How does the US medicare system work if you are living abroad?

Help for older US Expats living abroad

Medicare

Medicare does not cover you abroad for part A and B, the two main components of the care. However, there are private insurance companies that offer unique products in the US that coordinate with the Medicare program. These are Medicare supplements, and Medicare Advantage policies.

I am a licensed US broker, but these are complicated subjects and there are a wide variety of US policies that offer unique benefits. The guidelines below are generally accurate, but make sure to always check your current policy's conditions of coverage, or ask your current insurance company what would happen if you moved abroad.

Private Medicare Supplements

Medicare supplements may have coverage for you abroad; in our experience most plans are limited to the first 90 days of a trip, up to 50k in coverage, and reimbursement only. We don't recommend relying on this due to the restrictions on coverage if you are an expat.

Medicare Advantage

Advantage plans have more comprehensive coverage abroad, and do not have as limiting restrictions as the supplements have. We have seen clients successfully utilize an Advantage plan strategy and get paid on claims. One thing to note on these plans: they require you to maintain your US residence for the plan, which may not work for some full-time expats. If you are uncertain on your policy's geographical restrictions, search your policy's requirements for the term "Service Area." Most plans require you to notify them if you move cities in the US, let alone countries. If you violate these terms, your claims can be denied.

If you actually live in the US every year and meet your service area requirements, this can be a solid strategy. For example the many "snowbirds" that go to Mexico in the winters may consider this. This being said, never lie on your application to get around these restrictions and list a mailing service or a relative. In my professional opinion, I would consider this Medicare fraud, although it appears to have gained traction in recent years among certain expat communities.

If you are ever uncertain on your policy restrictions, ask your provider if you can update your address to a foreign country on the policy. If they say yes, you may have found the first Advantage plan I have seen that is unrestricted, email it to me; I'll update this article. justin.b@expatinsurance.com