The short answer
With Medicare and Social Security abroad, the rule of thumb is simple: Social Security usually keeps paying, Medicare usually does not. Plan private cover until you can join the local system. Portugal, Italy, Brazil and Malta open public care to legal residents; Spain and France do so after a wait.
Two US programs follow retirees abroad very differently. Social Security usually keeps paying wherever you live. Medicare mostly stays home. Planning a retirement abroad means knowing exactly where that gap falls and how each country fills it once you are a resident, because healthcare, not the visa, is often the hardest part of the move to get right.
Does Medicare cover you abroad?
Generally, no. Medicare says it usually does not cover health care while you are outside the United States, with narrow exceptions, and that in most cases you pay all costs abroad. Some Medigap policies cover emergency care abroad. Our Retiree guides repeat the point country by country: Medicare does not cover care in Portugal, Uruguay, the Netherlands, Mexico or Panama.
- Keep Part B or drop it? Some retirees keep Part B so they are covered if they return, because if you enroll late, Medicare charges a penalty for as long as you have Part B. Others drop it to save the premium. It is a personal decision worth making before you leave.
- Plan the gap. Between arrival and public enrollment you need private cover. Several visas require it anyway.
Can I get Social Security abroad?
In most countries, yes. The Social Security Administration's Payments Abroad Screening Tool tells you, country by country, whether payments continue, stop after six months, or face restrictions. Direct deposit to a foreign or US account is common; our Spain guide notes Social Security arriving by direct deposit.
Healthcare for retirees abroad, country by country
How a legal resident retiree reaches public or mandatory healthcare in each country we cover, the main condition or wait, and whether a US Social Security (totalization) agreement is in force.
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| Country | Healthcare for resident retirees | Wait or condition | US Social Security agreement |
|---|---|---|---|
| Argentina | Public care for legal residents | Emergency care for everyone regardless of status | No |
| Brazil | SUS, free for everyone in Brazil | Guaranteed by law regardless of nationality | Yes (2018) |
| Canada | Provincial coverage for eligible residents | Up to 3 months to start; no retiree visa | Yes (1984) |
| Colombia | EPS public system | Pensionado holders wait for resident status; first years private | No |
| Costa Rica | Caja (CCSS) | After residency and registration | No |
| Croatia | HZZO, for set categories of residents | Via residency category | No |
| Ecuador | Public MSP care | Aimed at residents; emergencies for everyone | No |
| France | PUMa | After 3 months of stable residence | Yes (1988) |
| Germany | Statutory (GKV) or private (PKV) insurance | Mandatory; over-55 arrivals usually routed to private | Yes (1979) |
| Greece | Public system | AMKA registration and entitlement proof first | Yes (1994) |
| Italy | SSN | A residency right; registration follows your permit | Yes (1978) |
| Malta | National health service, free at point of use | For entitled residents | No |
| Mexico | IMSS | Only once residency is secured; private first | No |
| Netherlands | Mandatory basic insurance | Within four months of registration | Yes (1990) |
| New Zealand | Resident-only public system | Retirement visitors pay their own care; ACC covers accidents | No |
| Panama | Public/private mix | Most retirees use private hospitals | No |
| Portugal | SNS | Every legal resident, once registered | Yes (1989) |
| Spain | Public system by buy-in (convenio especial) | €60–€157 a month after one year on the padrón | Yes (1988) |
| Thailand | Private, self-funded | Most retirees do not qualify for subsidized care | No |
| Uruguay | ASSE public system | Requires legal residency and a cédula | Yes (2018) |
Countries with public healthcare for expat retirees
The clearest routes are in Portugal, where the SNS covers every legal resident once registered, Italy, where SSN access is a residency right, Brazil, where the SUS treats everyone in the country at no cost, and Malta, where entitled residents use a national service free at the point of use. Costa Rica's Caja and Uruguay's ASSE open after residency and registration. France enrolls residents after three months. Spain asks non-lucrative visa holders to buy in after a year, at €60 to €157 a month. In Thailand and on New Zealand's retirement visa, care is private and self-funded.
Health insurance for retirees abroad
- Bridge cover first. Almost every country needs private insurance for the months before public enrollment: Costa Rica, Canada, Italy, France and Spain all say so.
- Watch age rules. In Germany, over-55 arrivals without prior insurance history are generally routed to private insurance.
- Read exclusions. Pre-existing condition exclusions are common in private plans, as our Spain guide warns.
- HIV care is often separate. Antiretroviral therapy is free in several systems once you are covered. Our HIV guide shows when treatment starts.
Totalization agreement countries
A totalization agreement coordinates Social Security between the US and another country, so you do not pay into both systems for the same work and can combine credits. The countries we cover with an agreement in force are Brazil, Canada, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain and Uruguay. It matters most if you will work abroad, even part-time. If you only draw a US pension, payment rules depend on the Payments Abroad tool, not the agreement.
Common questions
Does Medicare cover me if I live abroad?
Generally, no. Medicare usually does not cover care outside the United States, and in most cases you pay all costs abroad. Some Medigap policies cover emergency care abroad.
Can I receive Social Security if I retire abroad?
In most countries, yes. The Social Security Administration's Payments Abroad Screening Tool shows whether payments continue, stop after six months, or face restrictions in the country you choose.
Which countries give retirees public healthcare?
Among the countries we cover, Portugal, Italy, Brazil, Malta, Costa Rica, Uruguay, Ecuador, Greece and Croatia open public care to legal residents. France and Spain open it only after a waiting period or a buy-in payment. Thailand and New Zealand's retirement visa rely on private care.
Should I keep Medicare Part B when I retire abroad?
It depends on whether you may return. If you enroll late, Medicare charges a penalty for as long as you have Part B, so some retirees keep it as a fallback. Others drop it to save the premium.
Which countries have a Social Security agreement with the US?
Among the countries we cover: Brazil, Canada, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain and Uruguay.
Sources and method
Country facts come from the Out & Found Retiree Edition guides, verified as of 1 August 2026; Social Security agreement dates from the guides' US-tax research. US rules: Medicare.gov and the Social Security Administration. Requirements and laws change, so confirm the current rule with the official source before you act. This is research, not legal, immigration, medical or tax advice. How we research · Corrections