Will Medicare pay for my medical care in China?

Generally no. Original Medicare pays for care abroad only in narrow cases, such as an emergency in the U.S. where the closest hospital is in Canada or Mexico. Some Medigap plans cover foreign travel emergencies at 80% after $250, up to $50,000 lifetime, for the first 60 days of a trip.

What happens if I drop Part B while living in China?

When you return there's no Special Enrollment Period, so you sign up in the January–March General Enrollment Period, coverage starts the next month, and you pay 10% more for each full 12 months you were without Part B, for life. Eight years away means roughly 80% more.

When can a green card holder get Medicare?

At 65, after living in the U.S. as a permanent resident continuously for the 5 years before applying. With 40 quarters of U.S. work (yours or a spouse's), Part A is premium-free; otherwise you can buy A and B, at $311 or $565 a month for Part A and $202.90 and up for Part B in 2026.

Do years worked in China count toward Medicare quarters?

No. Quarters come only from U.S. earnings with Social Security and Medicare tax, and the U.S. and China have no totalization agreement. In 2026, each $1,890 of earnings is one quarter, up to 4 a year.

How does the OBBBA change Medicare for immigrants?

Section 71201 limits Medicare for noncitizens to green card holders, Cuban and Haitian entrants, COFA migrants and a few similar groups. Current enrollees without a green card, such as refugees, asylees and TPS holders, lose coverage around January 2027 and should watch for SSA notices. Green card holders aren't affected by this change.

Living in China: Keep or Drop Medicare Part B?

Medicare generally doesn't pay for care outside the United States, but as long as you have Part B, the premium is due every month. Drop Part B and you get no Special Enrollment Period when you come back: you can only sign up in the January–March General Enrollment Period, coverage starts the following month, and you pay a permanent penalty of 10% for each full 12 months you were without it. Keeping or dropping it is a trade-off between premiums on one side and the penalty plus a possible coverage gap on the other, based on how long you'll stay abroad and whether you'll need care back in the U.S.

First, who qualifies: green card holders and immigrant parents

U.S. citizens 65 and older can enroll in Medicare. Green card holders must have lived in the U.S. as permanent residents continuously for the 5 years before applying.

Premium-free Part A: you or your spouse need 40 quarters (about 10 years) of U.S. work with Medicare tax paid. In 2026, each $1,890 of wages or self-employment income earns a quarter, up to 4 a year. The U.S. and China have no Social Security (totalization) agreement, so years worked in China don't count.

Fewer than 40 quarters: you buy Part A, at $311 a month (30–39 quarters) or $565 (under 30) in 2026, and anyone who buys Part A must also have Part B ($202.90 a month and up). For parents who arrived late in life with no U.S. work record, a couple could pay up to 2 × ($565 + $202.90) = $1,535.80 a month. Many families compare that with ACA Marketplace premiums and subsidies.

The OBBBA restriction: Section 71201 of the One, Big, Beautiful Bill, signed July 4, 2025, limits Medicare for noncitizens to green card holders, Cuban and Haitian entrants, COFA migrants and a few similar groups. Current enrollees with other lawful statuses but no green card, such as refugees, asylees and TPS holders, lose coverage 18 months after enactment, around January 2027. If that's you, watch for SSA notices.

Living in China: what does Medicare cover?

Original Medicare pays for care abroad only in narrow cases, such as an emergency inside the U.S. where the closest hospital is in Canada or Mexico. Hospital stays, doctor visits and prescriptions in China are generally not covered.

Medigap's foreign travel emergency benefit: Plans C, D, F, G, M and N pay 80% after a $250 deductible, up to $50,000 lifetime, for the first 60 days of each trip. That's built for travel, not for living abroad.

Medicare Advantage: plans generally require you to live in their service area, and a long stay abroad can lead to disenrollment.

Part D: you can't enroll while living outside the U.S. When you move back you get a 2-month Special Enrollment Period. Under CMS rules, months you lived abroad and weren't eligible for Part D generally don't count toward the Part D penalty; confirm your situation with Medicare.

Part A and Part B: which to keep?

Premium-free Part A: it costs nothing to keep and covers hospital stays when you're back. There's no reason to drop it.

Part B: keeping it costs at least $202.90 × 12 = $2,434.80 per person per year in 2026, more with IRMAA. Dropping it means no Special Enrollment Period when you return (living abroad isn't one), so you'd sign up between January and March, start the next month and pay a permanent penalty.

Example (hypothetical numbers, to show the method)

Mr. and Mrs. Liu are green card holders over 65 with premium-free Part A and Part B. They plan to live in China for 8 years and then return to live near their children. To keep it simple, everything below uses the 2026 standard premium of $202.90, ignoring future increases and IRMAA.

Keep Part B throughout: over 8 years the couple pays $202.90 × 12 × 8 × 2 = $38,956.80, and they have Medicare the day they land.

Drop Part B when they leave: no premiums for 8 years. When they return, with roughly 8 full 12-month periods out, Part B costs 80% more for life: $202.90 × 180% = $365.22 per person per month, or $162.32 above standard, which is $3,895.68 a year for the couple. It would take about 10 years of penalties to use up the $38,956.80 they saved. They may also have a few months after returning before General Enrollment coverage starts, and any outpatient care in the U.S. during that gap is entirely out of pocket.

How to think about it: the later you plan to return and the longer you expect to live afterward, the more dropping costs. If your health is uncertain and you might need to fly back for treatment, keeping Part B is safer, and it's useful for occasional checkups during visits. It's an insurance decision and it's yours to make; we help you put the numbers side by side.

Paying premiums and IRMAA from abroad

If you're on Social Security: premiums keep coming out of your benefit while you're in China.

If you're not: Medicare bills you, and you can pay online through your Medicare.gov account or by automatic debit from a U.S. bank account. Keeping a U.S. bank account and a U.S. mailing address makes this much easier.

IRMAA: still based on your return from two years earlier. Foreign earned income excluded under the FEIE is added back to MAGI under Section 1839(i) of the Social Security Act, and selling a U.S. home or stocks after you move will raise premiums two years later.

Other points for green card holders

Continuous residence and the green card itself: long stays abroad can lead immigration authorities to treat the green card as abandoned (for example, a single absence of more than a year). Reentry permits and travel planning are immigration-law questions for an immigration attorney.

Your tax status doesn't change: while you hold a green card you're a U.S. tax resident, filing Form 1040 on worldwide income every year, with FBAR and Form 8938 for Chinese accounts over the thresholds.

Giving up the green card: abandoning it after holding it in 8 of the last 15 tax years can bring the expatriation (exit) tax rules and Form 8854 into play. That's separate from Medicare, but both feed into the decision about whether you'll come back.

How we can help

YCL handles the tax side: projecting IRMAA for the years after you move, timing home and stock sales and Roth conversions, and keeping your U.S. Form 1040, FBAR and Form 8938 in order while you live in China. On keeping or dropping Part B, we lay out the premium and penalty numbers, and the choice is yours. We're not an insurance broker. For Medicare in full, see our Medicare guide; for the tax side of retiring in China, see the retiring in China guide; and if you're thinking about giving up a green card, read the exit tax guide first. Start with a 15-minute free consultation, or reach us on WeChat at YCLUSA.