How to Handle Medicare When Returning to the U.S. After Living Abroad


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If you live abroad when you turn 65, don’t neglect Medicare.

This is the age at which you must register unless you encounter an exception. And depending on how long you plan to stay abroad or if you work there, it may make sense to be on Medicare.

“It’s essential that beneficiaries living overseas know the rules about this,” said Danielle Roberts, co-founder of insurance company Boomer Benefits.

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Otherwise, she said, you could return to the United States and find yourself waiting for coverage to kick in — in addition to facing late enrollment penalties.

Basic health insurance consists of two parts. Part A, which provides hospital coverage, is free as long as you have at least 10 years of system contribution history. Part B (ambulatory care) has a premium. In 2021, the base amount is $148.50 per month, with high earners paying more.

Except in very specific situations, basic health insurance does not cover medical services you receive outside of the United States and its territories. Exceptions include when you are on a ship less than six hours from a US port or you are in, say, Alaska, and the nearest hospital to treat you is in Canada.

Nevertheless, anyone living abroad may still want to enroll in Medicare.

It is essential that beneficiaries living abroad know the rules in this area.

Danielle Robert

Co-founder of Boomer Benefits

Medicare eligibility begins at age 65. You get an initial enrollment period, as it’s called, that begins three months before your 65th birthday and ends three months after (seven months in total).

The general rule is that unless you have qualifying coverage (as defined by the US government), you face a late enrollment penalty if you enroll in Part B after your enrollment period. initial. Is equivalent to a 10% higher monthly base premium for each 12-month period you should have been registered, but you weren’t. And these penalties are for life.

The rule also applies to people living abroad. According to “Medicare for Dummies” author Patricia Barry, if the initial enrollment period is missed, here are the circumstances under which you could enroll late without penalty:

  • You work for an employer (US or foreign) that offers you private group health insurance.
  • You work for an employer without special health benefits, but you are covered by the national health system of the country in which you live.
  • You are independent and covered by the national health system of the country in which you reside.
  • You are the spouse of anyone in the above three categories, with the same coverage.
  • You are volunteering abroad and have health coverage with an approved sponsoring organization, such as the Peace Corps.

Otherwise, you can expect to pay late registration penalties if you miss your initial registration period.

Be aware that you’ll also need to prove you had qualifying coverage while working overseas, Barry said. In other words, keep things like tax returns, payslips, medical statements, and records of doctor visits and bills.

Also, different situations come with different enrollment deadlines if you enroll late in Medicare.

For example, if you have a “special enrollment period” because you had eligible coverage and were employed, this window to enroll begins when you lose that coverage (or your job, whichever comes first). and lasts eight months. In this situation, your coverage begins the month following your registration.

However, if you don’t have an eligible health plan and enroll late, you can only enroll during Medicare’s general enrollment period, which runs from January 1 through March 31. Then you have to wait for the coverage to take effect on July 1st.

Separately, if you live overseas and don’t qualify for the free Part A and enroll in Medicare after age 65, you get a three-month window once you return to the United States to register. In this situation, there are no late penalties.

If you plan to commute back and forth between the U.S. and where you’re staying abroad, it might be a good idea to enroll in Medicare if you wouldn’t otherwise have coverage, said Elizabeth Gavino, Founder of Lewin & Gavino and Independent Broker and Managing General Agent for Medicare.

“Having both parts A and B gives the Medicare beneficiary [some] coverage when they come to the United States,” Gavino said.

Meanwhile, Medicare Part D is prescription drug coverage and is sold through private plans – either as a standalone policy or as part of an Advantage (Part C) plan, which provides Part A and B and usually includes extras like dental and vision care. Like Basic Medicare, you get no Part D coverage abroad.

For individuals living overseas who enroll in Part D upon returning to the United States, there is no late enrollment penalty as long as you have coverage within a certain relocation window (i.e. two or three months, depending on the specifics of your situation).

If you miss your window, you will be subject to a lifetime penalty of 1% for each month that you did not have coverage but should have, plus any delay in the start of the blanket. This penalty amount is based on the base Part D premium, which for 2021 is approximately $33.


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