Key Takeaways
- A dual U.S. and Canadian citizen with more than $10 million is weighing retirement in Canada, largely for its health care.
- Medicare usually doesn’t pay for care outside the U.S., but signing up for Part B late adds 10% to the premium for each full year missed, usually for life.
- After 10 years without Part B, that penalty would double this year’s $202.90 monthly premium, adding $2,434.80 a year.
- Keeping Part B while living in Canada costs the same $2,434.80 a year at this year’s rate, which is a small price for a $10 million household to keep the option of coming home.
If you’re planning to retire abroad, Medicare can look like one more bill to drop, since it usually doesn’t pay for health care outside the U.S. But if you walk away from Part B and come back later, you could pay for that choice every month for the rest of your life.
Canada’s “free” health care is the draw
A dual U.S. and Canadian citizen posting in Reddit’s r/ChubbyFIRE forum earlier this month has more than $10 million and zero debt, and is seriously weighing a move to Canada’s West Coast, largely for the health care. The poster mostly hates Canada as a place to work and own a business. Even so, they see a chance to “enjoy the ‘free’ healthcare, quality of life” there while keeping all their assets in the U.S. They expect some tax consequences, and they know the plan looks best if the U.S. dollar stays strong against the Canadian dollar.
The poster didn’t say how old they are or how long they’d stay. So let’s say they turn 65 in Canada, skip Part B since they’d hardly use it there, and decide to move back 10 years later. That decade could add $2,434.80 a year to their Medicare bill, usually for life.
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Part B charges for every year you skip
Medicare’s exceptions abroad are narrow. It covers care on a cruise ship that’s in a U.S. port or no more than 6 hours from one, and in rare cases a hospital stay, doctor and ambulance services in a foreign country. For someone living full time on Canada’s West Coast, Part B would mostly sit unused.
The catch: if you sign up for Part B late, without a Special Enrollment Period, you pay an extra 10% on the premium for each full 12-month period you could have signed up and didn’t. That extra charge usually lasts as long as you have Part B, so for most people it’s a lifetime penalty.
Your first chance to sign up lasts 7 months, from 3 months before the month you turn 65 to 3 months after it. Miss it without other coverage, and your next chance is January 1 to March 31 of each year.
Ten years away doubles the premium
Ten full years without Part B means 10 penalties of 10% each, or 100%. At this year’s standard premium of $202.90 a month, our poster would pay another $202.90 a month on top of it, or $2,434.80 a year in penalties. That’s $405.80 a month and $4,869.60 a year in total, for the same coverage most people get for $202.90 a month.
Ouch. And since the next chance to sign up is January 1 to March 31, someone who moves back in June has to wait until January just to apply. Any doctor’s bills in the meantime are theirs to pay.
Keeping Part B in Canada costs money too, though. At this year’s rate, $202.90 a month comes to $2,434.80 a year, or $24,348 over those 10 years, for coverage that usually pays nothing in Canada:
| At 2026’s standard premium | Keep Part B in Canada | Skip it, sign up at 75 |
|---|---|---|
| Each year from 65 to 75 | $2,434.80 | $0 |
| Each year from 75 on | $2,434.80 | $4,869.60 |
So skipping Part B saves $24,348 up front. Ten years of penalties after coming home would cost all of it back: by about 85, for someone who returns at 75.
Part B is cheap insurance on coming home
If the poster never comes back, they never pay the penalty, and that $24,348 would have bought nothing. For someone sure they’re gone for good, dropping Part B is a reasonable call.
But a lot can change in 10 years. The poster’s own plan depends on the exchange rate staying strong, and they admit that isn’t guaranteed. A weaker dollar, their health or their family could all bring them back in their mid-70s. That’s when a doubled premium and a wait until January hurt the most.
Frankly, I’d keep paying it. $2,434.80 a year is about 0.02% of a $10 million portfolio, and it keeps the way home open, with no penalty and no gap in coverage. CMS published this year’s Part B premium on Nov. 14 last year, so 2027’s should be out soon. The penalty is a share of the premium, so any increase raises the cost of keeping Part B and the cost of skipping it by the same proportion.
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Disclaimer:
Please note that the articles on TIKR are not intended to serve as investment or financial advice from TIKR or our content team, nor are they recommendations to buy or sell any stocks. We create our content based on TIKR Terminal’s investment data and analysts’ estimates. Our analysis might not include recent company news or important updates. TIKR has no position in any of the stocks mentioned. Thank you for reading, and happy investing!
