int/data/gho/data/indicators/indicator-details/GHO/current-health-expenditure-(che)-per-capita-in-us-dollar — checked 2 August 2026

Figures and rates cited were current as of August 2026 and are subject to change.