The Three Most Important Questions When It Comes To Medicare For Expats

U.S. expatriates who want to come back to the United States can face challenges getting Medicare.

Here’s an example:

“I am 69 years old and a U.S. citizen but I have lived in Greenland for a long time. I am homesick. Plus, I have cancer. Can I qualify for Medicare back home and, if so, can I get it with my medical issues? I don’t have a lot of money.”

Patricia’s question touches on three concerns of most expatriates.

1. Can I qualify for Medicare?

Basically, any person 65 and over who meets the requirements for citizenship and residency can qualify for Medicare, along with those people younger than 65 with disabilities or End Stage Renal Disease.

2. How much will Medicare cost?

To qualify for premium-free Medicare Part A, hospital insurance, a person (or his or her spouse) must have worked and paid taxes for 10 years (40 quarters). Those who do not qualify for free Part A can purchase it. Patricia worked only a few years in this country so she likely will pay the maximum monthly premium for Part A, which will be $458 in 2020. 

Once enrolled in Part A, a person is eligible to and must purchase Part B. The standard monthly premium in 2020 will be $144.60. 

Unfortunately, Patricia will also face late enrollment penalties. 

• Because she did not buy Part A when first eligible at age 65, she will pay an additional 10% penalty for twice the number of years in which she should have been enrolled in Part A but wasn’t.
• She did not enroll in Part B at age 65 so there’s a penalty on that, as well. If she returns in 2020, that will be $14.46 a month for every full year she did not have Part B, most likely four years. 
• If Patricia wants prescription drug coverage, she will probably face a Part D late enrollment penalty, too. 

3. Will I be able to get Medicare if I have health issues? 

Here’s some good news for Patricia. Her health history will not affect her ability to get the Medicare coverage of her choice. Medicare Advantage plans do not use medical underwriting. (However, those with End-stage Renal Disease cannot initially enroll in a plan.) If she wants a Medicare supplement plan (Medigap policy), she will have a six-month guaranteed issue right, beginning with the effective date of Part B enrollment, to get a policy. 

If you’re an expatriate toying with the idea of going home, look into your unique situation soon.  If you wait too long, the challenges can become daunting, not to mention expensive.