Healthcare Alternatives When Medicare Won't Cover Abroad

Introduction

Medicare—the US health coverage for those 65 and older—does not cover healthcare received outside the United States, with very limited exceptions. Expat retirees must arrange alternative coverage, whether through international insurance, local national systems, or self-insurance.

This guide covers options by cost, coverage level, and practical considerations.

Medicare's Limited Foreign Coverage

What Medicare Covers Abroad

**Almost nothing.** Specific exceptions:

1. **Emergency care in Canada** (very limited circumstances—traveling most direct route between Alaska and lower 48)

1. **Emergency on ship** within 6 hours of US port

1. **Qualified foreign hospital** closest to US for emergency

**In practice:** Don't rely on Medicare abroad.

Keeping Medicare While Abroad

• Premium-free if 40+ work credits
• Can maintain enrollment
• Won't pay claims abroad
• Useful if returning to US periodically

• Costs $174.70/month (2025)
• Can disenroll to save money
• 10% permanent penalty per year delayed if re-enrolling later
• Decision: Are you returning to US within a few years?

• Can't use abroad
• Penalty for late enrollment if re-enrolling
• May want to maintain if prescriptions are stable and you'll return

International Health Insurance

Major Providers

• Age limit: Typically up to 74 for new enrollment
• Coverage: Comprehensive including US
• Cost: $300-800/month depending on age, coverage
• Pre-existing: 24-month lookback, some exclusions

• Age limit: 74 for new applications
• Coverage: Multiple plan levels
• Cost: $200-600/month
• Pre-existing: Varies by plan

• Age limit: 84 with limitations
• Coverage: International, limited US coverage
• Cost: $300-700/month
• Pre-existing: 6-month exclusion period

• Age limit: Varies by plan
• Coverage: Multiple options
• Cost: $200-500/month
• Pre-existing: Some plans cover after waiting period

What to Look For

• Does it cover US for visits back?
• Does it cover your destination country?
• Are there exclusions (war zones, etc.)?

• Waiting periods
• Moratorium approach (excluded initially, covered later)
• Full medical underwriting

• $1,000-$10,000 deductible options
• Lifetime maximum: $1M-$5M typical

• Coverage amount
• What triggers evacuation
• Repatriation of remains

Sample Costs (65-year-old)

| Provider | Coverage Level | Monthly Cost | Deductible | |----------|---------------|--------------|------------| | Cigna Global | Silver | $450 | $2,500 | | GeoBlue | Premium | $520 | $1,000 | | IMG Global | Standard | $380 | $5,000 |

Local National Health Systems

Countries With Accessible Systems for Expats

• Can join Securite Sociale after 3 months of residency
• Covers 70-80% of costs
• Top-up insurance (mutuelle) common
• High quality care

• Can join Social Security system
• Coverage for legal residents
• Good quality, wait times for non-emergency

• SNS (National Health Service)
• Available to residents
• Low cost, quality varies

• IMSS (voluntary enrollment)
• ~$600/year
• Basic coverage, varies by location

• CAJA (Caja Costarricense de Seguro Social)
• Required for residency
• $60-200/month based on income
• Comprehensive coverage

• No public option for expats
• Private insurance or self-pay
• Low costs make self-pay viable

Enrollment Requirements

• Legal residency status
• Registration with local authorities
• Proof of address
• Sometimes: income documentation

Self-Insurance Approach

When It Makes Sense

• Thailand
• Mexico
• Ecuador
• Colombia
• Parts of Southeast Asia

How to Structure

1. **Catastrophic coverage only** ($10K+ deductible international plan)
2. **Pay routine care out of pocket**
3. **Keep emergency fund** ($50,000+ accessible)
4. **Consider evacuation coverage** separately

Example Budget (Thailand)

| Expense | Cost | |---------|------| | Doctor visit | $20-50 | | ER visit | $100-300 | | Hospital day (private room) | $100-200 | | Specialist consultation | $40-80 | | MRI | $200-400 | | Catastrophic policy | $150/month |

**Annual budget:** ~$5,000-8,000 for moderate healthcare use

Medical Tourism

Returning to Lower-Cost Country for Care

• Plan elective procedures for medical tourism destinations
• Mexico, Thailand, Costa Rica popular
• Significant savings on dental, orthopedic, cardiac

Quality Considerations

• JCI accreditation (international standard)
• Research specific facilities
• Arrange follow-up care before traveling

Managing Prescriptions

US Prescriptions Abroad

• US prescriptions often not accepted
• Some medications controlled differently abroad
• Supply chain varies

**Solutions:** 1. **Local doctor** - Get local prescription 2. **International pharmacy services** - Some mail-order options 3. **Stock up during US visits** - 90-day supplies 4. **Mark Cuban's Cost Plus** - Some international shipping

Cost Comparison

| Medication (30-day) | US Price | Mexico Price | Thailand Price | |---------------------|----------|--------------|----------------| | Lipitor generic | $15 | $8 | $5 | | Metformin | $10 | $4 | $3 | | Brand name drug | $500+ | $100-200 | $50-150 |

Key Takeaways

• Medicare does not cover care abroad (few exceptions)
• International health insurance costs $200-800/month for retirees
• Local national systems available in many countries (France, Spain, Portugal, Costa Rica)
• Self-insurance viable in low-cost countries with catastrophic backup
• Keep Medicare Part A (free); evaluate Part B based on return plans
• Pre-existing conditions complicate international insurance

Next Steps

1. Evaluate healthcare costs in your destination country
2. Get international insurance quotes before turning 65 or 74
3. Research local national health system requirements
4. Decide on Medicare Part B enrollment
5. Plan prescription medication logistics
6. Build emergency fund for health expenses