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Sooner or later, an American who is planning a move to France looks at a bank statement, sees the $202.90 that leaves the account every month for Medicare Part B, and wonders what that money will actually buy once the person is living in a country where no doctor can send a bill to Medicare. The question sounds small and deserves a slower answer than it usually gets, because keeping the premium out of habit and cancelling it to save money both have consequences that only show up years later.
Start with what Medicare does and does not do. It pays for care given in the United States and its territories. The fact sheet that Medicare publishes on coverage outside the country lists three situations in which it may pay a foreign hospital, and every one of them concerns someone who is in the US or who lives there, next to a border. Living abroad is not among them, there is no list of friendly countries, and France is treated like any other place. Part A, the hospital part, costs nothing for about 99 percent of beneficiaries and, when it carries no premium, it generally cannot be dropped anyway, so it can stay in the background. Part B is where the decision sits.
What Part B costs while you live in France
In 2026 the standard Part B premium is $202.90 a month, with a $283 annual deductible, and it rises with income: above $109,000 of modified adjusted gross income on an individual return, or $218,000 on a joint one, the monthly total climbs until it reaches $689.90. From France that premium does not pay for a single visit to a French doctor. What it does is keep your Medicare position intact for the days you spend in the US and for the day you move back, and it is a condition of two other things. You must have Part B and keep paying for it to hold a Medigap policy or to stay in a Medicare Advantage plan. Military retirees have a further reason, because TRICARE For Life requires Part A and Part B, and TRICARE says that a person who lives overseas still needs Part B to remain eligible, even though Medicare does not pay for care outside the United States.
What dropping it costs
Ending Part B is simple. You send Social Security a signed written request, and coverage ends on the last day of the month after the one in which you filed, so a request made on April 5 ends it on May 31. The cost comes on the way back. For every full 12 months in which you could have had Part B and did not, your premium is raised by 10 percent, and that increase is generally charged for as long as you have Part B. Medicare gives its own example of a person who waited 24 months without qualifying for a special enrollment period: a 20 percent penalty, which makes the 2026 premium $243.50 a month instead of $202.90.
There is a second cost, and it is time. Medicare.gov lists the special enrollment periods that let you sign up outside the normal windows: job-based coverage through yourself or a family member, TRICARE, volunteering in a foreign country, losing Medicaid, a declared disaster, inaccurate information from a plan or an employer, release from prison, and exceptional conditions that you raise with Social Security. Having lived abroad is not on the list. For most people the way back is the General Enrollment Period, which runs from January 1 to March 31, with coverage starting the month after you sign up, so an American who comes home in April with no Part B waits until the following winter to ask for it.
It helps to put numbers on a five-year stay at the 2026 rate. Five years of premiums comes to about $12,174 that stays in your pocket if you drop Part B. If you then come home and take it again, the penalty is 50 percent, which brings the premium to roughly $304 a month, about $1,217 a year above the standard figure, and it would take around ten years of paying that surcharge to give the $12,174 back. Premiums change every year, so read these as an illustration, but the shape holds. The arithmetic favours dropping for as long as you stay in France and turns against you the longer you live in the US afterwards, and nobody knows that length on the day they sign the form.
The other parts do not travel either
To join a Medicare Advantage plan or a Part D drug plan you must live in the plan's service area, which France is not, and Medicare plans cannot cover drugs you buy outside the US. A Medigap policy with the foreign travel benefit is written for trips. It pays 80 percent of the billed charges for certain emergency care after a $250 annual deductible, up to $50,000 over a lifetime, and only if the care begins during the first 60 days of a trip. That is a useful cushion on a two-week visit home and a thin one for someone who lives abroad.
Which way the decision tends to fall
Four questions settle it for most people: how long you expect to stay in France, how many weeks a year you will spend in the US, whether you hold a Medigap policy or TRICARE For Life, and whether you can carry the monthly figure without strain.
For a retiree who has settled in France for good, who does not expect to seek care in the US and who has no TRICARE For Life, dropping Part B can be a sensible saving, since the penalty is only ever charged if the person comes back. The price of that choice is the loss of an inexpensive way to change course when health or family circumstances shift. For someone who expects to return, or who spends several months a year in the US, keeping Part B is closer to paying for an option, and the premium is what it costs to use that option later without a surcharge. Someone who has not reached 65 has nothing to decide yet, but the seven-month initial enrollment period around the 65th birthday runs on the same clock in Lyon as in Ohio, and a Part B that was never taken counts toward the penalty just as one that was dropped does.
What actually covers you in France
France does, and it does so in two steps. The first is private insurance, the one your long-stay visa asks for. Service-public.fr states that an applicant for the visitor residence card must hold insurance covering the length of the stay and hand over an attestation of it with the file. Medicare pays nothing for care given in France, so it cannot be that insurance, and neither can a Medigap card. Which attestation your consulate accepts is a question for the consulate, and our guide to private health insurance before CPAM compares the policies Americans use for this period.
The second step is the public system. A person who does not work has to wait 3 months of stable residence before the Protection Universelle Maladie, PUMa, opens, and the rights then stay open as long as you live in France at least 6 months of the year, which is worth knowing if you plan long summers in the US. For a consultation the standard reimbursement rate is 70 percent of the reimbursement base, and the remaining 30 percent, the ticket modérateur, is what a mutuelle can cover if your contract provides for it. A mutuelle plays the part that Medigap plays on top of Medicare, a comparison that tends to land with people who have never seen the French setup. The registration itself is explained in our guide to registering with the CPAM, and the mutuelle options are in the guide for American expats.
One change from 2026 deserves a line. The social security financing law for 2026 provides for a financial contribution from PUMa beneficiaries who live in France without working and who owe no CSG, CRDS or health insurance contribution under an international convention, which can describe a retiree living on US Social Security. Service-public.fr says the amount is not yet known and that a decree is awaited; it belongs in the budget conversation; our guide to the 2026 healthcare contribution follows it.
Whatever you decide, put the question to Social Security in writing before the request goes in, since enrollment, penalties and special periods are theirs to decide, and keep the dates in front of you. The long version of all this, with every Medicare part, the 2026 figures and the case of someone who comes back, is in our guide to Medicare in France.
Aurelio Maurici is the co-founder of EasyFranceNow, a set of guides to the administrative side of living in France for Americans. He is based in Aix-en-Provence and holds a Master's degree in Business Law from Aix-Marseille Université.
