Medicare in Portugal: US Health Insurance Abroad for Americans

No, Medicare usually does not pay for care you get in Portugal. Medicare.gov says it “usually doesn’t cover health care while you’re traveling outside the U.S.”, and the U.S. Embassy in Portugal says Medicare does not work overseas, so Americans moving here need other cover for care in Portugal.

We read the pages below on 2026-10-18. The latest information the article rests on is the Portuguese government’s migrant health guide, which says it was updated on 23 June 2026; Medicare’s own fact sheet is dated April 2026. This is a summary of what those pages say, not insurance, tax or legal advice. The Social Security Administration pages we opened say nothing about living abroad, and the article says where that leaves a gap.

Does Medicare pay for care in Portugal?

Almost never. Medicare.gov defines the U.S. as the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands and American Samoa, and says anywhere else is outside the U.S. Its travel page says you pay all costs in most cases.

The exceptions are narrow. The Medicare fact sheet lists three situations in which Medicare may pay for certain services in a foreign hospital:

1. You are in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat you.
2. You are traveling through Canada without unreasonable delay by the most direct route between Alaska and another state, and the Canadian hospital is closer.
3. You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat you.

All three are written around someone who is in or lives in the United States. None describes a person who lives in Portugal. In those rare cases, the sheet says Part A covers inpatient hospital care and Part B covers ambulance and doctor services immediately before and during the covered stay, not afterward. It also says foreign hospitals are not required to file Medicare claims, so you may have to pay in full and claim reimbursement yourself.

Two other lines matter for daily life. Medicare.gov says Medicare drug plans do not cover prescription drugs you buy outside the U.S., and the fact sheet says Medicare does not cover dialysis outside the U.S. except during a covered inpatient stay.

The U.S. Embassy in Portugal’s page for older travelers says the same thing in one sentence: “Medicare does not work overseas.” Its health pages add that the U.S. government does not provide medical insurance or pay medical bills for U.S. citizens overseas. For how the Portuguese side works once you are a resident, see our guide to healthcare access for newcomers.

Should I keep Medicare Part B if I live in Portugal?

The official pages we read give the facts that frame the decision, but not the full answer. The Social Security Administration handles Part B enrollment, and the pages we opened on its Medicare and international services sections say nothing about enrolling in or cancelling Part B from abroad, how the premium is paid from abroad, or whether the penalty applies to someone who enrolls after moving. We did not find an official page that answers those three questions.

What Medicare.gov says:

• Penalty. If you do not sign up for Part B when first eligible and do not qualify for a Special Enrollment Period, you pay an extra 10 percent for each full 12-month period you could have signed up. The penalty is added to the monthly premium, is not a one-time fee, and is usually charged for as long as you have Part B. The standard 2026 premium it quotes is 202.90 dollars, and its example is 243.48 dollars after a 20 percent penalty.
• Enrollment windows. The Initial Enrollment Period lasts 7 months, starting 3 months before the month you turn 65. After it, you can sign up between January 1 and March 31 (General Enrollment Period), and coverage starts the month after you sign up.
• A Special Enrollment Period for work coverage. The page says it is for people who have or had health insurance through their job, their spouse’s job (or a family member’s job if disabled), and lists coverage that does not qualify, such as COBRA, retiree coverage and Marketplace plans. A separate one exists for people who volunteer in a foreign country, listed on the same page.

A CMS letter addressed to people who live outside the United States, which we read as a PDF (its premium figure is for 2017, so treat its numbers as dated), describes the choice in plain terms. It says Part B is optional if you are entitled to Social Security benefits, and that you need Part B to join a Medicare Advantage plan or buy a Medigap policy. It also says that if you have TRICARE or CHAMPVA you must have Part B to keep that coverage (it says an active-duty service member, or their spouse or dependent child, may not have to get Part B when first eligible), and that if you plan to return to the U.S., you may want to enroll.

Because the penalty runs for as long as you have Part B, the decision is worth making with the Social Security Administration before you act, not after. For the insurance the visa file asks for, see private health insurance and the Portugal visa.

Can a Medigap or Medicare Advantage plan help in Portugal?

Only a little, and only for emergencies. The Medicare fact sheet says a Medigap policy may cover services Original Medicare does not, such as emergency medical care outside the U.S. Most Medigap plans (C, D, E, F, G, H, I, J, M and N) provide foreign travel emergency health care with a lifetime limit of 50,000 dollars. They pay 80 percent of billed charges for certain medically necessary emergency care after a 250 dollar deductible for the year, and cover it if it begins during the first 60 days of a trip and Medicare does not otherwise cover it. That is a rule written for trips. Ask your Medigap company how it treats someone who lives abroad.

For Medicare Advantage, the sheet says plans must follow Medicare’s rules, including for coverage outside the U.S., but may cover additional services abroad; check with the plan.

What insurance do I need to enter Portugal and what happens after?

This is where Portuguese rules take over. The ministry’s page of documents for a residence visa lists valid travel insurance covering necessary medical expenses, including urgent medical assistance and possible repatriation. A footnote says it may be waived under a bilateral or international agreement on medical assistance and names Brazil and the United Kingdom as examples. See our guide to applying for the national visa from the US for the rest of the file.

The U.S. Embassy’s page adds that non-EU citizens visiting Portugal need travel medical insurance covering emergency medical care, hospitalization and repatriation, with minimum cover of 30,000 euros valid in the Schengen area for the length of the stay. That figure is the embassy’s description of the rules for visitors.

Once you hold legal residence, the Portuguese government’s guide says you can get an SNS user number, and that the SNS covers your costs when your registration also has an identification document, a Portuguese NIF, a full Portuguese address and a valid residence permit, and that in some cases provided for by law it can cover costs without them. The ACSS page, which shows no update date, lists the countries whose bilateral agreements cover sickness for workers, pensioners and their families: Andorra, Brazil, Cape Verde, Quebec, Morocco and Tunisia. The United States is not among them. Our NIF guide covers one of those four items.

What about taxes and the visa route?

How your U.S. income is taxed while you live here is a separate question, covered in our guide on US taxes from Portugal. If your plan is the retirement route, the retirement and passive income visa guide covers the visa side.

What should I do before I leave the US?

A checklist built only from what the pages above say:

More guides on this site: registering with the SNS; how Social Security is paid abroad; the agreement does not cover Medicare.

What we read, and the day

On 2026-10-18 we read: Medicare.gov, “Travel outside the U.S.” and “Avoid late enrollment penalties”; the CMS fact sheet “Medicare Coverage Outside the United States” (April 2026); Medicare.gov’s pages on when to sign up and on Special Enrollment Periods; a CMS letter to people living outside the United States (premium figures from 2017); the U.S. Embassy in Portugal pages on older travelers and on health abroad; the Portuguese government’s migrant health guide (updated 23 June 2026); the ACSS page on foreigners and the SNS; and the Ministry of Foreign Affairs residence visa documents page. We found no Social Security Administration page on Part B from abroad, travel.state.gov was blocked (we read the embassy mirror instead), and USAGov had no relevant page.