What is Medicare?
Medicare is a US federal health insurance program for people age 65 and above, or younger individuals with disabilities. According to the official Medicare website, the program covers hospital stays, doctor visits, preventive care, and prescription drugs through its various parts.
The Four Parts of Medicare
| Part | Coverage | Cost |
|---|---|---|
| Part A | Hospital visits, skilled nursing, hospice | Free if you paid Medicare through payroll taxes |
| Part B | Doctor's visits, preventive care, medical equipment | Monthly fee (~$185 in 2025) |
| Part C | Medicare Advantage — private insurance alternative bundling A, B, and often D | Varies by plan |
| Part D | Prescription drugs | Monthly fee varies |
Who is Eligible for Medicare at Age 65?
✅ Eligibility Requirements
- ✓US citizen, OR
- ✓Non-US citizen who has worked for at least 10 years (40 quarters)
Important: You're eligible for Part A even if you're an Indian citizen, as long as you have 40 credits. That's equivalent to working 10 years in the US. The Social Security Administration provides detailed eligibility information.
This is a common question among NRIs planning their return. Many assume citizenship is required, but it's actually your work history that matters. If you've contributed to Medicare through payroll taxes for 10 years, you've earned your eligibility.
Does Medicare Work in India?
⚠️ The Reality
Original Medicare (Part A and Part B) doesn't cover medical care outside the US.
If you're living in India full-time, your medical care expenses are NOT reimbursed.
Very Limited Exceptions
Medicare may cover care abroad only if:
- You live in the US and an emergency occurs while traveling through Canada or Mexico
- A foreign hospital is closer than a US one during emergencies
These cases are rare and not relevant if you're living in India permanently.
What About Medicare Advantage (Part C)?
Even with Medicare Advantage (Part C), medical care costs outside the US are NOT covered unless it's an emergency.
Please look into the documentation from your private insurance to see what's included and what's not. Coverage is typically only during emergencies while abroad.
Since Medicare won't cover your healthcare in India, you'll need to explore health insurance options for NRIs and OCI holders in India. A major illness can cost 5-10 lakhs or more in private hospitals, making local coverage essential.
Should You Sign Up for Medicare at 65?
Many people wonder: if Medicare doesn't work in India, should I even sign up at age 65?
The Breakdown
| Part | Cost | Recommendation |
|---|---|---|
| Part A | Free (for most) | ✅ Enroll — it doesn't hurt |
| Part B | ~$185/month in 2025 (goes up with income) | ⚠️ Depends on your plans |
⚠️ The Critical Question: If you don't sign up for Part B when first eligible and later move back to the US, you could face a permanent penalty — a 10% extra premium for each year you delayed enrollment.
The Part B Penalty Explained
Let's walk through this with an example to understand the real financial impact.
Example: Meet Raj
- Age 65 (2020): Raj turned 65 but didn't sign up for Part B
- Reason: He moved to India and thought he wouldn't need it
- No creditable coverage: He didn't have US-based employer insurance during that time
- Age 70 (2025): Raj moves back to the US and finally signs up for Part B
Calculating Raj's Penalty
| Factor | Value |
|---|---|
| Years delayed | 5 years |
| Penalty per year | 10% |
| Total penalty | 50% |
| 2025 standard premium | ~$185/month |
| Penalty amount | $92.50/month |
| Raj's monthly premium | $277.50/month |
"And here's the kicker: he pays this high premium amount every month for the rest of his life."
✅ How to Avoid the Penalty
- ✓Sign up during your initial enrollment period (around your 65th birthday)
- ✓OR have creditable health coverage (like an employer plan) and sign up during special enrollment periods later
Ask Yourself
- Will you ever return to the US in the future for retirement or medical treatment?
- Do you want to keep your options open for the future?
If you answer yes, you might want to enroll and pay the Part B premium even though you can't use it right now.
This decision is part of your broader financial planning. If you're also managing retirement accounts, check out our guide on financial planning for NRIs returning to India including 401k, IRA, and Social Security.
What Returning NRIs Actually Do
I've spoken to several returnees who are in this exact situation. Here's what they typically do:
Sign Up for Part A at 65
Because there's no premium to pay — it's completely free. This keeps your base eligibility intact.
Skip Part B and Part D
Especially if they have plans to live in India long-term and don't anticipate returning to the US.
Some Sign Up for Part B
And pay the premium — especially if they have plans to visit the US frequently or want to be there for some treatment.
Rely on India Healthcare
They rely on healthcare insurance in India or pay out of pocket for medical care — because healthcare costs are more affordable in India.
Many NRIs also take advantage of RNOR status tax benefits during their first 2-3 years back in India, which can help offset healthcare costs and other transition expenses.
My Recommendation
✅ What I Suggest
- ✓Sign up for Part A — it's free and keeps your base eligibility intact
- ✓For Part B and Part D — weigh the costs and penalties based on your future plans and decide
- ✓Remember: Medicare is NOT a substitute for insurance in India
- ✓Explore NRI-friendly healthcare insurance plans or talk to your advisor if you're unsure
Your healthcare strategy should be part of a comprehensive return plan. If you're planning your move, our guide on hidden essentials for returning to India covers the financial and documentation steps most NRIs miss.
Summary: Key Points to Remember
Final Checklist
- ✓Medicare can't be used for Indian hospitals or for reimbursements
- ✓Medicare Advantage (Part C) plans don't usually offer foreign coverage unless they have worldwide emergency benefits — read the fine print
- ✓If you have plans to travel frequently or return to the US in the future, consider taking Part B and paying the premium
- ✓If you return to the US and haven't signed up for Part B, it might take a few months to re-enroll — and you might be uninsured during that time
- ✓Get proper health insurance coverage in India — it's essential and affordable