Original Medicare almost never pays for care you receive outside the United States.
Separately, declining Part B when first eligible — without qualifying employer coverage as the reason
— can attach a penalty to your premium for as long as you keep Part B. The two traps pull in opposite
directions and catch different people. Nothing you enter reaches any server.
Your situation
The rulebook, verified
Original Medicare almost never pays for care received outside the U.S. verified
Original Medicare (Part A and Part B) generally does not cover health care received outside the United States and its territories, apart from a small set of narrow exceptions (for example a medical emergency on a cruise ship within a limited distance of a U.S. port, or specific cases where a foreign hospital is closer than the nearest U.S. one to the beneficiary's residence). Someone who splits time between the U.S. and another country cannot rely on Medicare to cover care received while abroad in the ordinary case.
42 U.S.C. § 1395f(f); CMS Medicare & You handbook — 'Your Medicare coverage while traveling outside the U.S.'primary sourceverified 2026-08-29
Declining Part B while abroad can attach a permanent, lifelong penalty verified
A person who is eligible for Medicare but does not enroll in Part B when first eligible — and who does not have qualifying employer group coverage as the reason for the delay — can face a late-enrollment penalty added to the Part B premium for as long as they have Part B, once they do enroll. Living outside the U.S. during the initial enrollment window is not itself an exception to this rule; only specific circumstances (chiefly current employer-sponsored coverage through active work) create a special enrollment period that avoids the penalty.
42 U.S.C. § 1395r(b) — Part B late enrollment penalty; CMS Medicare & You handbookprimary sourceverified 2026-08-29
Part A often costs nothing to keep even if you mostly live abroad verified
Most people qualify for premium-free Part A based on their own or a spouse's work history, meaning there is frequently no ongoing premium cost to simply staying enrolled in Part A even while spending most of the year outside the United States — the cost/benefit question that matters is usually about Part B (which does carry an ongoing premium) and Part D, not Part A.
42 U.S.C. § 1395i-2; CMS Medicare & You handbook — Part A costsprimary sourceverified 2026-08-29
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