Updated August 6, 2026. Quick answer: Medicare does not travel, so Part B premiums paid while you live abroad buy you nothing. Dropping it looks obvious and is not, for one reason people rarely discover in time: there is no special enrolment period for coming home from living abroad. Returning retirees wait for the general enrolment window, with a penalty that has been accruing the entire time.
The premise, in one line
Medicare pays for almost nothing outside the United States, and the regulation that says so is a single sentence. That page owns the rule and the narrow foreign-hospital exceptions. This page is about the decision the rule forces, which is a different question and a genuinely close one.
Note also that “the United States” here is a defined term covering the states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam and American Samoa. A move to a US territory on that list is not a move abroad for this purpose, which for some retirees changes the whole calculation.
The asymmetry: dropping is easy, returning is not
If you drop Part B and later come back, two mechanisms apply and both cut the same way.
The penalty. Under 42 C.F.R. §408.22, the standard premium “is increased by ten percent for each full twelve months” of delay. The statute ties that increase to your continuous period of eligibility, with nothing in it that switches the increase off later — so for practical purposes it rides with the premium for as long as you keep the coverage. What that compounds to in dollars.
The enrolment window, which is the part that surprises people. We went looking for a special enrolment period for people returning from abroad. There is not one. The only special enrolment period in the statute tied to being outside the country is for volunteer service — someone serving “as a volunteer outside of the United States through a program that covers at least a 12-month period”, sponsored by a tax-exempt 501(c)(3) organisation, who had health coverage while serving. That is a narrow door, and an ordinary retiree who simply moved to Portugal does not fit through it.
Everyone else falls back on the general enrolment period, “beginning on January 1 and ending on March 31 of each year”. One recent improvement is worth knowing: coverage now begins the first day of the month after you enrol, rather than being held until the following July as the old rule required. The wait is much shorter than it used to be. The penalty is unchanged.
How the decision actually turns
Strip it back and it is a bet on whether you will return, priced in two currencies.
Keeping Part B costs the premium every month for coverage you cannot use, and buys certainty: no penalty, no enrolment window, no gap on the day you come back needing care. Dropping it saves the premium and buys an unpriced liability that grows at ten percent per twelve months and can only be settled in a window that opens once a year.
The factors that should move you:
- How reversible your move is. A retiree who has sold everything and taken permanent residency abroad is in a different position from one who may return for family or care. The people most likely to return are those who need care, which is exactly when the penalty and the window bite hardest.
- Whether your destination will actually cover you. Public systems vary in whether they admit a foreign retiree, on what waiting period, and at what age. This is a country question and we do not answer country questions.
- Your age at the move. Before 65 the question is a private bridge to Medicare eligibility; after 65 it is this decision directly — and if you are approaching 65 abroad, the enrolment mechanics are worth settling before your birthday, not after. The choices at 65.
- Premiums are not flat. If your income is high enough, a surcharge applies on top, set from a tax return two years old — the lookback. That raises the cost of keeping coverage you are not using.
There is no general answer, and be sceptical of anyone who gives you one. What can be said is that the decision is asymmetric: the cost of keeping it is known, small and monthly, and the cost of dropping it is unknown, potentially permanent, and falls due at the worst possible moment.
Sources
42 U.S.C. §§1395p(e) and (k), 1395q(a)(2)(C), 1395r(b), 1395y(a)(4), 1395x(x) and 410(i), and 42 C.F.R. §§408.20 and 408.22, all read at the Legal Information Institute on 2026-08-06.
Honest gaps. The 2026 Part B premium is $202.90 a month, per Medicare’s own costs page, read 2026-08-06. That figure is the base: a late-enrolment penalty of ten percent per twelve months of delay is applied on top of it, and a high income can add a surcharge as well. An earlier version of this page said we could not reach a primary source for this figure. That was true of the requests we made at the time and is no longer true, so the number is now published. We still describe the penalty’s permanence from the statute and regulation rather than from consumer wording, because that is where the mechanism is actually set. We also found no general Mexico emergency exception in the statute, despite it being widely repeated; if it exists it is in a regulation we could not reach.
See methodology and corrections. General information about published law, not tax or legal advice. No affiliate links, nothing sold.