Does IRMAA Apply If You Live Abroad? Yes, If You Keep Part B

Q: Does IRMAA apply if you live abroad?

Yes, if you are enrolled in Part B or Part D. IRMAA is a surcharge on those premiums, and it does not switch off because you live outside the United States. If you do not enroll in Part B, you pay no IRMAA.

Q: Does Medicare cover care abroad?

Generally no. Medicare generally does not pay for care outside the United States, with narrow exceptions. Part B premiums abroad are essentially paying to keep the coverage for a return to the US.

Q: Do excluded foreign earnings count toward IRMAA?

Yes. Income excluded under the foreign earned income exclusion on Form 2555 is added back when computing MAGI for IRMAA, so excluding it from tax does not exclude it from the surcharge.

Q: What happens if I drop Part B abroad and re-enroll later?

You may face a late enrollment penalty, generally 10% of the standard premium for each full 12-month period you delayed, unless you qualify for a special enrollment period. Confirm your situation with Social Security before dropping.

If you live outside the United States and keep paying for Medicare Part B, you are paying for coverage you generally cannot use at your local clinic. That is a strange enough bargain on its own. Add IRMAA, and the bargain gets stranger: the surcharge follows your enrollment, not your address, so a retiree abroad with high income pays the same surcharge as a retiree in Ohio.

The rule in one sentence, then the numbers

IRMAA is not a tax on living in America. It is an extra charge on Part B and Part D premiums for higher-income beneficiaries, set from your modified adjusted gross income two years earlier. If you keep Part B, you pay the standard premium plus any IRMAA tier you land in. If you do not enroll in Part B, you pay no IRMAA, because there is no premium for it to attach to.

2026, single filer, 2024 MAGI	Total Part B premium	Part D IRMAA
$109,000 or less	$202.90	$0
Above $109,000 through $137,000	$284.10	$14.50
Above $137,000 through $171,000	$405.80	$37.50
Above $171,000 through $205,000	$527.50	$60.40

Joint thresholds are double the single figures at the first tier: $218,000 or less for no surcharge in 2026. At the first tier, the Part B surcharge alone is $81.20 a month, or $974.40 a year, on top of a premium for coverage that generally does not pay abroad. That is the number to hold in your head while you weigh keeping Part B, because it is the cost of the option, not the cost of care you will receive.

The foreign earnings trap

Here is the detail that catches expats who did their tax planning carefully and still get surcharged. If you excluded foreign earned income on Form 2555, that excluded amount is added back when Medicare computes your MAGI. Excluding it from income tax does not exclude it from IRMAA. The same add-back applies to tax-exempt interest. Run your MAGI the Medicare way, not the tax-return way, before you assume you are under a threshold.

The question I cannot settle for you. Whether keeping Part B is worth it depends on how likely you are to return to the United States, how long you plan to stay abroad, and whether you have employer coverage that preserves a special enrollment period. Those are personal facts, not a formula, and the late enrollment penalty is the reason the decision is not reversible for free: generally 10% of the standard premium for each full 12-month period you delayed, unless a special enrollment period applies. If your return is uncertain, that penalty risk deserves more weight than the monthly premium saving. If your move is permanent and you have solid local coverage, dropping Part B is often the rational call, and plenty of long-term expats make it.

One more practical point. Part A is usually premium-free if you or your spouse paid Medicare taxes for at least 10 years, so most people keep Part A abroad at no cost. The keep-or-drop decision is really about Part B, and therefore about IRMAA. Run your own MAGI and tier through our IRMAA calculator using the Medicare MAGI definition, including any Form 2555 add-back, before you decide.

Part D and Medicare Advantage need a separate look, and they are easy to forget while you agonize over Part B. A Medicare Advantage plan generally requires US residence, so a move abroad usually means disenrolling, and Part D needs active management before you leave, since the plan you had may not fit a life outside the country. Neither changes the IRMAA rule itself, but both change what "keeping Medicare" actually means in practice. If you keep Part B and drop the rest, make sure that is a deliberate package, not an accident of paperwork.

Frequently Asked Questions

Does IRMAA apply if you live abroad?

Yes, if you are enrolled in Part B or Part D. IRMAA follows enrollment, not address. If you do not enroll in Part B, you pay no IRMAA.

Does Medicare cover care abroad?

Generally no, with narrow exceptions. Part B premiums abroad are largely paying to keep coverage available for a return to the United States.

Do excluded foreign earnings count toward IRMAA?

Yes. Foreign earned income excluded on Form 2555 is added back in the MAGI computation for IRMAA.

What happens if I drop Part B abroad and re-enroll later?

You may face a late enrollment penalty, generally 10% per full 12-month delay, unless you qualify for a special enrollment period. Confirm your situation with Social Security before dropping.

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