| Verified against primary record | |
| United States | Medicare usually does not cover care outside the country; all three exceptions require presence or residence in the United States[1] |
|---|---|
| European Union | A pensioner requests the S1 from the institution in the country paying the pension[2] |
| Coordination principle | A person is covered by one country’s system at a time[2] |
| Records read | Medicare and Commission pages and the statistical supplement, 30 September 2026 |
| Independently reported | |
| Moving abroad for healthcare | No measured figure located |
| Bands apply only to the rows beneath them. No count of retirees resident abroad is given, for the reason set out in the text. No provider-supplied figures are used. | |
Healthcare for international retirees concerns how people who have retired to another country obtain and pay for medical care there. It is distinct from medical travel proper: the person has moved, and the question is which system they belong to rather than which one they visit. The answer differs sharply between the two largest retirement-destination systems, and the difference is the most consequential fact in the subject.
The American position
Medicare states plainly that it usually does not cover health care while the beneficiary is travelling outside the United States. For this purpose the United States comprises the fifty states, the District of Columbia, Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands and American Samoa; anywhere else is outside.[1]
Three exceptions are given. Payment may be made where the beneficiary is in the United States when a medical emergency occurs and the foreign hospital is closer than the nearest American one; where the beneficiary is travelling through Canada without unreasonable delay by the most direct route between Alaska and another state when an emergency occurs; and where the beneficiary lives in the United States and the foreign hospital is closer to their home than the nearest American hospital able to treat the condition, whether or not there is an emergency.[1]
Every one of the three is anchored to the beneficiary being in, or resident in, the United States at the relevant moment. None is available to someone who has moved permanently abroad. The practical consequence follows from the text rather than from interpretation: Medicare does not travel with the retiree. Supplementary policies may cover emergency care abroad, but the official page states only that they may, without guaranteeing it.[1]
The European position
European coordination works on the opposite principle. A person is covered by the social security system of one country at a time and contributes in one country only, and entitled individuals can draw cash benefits such as pensions while resident in another covered country. The framework covers the European Union plus Iceland, Liechtenstein, Norway and Switzerland, with separate arrangements for the United Kingdom, and rests on Regulations 883/2004 and 987/2009, in force since 2010.[2]
For healthcare specifically, a pensioner who moves requests an S1 document from the health insurance institution in the country paying the pension, which entitles the holder and their family to healthcare in the country where they live.[3] The exception catches many people out: where the country of residence itself pays a pension that carries an entitlement to healthcare benefits, the pensioner is covered by that country’s system instead, even if pensions are also received from elsewhere.[3]
A figure that is routinely miscited
The United States Social Security Administration publishes a table of beneficiaries under totalisation agreements, recording 244,262 beneficiaries as at December 2025, of whom 154,929 were retired workers, with an average monthly benefit of 356.04 dollars.[4] This figure is frequently reproduced as the number of Americans receiving Social Security abroad. It is not.
Totalisation beneficiaries include foreign nationals living in their own countries who accrued some American credits, and exclude an American retiree living in a country with which there is no totalisation agreement. The low average benefit is itself evidence of what the table counts: pro-rated awards, not full pensions paid to emigrants. No figure for total beneficiaries resident outside the United States was located.
Nor was any measured figure located for retirement migration undertaken for healthcare reasons. That people retire abroad partly for the cost or availability of care is plausible and often stated; it is not, on the sources consulted, measured.
See also
- Medical travel for older adults, for travel as distinct from relocation
- Expatriate healthcare, the general case of living outside one’s country of citizenship
- Healthcare for digital nomads, the newer case of no fixed country of residence
- Emergency healthcare abroad, what cover applies when something happens unexpectedly
References
- Centers for Medicare and Medicaid Services. Travel outside the U.S. Page carries no date. Verified against primary record: official programme page opened and read. Retrieved 30 September 2026.
- European Commission, Directorate-General for Employment, Social Affairs and Inclusion. EU social security coordination. Verified against primary record: Commission directorate page opened and read. Retrieved 30 September 2026.
- European Commission. Health insurance cover in your host country. Your Europe portal, page last updated 19 August 2026, citing Regulation (EC) No 883/2004. Verified against primary record: official citizen information portal opened and read. Retrieved 30 September 2026.
- Social Security Administration. Annual Statistical Supplement, 2026, Table 5.M: Number of beneficiaries and average monthly benefit under U.S. totalization agreements. Reference date December 2025. Verified against primary record: official statistical publication opened and read. Retrieved 30 September 2026.
Sourcing note: the Medicare page, the two Commission pages and the statistical supplement were opened and read on 30 September 2026. The totalisation figure is reproduced only alongside an explanation of what it counts, because it is widely misreported as the number of Americans drawing Social Security overseas. The Medicare page carries no date stamp, which is noted rather than smoothed over. No figure is given for retirees who moved abroad for healthcare reasons, because none was located.