Original Medicare and the foreign care reality
Original Medicare doesn't pay for care outside the US, with four narrow exceptions: emergency care in the US when a foreign hospital is closer; emergency on a cruise ship within 6 hours of a US port; care you receive in Canada or Mexico when the closest hospital is in those countries; and care for veterans through the VA in some cases.
If you move abroad permanently, Original Medicare effectively pays for nothing. Yet you pay $202.90/mo Part B premium ($2,434.80/year) plus IRMAA if applicable.
Three scenarios for Medicare abroad
Scenario 1: Permanent move abroad, never returning. Drop Part B. Save $2,500-$8,000/year (depending on IRMAA). Keep Part A (it's free). Accept that if you ever return to the US for care, you'll have a Part B late penalty (10% per year you went without coverage) when you re-enroll.
Scenario 2: Splits time between US and abroad. Keep Part B. Use it during US visits. The premium is annoying but cheaper than the late-penalty + reapply hassle.
Scenario 3: Move abroad but uncertain duration (1-3 years, possibly returning). Keep Part B as a hedge. The 8-month return SEP only triggers when you 're-enroll' after losing other coverage — moving back doesn't automatically qualify.
Form CMS-1763 to drop Part B
If you decide to drop Part B: download Form CMS-1763 from cms.gov. You can't drop online — you have to mail/fax/in-person submit.
Stop date is the month after you submit. So submit in December for January 1 stop.
If you ever want Part B back: enroll during the General Enrollment Period (Jan 1 – Mar 31, coverage Jul 1) and pay the late-enrollment penalty for the years you went without. Penalty is 10% of standard premium per 12 months of delay, permanent.
Medicare Advantage abroad doesn't work
MA plans are tied to a US service area. If you move abroad permanently, you'll lose your MA enrollment (out of service area triggers automatic disenrollment after a few months).
MA plans are even worse for travelers than Original — they have networks, and out-of-network care abroad is on you.
If you have an MA plan and you're moving abroad: switch to Original Medicare during AEP (Oct 15 – Dec 7) BEFORE the move. Then decide whether to keep or drop Part B.
Expat health insurance — what to buy instead
International health insurance for expat retirees: Cigna Global, GeoBlue Xplorer, IMG Global Medical. Premiums $100-$300/month for comprehensive coverage in popular expat destinations.
Most cover hospitalization, doctor visits, and prescription drugs. Some include US coverage if you visit (often capped); others don't (cheaper).
Public healthcare access: Costa Rica's CAJA, Spain's SNS, Portugal's SNS, France's Sécurité Sociale, Italy's SSN — all available to legal residents at low monthly cost ($50-$200/month). Quality is generally excellent for routine care; longer waits for elective procedures.
Cash-pay medical tourism: many expensive procedures are 60-80% cheaper in popular destinations. A hip replacement that's $40,000 in the US is $9,000-$15,000 in Costa Rica, Mexico, or Thailand. Quality at top private hospitals matches or exceeds US.
The 8-month return SEP
If you keep Part B abroad and later return to the US: you have an 8-month Special Enrollment Period to enroll in MA or change plans. If you dropped Part B, you go through the GEP penalty path.
Practical implication: keeping Part B at $202.90/mo for 5 years costs $12,174. The late penalty for 5 years of dropping = 50% added to premium permanently. At 20-year retirement that's $24,000+. So mathematically: keep Part B if there's any meaningful chance of returning. Drop only on permanent moves.