The permanent move
You've decided.
Here's what comes next.
You're not testing it. You're not rotating. You've decided to move abroad — for good. Portugal, Greece, Italy, or somewhere else. The trial is over before it started.
The permanent move is the most comprehensive setup of the four scenarios. Medicare Part B is a genuinely open question here — the first scenario where dropping it might actually make financial sense. Your IPMI plan becomes your primary health coverage. And your US financial infrastructure needs real restructuring, not just a travel notification.
Published
This page is educational, not professional tax, legal, or financial advice. Medicare rules, visa requirements, brokerage policies, and tax treaty interpretations change — verify current details with official sources and qualified advisors before making permanent decisions.
Five things that are different
on a permanent move.
The permanent move has a different setup than any of the other scenarios. Here's what changes:
- Medicare Part B is a real decision — for a trial move, you always keep it. For a permanent move, the math changes. Under 70 and visiting the US regularly: keep it. 70+ and genuinely never coming back: it's worth running the numbers.
- IPMI is your primary health plan — not a gap filler. Medicare covers your US visits (if you keep Part B). Your International Private Medical Insurance is your actual health coverage for the rest of the year.
- Your US brokerage accounts may close — since 2024, Vanguard, Fidelity, and others have been restricting or closing accounts for customers with foreign addresses. Schwab International and Interactive Brokers are the reliable options. Set up before you change your address.
- Foreign tax residency + regime choice matters — Greece's 7% flat tax and Italy's southern 7% are the most favorable regimes for US retirees with large pension income. Portugal now applies standard rates to most retirees. This is a destination decision, not just a lifestyle one.
- There's an 18-month timeline — Medicare, money, visa, insurance, and the rest, phased so nothing gets locked in the wrong order. We built it. Use it.
The one decision that's
actually open here.
For a snowbird or trial mover, keeping Part B is almost always right. For a permanent mover, the math genuinely changes — and for the first time, dropping it might make sense.
Keep Part B
If you're under 70, the penalty math still skews against dropping Part B — there's too much life left for the 10-year post-return break-even to work in your favor. And if you're returning to the US regularly for family, doctors, or extended visits, Part B will get used. At $202.90/month, a single specialist visit without it can run $300–500 out of pocket.
Run the break-even math
The late enrollment penalty is 10% per 12-month period you were without Part B — permanent. If you drop it for 10 years and return at 75, the penalty is $203/month forever. The break-even against saved premiums is around 10 years post-return. At 75+, returning to the US as a long-term resident becomes less likely, and the math starts to shift. Use the detailed break-even tables in the Medicare guide.
Buy Medigap before you go — even if you plan to drop Part B later —
Your primary health plan.
Not a gap-filler.
For a permanent move, the framing flips. Medicare (if you keep it) covers your US visits. Your IPMI plan is your actual health coverage for the rest of the year — meaning it needs to function like a real health plan, not just an emergency backstop.
Full inpatient + outpatient coverage
GP visits, specialist appointments, diagnostics, ongoing prescriptions, chronic condition management, inpatient hospital stays. Travel insurance and nomad plans don't cover this. You need a full annual IPMI plan.
No age-out cutoffs
Some plans stop accepting new members above 70 or 75, or stop renewing at 80. For a permanent move, you need a plan that's still available to you a decade from now. Confirm renewal guarantees before you buy.
Local public system access
Portugal's SNS, Greece's EOPYY, and Italy's SSN are technically available to legal residents — but practical access for US expats typically requires several years of residency and registration. Most permanent movers use private IPMI for the first few years while they work through the process.
Choose your destination
partly for its tax regime.
You'll be a foreign tax resident. Which country you're a resident of has a direct, calculable effect on your after-tax income — especially for retirees with substantial pension, Social Security, or IRA distributions.
7% flat tax, up to 15 years
Article 5B taxes all foreign-source income at 7% flat for pensioners who become Greek tax residents. Social Security, pension, IRA distributions, and investment income all qualify. Must be applied for separately — not automatic at residency.
Greece 7% flat tax guide →7% flat tax, up to 10 years
Italy's southern-region regime applies the same 7% flat rate to all foreign-source income for retirees who relocate to qualifying municipalities (Abruzzo, Molise, Campania, Puglia, Calabria, Sicily, Sardinia, Basilicata). 10-year cap.
Italy retirement guide →Standard rates apply
Portugal's NHR scheme was replaced by the more restrictive IFICI in 2024. General retirees are not eligible for IFICI — standard Portuguese income tax rates (progressive, up to 48%) apply. US-Portugal treaty reduces double taxation; a CPA familiar with both systems is essential.
Portugal retirement guide →You still file US taxes every year.
US citizenship-based taxation applies regardless of where you live. Social Security, pension, IRA distributions, and investment income are all still reported on your US return. The foreign tax regime affects what your host country taxes — not whether the US taxes you. The foreign tax credit typically prevents double taxation, but the mechanics depend on the treaty and the type of income. An expat CPA familiar with both countries is worth it.
Restructure before
you change your address.
The single most common financial mistake in a permanent move: updating your address with a US brokerage before you've moved assets to an expat-friendly institution. The account closes, and you're dealing with it from abroad.
Do this before you change your address
Since 2024, Vanguard, Fidelity, TIAA, and USAA have been closing or restricting accounts for customers who update to a foreign address. The reliable options for permanent expats are Schwab International and Interactive Brokers — both explicitly support US citizens abroad and won't close the account when you update your address.
Open your Schwab International account while you still have a US address. Transfer assets. Then update your address on the new account when you're abroad.
Keeping your investments when you move abroad →Keep one US account. Add local.
Social Security deposits to US accounts only. IRS correspondence, refunds, and financial statements all need a US address. Keep your Schwab checking account as the US anchor — it receives deposits and reimburses all ATM fees worldwide.
Your destination country's visa process will require a local bank account anyway — that's where you'll pay local bills and handle day-to-day spending. Wise bridges the two, converting from USD at mid-market rates when you need to move money.
Banking guide for US retirees abroad →FBAR: if foreign accounts exceed $10,000.
Once your foreign bank accounts (combined) exceed $10,000 at any point in the calendar year, you're required to file FinCEN 114 (the FBAR) by April 15 (with automatic extension to October 15). It's a disclosure, not a tax — but the penalties for missing it are steep. Most permanent movers will cross this threshold once they set up a local account and move living expenses into it.
Three proven paths for
US permanent movers.
These three destinations have documented, functional visa programs for US retirees and well-established expat communities. For a permanent move, the long-term picture — citizenship path, tax regime, public healthcare access — matters as much as the day-to-day lifestyle.
Portugal
Lowest income threshold of the three at €920/month. English widely spoken, large established expat community, Atlantic climate in Lisbon and the Algarve. 5-year path to citizenship — one of the fastest in Europe. SNS public healthcare access after completing residency.
Tax: Standard Portuguese income tax rates apply to most retirees. No NHR/IFICI equivalent available to general retirees since 2024.
Greece
Higher income threshold, but the 7% flat tax on all foreign-source income is the most compelling tax regime in Europe for retirees with substantial pension or Social Security income. Up to 15 years. EOPYY public health access after residency.
Tax: Article 5B: 7% flat tax on foreign-source income for up to 15 years. Must apply separately — not automatic.
Italy
Southern Italy — Abruzzo, Calabria, Sicily, Sardinia — offers the same 7% flat tax regime as Greece but applied regionally. For retirees willing to live outside the major tourist centers, costs are dramatically lower than northern Italy.
Tax: 7% flat tax on all foreign-source income in qualifying southern municipalities, for up to 10 years.
The wall most permanent
movers hit — and get through.
This is the part most guides leave out. The logistics are manageable. The psychological adjustment is harder.
The honeymoon
Everything is new. Every meal is an adventure. The bureaucracy is an interesting puzzle. The weather is good. You can't believe you waited this long. This phase passes.
The wall
The novelty has worn off. The bureaucracy is no longer interesting. You miss specific things — not everything, but specific things. The social network you spent decades building isn't here. You're still a foreigner. Most of the movers who go back do so in this phase.
Integration
The movers who get through the wall report a different relationship with the place — less tourist, more resident. You know where things are, who to call, what to avoid. It starts to feel less like an adventure and more like a life.
What helps —
Common Questions
When should I actually drop Part B — if ever?
Will my US brokerage accounts stay open after I move abroad?
Can I access the public healthcare system in my destination country?
Do I need to keep a US bank account?
What's the two-year wall and how do I prepare for it?
Seven things to do, in this order.
-
Read the 18-month permanent move timeline
Medicare, domicile, money, visa, insurance, and the rest — phased so nothing gets locked in before the thing it depends on. The order matters more than the pace.
The 18-month permanent move timeline → -
Buy Medigap Plan G while your guaranteed issue window is open
6 months from Part B enrollment. Buy it before you leave, even if you're considering eventually dropping Part B. You can drop it later. You can't go back and buy at guaranteed rates once the window closes.
Medicare guide for a permanent move → -
Move investments to Schwab International before changing your address
Open the account while you have a US address. Transfer assets. Then update your address when you're established abroad. Don't update your address on a Vanguard or Fidelity account without doing this first.
Keeping your investments when you move abroad → -
Choose your visa and understand the income + tax requirements
Portugal D7 (€920/month, standard Portuguese tax), Greece FIP (€3,500/month, 7% flat tax option), or Italy ERV (~€2,600/month, 7% in southern municipalities). Apply 3–6 months before departure — consulate backlogs are real.
Portugal D7 visa guide → -
Get full annual IPMI — no age-out cutoffs, direct billing in your country
This is your primary health coverage. Look for full inpatient and outpatient coverage, confirmed renewal past age 80, and direct billing at hospitals in your destination. Apply 4–6 weeks before departure.
Compare full IPMI plans → -
Set up a virtual mailbox in your domicile state
You need a US mailing address for Social Security, Medicare correspondence, IRS notices, and financial statements. A virtual mailbox receives, scans, and forwards physical mail from anywhere.
How to maintain a US address abroad → -
Find an expat CPA before your first full tax year abroad
Dual US and foreign filing obligations, treaty elections, FBAR, and any tax regime elections (Greece's 7% flat tax requires a separate application — it's not automatic). Worth the fee in the first year especially.
The Medicare decision, with the real math.
Part B break-even tables for 5, 10, and 20 years abroad. The Medigap guaranteed issue window. The abroad exception to the late enrollment penalty. The complete coverage stack for a permanent move.
Medicare guide for a permanent move