Medicare ends at the border.
Your bills don't.
Original Medicare doesn't follow you abroad. Medicare Advantage auto-disenrolls at six months out of the country. Part D pays nothing overseas. The gap is real — and going uninsured is the most expensive way to handle it.
A full international plan for a 65-year-old runs $150–300/month. Against a six-figure hospitalization, it isn't a premium — it's the math on not self-insuring a risk you can't afford to carry.
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This page is educational, not licensed insurance advice. Plan terms, pricing, eligibility, and exclusions vary by age, destination, and individual circumstances — always confirm current details directly with the insurer or a licensed broker before purchasing a policy.
Insurance abroad is one decision, not ten.
For a typical retiree — 65+, relocating overseas — here's the whole picture:
- Medicare covers almost nothing outside the US. Part D covers nothing. Medicare Advantage drops you at six months abroad.
- If you're fully relocated, a "Worldwide Excluding USA" plan is the default — cheaper, and you cover US visits with short-term travel insurance.
- If you're splitting time, you need a plan that includes US coverage — expect 30–50% more in premium.
- The three things to actually check: pre-existing waiting periods, medical evacuation, and renewal-age limits.
A full international plan for a 65-year-old typically runs $150–300/month. See why we recommend IMG →
Managing a chronic condition? Diabetes, hypertension, statins, GLP-1 medications, or a cardiac history all affect which carrier covers you and on what terms — and two of the five major insurers are genuinely bad choices for certain conditions. See the pre-existing conditions guide →
Four retirement styles. Four different answers.
International insurance isn't automatically the right answer. Start with how you're actually going to live — the rest follows from that.
Seasonal: 3–5 months abroad
Full annual IPMI is overkill. Short-duration travel medical policies (3–6 months) are the right-sized option for your abroad window.
Medicare Advantage watch: plans auto-disenroll at six months abroad. Most snowbirds stay under that threshold — but confirm your plan’s exact terms before you go.
Don’t drop Medicare while you’re still testing the snowbird life. The late-enrollment penalty is permanent.
Medicare rules for snowbirds →Trial year: one country, 6–12 months
A local private plan is often $80–150/month — cheaper than full IPMI, and sufficient if you’re not crossing borders during the trial.
Trade-off: local plans don’t travel with you. Layer short-term travel insurance for trips back to the US. If you plan to visit other countries during the trial, full IPMI makes more sense.
Medicare during a trial move →Country-hopping: no fixed base
Full IPMI is the right category — but one underwriting detail to check before applying: most plans require you to declare a home country of residence. Without one, some insurers won’t cover you — and others price the policy as if you live in the US.
Common workaround: your domicile state (South Dakota is the standard for perpetual travelers) can serve as your declared home base. Confirm the insurer accepts this arrangement before applying — not all do.
Medicare for perpetual travelers →Fully relocated abroad
Full IPMI is the clear answer. If you’re not relying on US healthcare day-to-day, Worldwide Excluding USA is the default — cheaper, and you cover US visits with short-term travel insurance.
Watch for: if you’re spending several months a year stateside, or your destination visa requires worldwide coverage by name, you’ll need US coverage built in.
Medicare for permanent movers →Snowbird or trial mover? Your path is shorter.
The rest of this page covers full IPMI — the right category for permanent movers and perpetual travelers. If you’re spending a season abroad, short-term travel medical policies (3–6 months) are what you need, available through most travel insurance brokers. If you’re doing a trial year in one country, look for local private insurance in your destination — Portugal, Greece, and Italy all have accessible private markets for expats at $80–150/month.
For country-specific notes on local plans and how the public health system fits in, see our country guides.
Six things worth checking before you sign.
Most of the friction with international policies shows up after you file your first claim. These are the terms that decide whether the plan actually covers you when it matters.
Pre-existing conditions
Most plans impose a 6–24 month waiting period; some exclude pre-existings entirely. Be upfront on the application — a non-disclosure is what gets claims denied later.
Medical evacuation
A medevac flight back to the US runs $50,000–100,000+. Confirm it's included in the policy, not a separate rider you forgot to buy. Aim for at least $100k of evac coverage.
Renewal-age limits
Some plans stop accepting new enrollees at 65–70; others price you out at 75+. You want a plan you can actually keep — check the long-term renewal terms, not just the entry premium.
US coverage included?
If you're splitting time or visiting often, you need US coverage built in. Not all plans offer it; those that do charge significantly more. Decide this before requesting quotes.
Direct billing vs. reimbursement
Some insurers pay the hospital directly — you show your card and walk out. Others want you to front $10,000–20,000 and wait months for a check. On a fixed income, the cash-flow gap matters. Confirm the model.
English-language support
IMG, Cigna Global, BCBS Global all operate in English by design — claims, customer service, policy documents. Local-country insurers usually don't. If you're not fluent, this matters more than it sounds.
The Worldwide
Excluding USA play.
Adding the US to an international plan inflates your premium 30–50%. If you're truly relocated and only visit the US a few weeks a year, there's a smarter setup — and the math isn't close.
A two-week US trip on travel insurance is a fraction of carrying US coverage all year.
Buy Worldwide ex-USA
Covers you everywhere except the US. The default for retirees who've genuinely relocated and aren't relying on US healthcare day-to-day.
Layer travel insurance for US visits
Buy a short-term inbound travel policy for each US trip. Two weeks runs $50–150 — far less than carrying US coverage on your main plan for 12 months.
When this doesn't apply.
If you're spending several months a year stateside, you need a plan with US coverage built in. And check your destination's visa rules — some require worldwide coverage by name, regardless of how often you visit the US.
What happens, and when.
The retirees who handle insurance smoothly buy the policy before they leave — not after a hospital visit forces it.
Decide and shop
- —Decide situation 01, 02, or 03 above — this drives the quote
- —List your pre-existing conditions before requesting quotes
- —Get quotes from at least two insurers
- —Confirm evac coverage and direct-billing model in the fine print
Activate before you fly
- —Policy effective date before wheels-up — not the day after
- —Decide whether to drop Medicare Part B (see the Medicare guide)
- —Save the insurer's 24-hour assistance number on your phone
Renew & reassess
- —Annual renewal — check for age-band repricing at 70 and 75
- —Layer travel insurance for each US visit (Worldwide ex-USA path)
- —Reassess if your travel pattern changes — full relocate vs. split time
IMG.
Built for expats.
Plans that don't age you out.
We send people to IMG because their plans are designed for people doing what you're doing — relocating in retirement, holding coverage long-term, dealing with evacuation and pre-existing waiting periods up front instead of buried in fine print.
- Multiple plan tiers — from basic to comprehensive
- Medical evacuation included — on most plans, not a separate rider
- US coverage available — as an add-on if you split time
- Built for long-term expats — not travel/nomad short-term policies
- Pre-existing waiting period — 12 months on most plans, disclosed up front
You'll land on IMG's quote tool. Enter your age, destination country, and whether you need US coverage — it shows pricing at each deductible level side by side. No account or contact information required to see numbers.
Affiliate link — we earn a commission if you purchase, at no cost to you.
Not ready to quote? See typical costs by age first — no insurer contact required.
Quoted ranges are typical for a healthy 65-year-old. Final pricing depends on plan tier, deductible, destination country, and disclosed conditions — always confirm with the insurer.
Also worth getting a quote from.
Pricing varies more than you'd expect for nearly identical coverage. Get IMG plus one of these — comparison is the only way to know what you're overpaying.
Cigna Global
Large provider network, strong in Europe and Latin America
Allianz Care
Modular plans, strong European coverage
AXA Global Healthcare
Comprehensive coverage with mental health included, strong in Europe
BCBS Global Solutions (formerly GeoBlue)
US-style BCBS network — familiar coverage and claims experience for Americans
Frequently Asked Questions
Does Medicare cover anything when I'm abroad?
What about Medicare Advantage — doesn't it cover travel?
How long are pre-existing condition waiting periods?
What's the difference between travel insurance and IPMI?
Why don't you list SafetyWing?
Can my visa application require a specific kind of insurance?
Can I keep my international plan if I move back to the US?
What to re-verify each fall
Premium ranges and Medicare interactions on this page reflect 2026 rates. Reverify when CMS publishes the following year's figures (typically October/November).
- IMG quote ranges — reverify against fresh quotes; insurer pricing drifts year over year
- Medicare Part B premium baseline — updated by CMS each fall, used for the drop-vs-keep math
- Provider rebrands or acquisitions — e.g., GeoBlue → BCBS Global Solutions; check provider names yearly
- Medicare Advantage 6-month abroad rule — confirm CMS hasn't modified the auto-disenrollment threshold
Three things to do, in this order.
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Decide your situation — local, Worldwide ex-USA, or with US coverage
This single decision drives everything else. If you're truly relocated, default to Worldwide ex-USA and layer travel insurance for visits home.
Get the 60-second coverage summary → -
List your pre-existing conditions before requesting quotes
Insurers will ask, and disclosure is what protects your future claims. Knowing what you'll disclose makes the quote process honest from the start.
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Get your number: run IMG's quote tool, then one alternative
Pricing varies more than you'd expect for similar coverage. Two quotes is the minimum that tells you whether you're overpaying.
Why we recommend IMG →
Insurance is half the picture. Medicare is the other half.
Whether to keep, drop, or pause Medicare Part B when you move overseas is one of the most expensive decisions a retiree makes — and the late-enrollment penalty is permanent. Our Medicare guide walks through the keep-vs-drop math by scenario.
Read the Medicare guide