Social Security and Medicare Abroad: One Follows You, One Does Not

Updated August 2, 2026. Quick answer: two benefits, two completely different answers. Social Security generally keeps paying you overseas — but if you are not a US citizen, payments stop after six consecutive months abroad unless you fit an exception, and exceptions turn on your country. Medicare does not travel at all. The regulation is one sentence long and there is no version of retiring abroad in which it stops being true.

Medicare: the sentence that decides it

“Medicare does not pay for services furnished outside the United States.”

42 CFR 411.9

You keep paying Part B premiums if you stay enrolled, and you get nothing for them while you are away. Drop it and you face a late-enrolment penalty that raises the premium permanently if you return — what that penalty comes to. Neither branch is comfortable, which is why this decision deserves attention before departure rather than after.

The narrow exceptions, now verified. We previously left these undescribed because we could not read a source we trusted. We can now: 42 U.S.C. §1395f(f) covers inpatient care in a foreign hospital that “was closer to, or substantially more accessible from, the residence of such individual than the nearest hospital within the United States”, and two emergency cases — an emergency arising while you were physically present in the United States, and an emergency arising in Canada while travelling by the most direct route between Alaska and another State. All three are border and transit situations, not a benefit for living abroad. We found no general Mexico carve-out in the statute, despite it being widely repeated. The keep-or-drop decision this forces is on its own page.

Social Security: citizenship changes everything

If you are a US citizen, benefits generally continue wherever you live, with a separate sanctions rule below.

If you are not, the alien non-payment provision applies: an alien “residing outside the United States for six full consecutive calendar months cannot be paid benefits beginning with the seventh month of their absence.”

The exceptions are broad enough that many people never hit it, and they include the worker having lived in the US for at least 10 years or earned 40 quarters of coverage, being a citizen of a treaty country, or being a resident or citizen of a country with a US social security agreement.

But which exception applies depends on your country, and SSA keeps a chart for exactly that purpose — it “contains a list of countries and shows what citizenship exception, if any, applies.” That is a per-country answer, so we are not going to give you a general one. Look up your own row, or ask SSA.

Two countries where payment stops regardless

Separately from all of the above, Treasury sanctions bar delivery of US government payments — “including Social Security benefit checks” — to beneficiaries in certain countries. SSA’s country table names Cuba and North Korea. This applies to citizens too. Withheld payments to a US citizen can generally be paid retroactively after leaving such a country.

Totalization agreements, and what they do not do

If you worked in two countries, a totalization agreement does two things. It ends double taxation — the agreements “eliminate dual social security coverage and taxation, the situation that occurs when a person from one country works in another country and is required to pay social security taxes to both countries for the same earnings.” And it lets divided careers qualify at all, by combining coverage.

Here is the part almost every summary gets wrong. Combining credits gets you through the door; it does not enlarge the cheque.

• Credits are not moved: they “remain on the worker’s record in the country where they were earned.”
• The combination establishes entitlement — US quarters “can be combined with periods of foreign coverage to establish fully insured status.”
• The amount is then computed on your US record alone: totalization benefits “are always based on the pro rata primary insurance amount.”

So someone with eight years of US work and twenty abroad may become eligible for a US benefit they could not otherwise claim — and it will be a small one, sized to eight years. That is the correct and often disappointing answer, and it is better to know it in advance than to plan around a number that was never going to arrive.

We are not publishing a country list. SSA’s authoritative list of agreement countries sits on a page that blocks automated reading, and we will not reproduce a list — or even a count — from a secondary source on a question this consequential. SSA publishes it; check there.

What this means before you go

Check citizenship first. It is the variable that decides the Social Security answer, and in a mixed-status household the two spouses may get different answers on the same move.

Budget for health cover separately. Medicare is not a fallback abroad. What replaces it — national systems, private international cover, returning for treatment — is a real cost line, not a detail.

Do not assume the tax side follows the benefits side. Whether the country you move to taxes your US benefits is treaty-dependent and specific to the pair of countries involved. We are not going to guess at yours.

If a non-citizen spouse is part of the picture, the estate side has a trap worth knowing before anything else: there is no unlimited marital deduction for a non-citizen spouse. And on the domestic-benefits side, how remarriage affects survivor and divorced-spouse benefits.

Alien non-payment rule and its exceptions from SSA POMS RS 02610.001, .010 and .015; Treasury restrictions from POMS GN 00905.600 and RS 02650.001; totalization from POMS GN 01701.005, .100, .135 and .225; the Medicare rule from 42 CFR § 411.9. The statutory text of 42 U.S.C. § 402(t) could not be retrieved in full, so the rule is quoted from SSA’s own manual implementing it. Read August 2026. Entitlement abroad is individual — confirm your own case with SSA. General information, not advice.