Public health cover in Europe for American retirees

United States: Medicare

Medicare does not pay for care abroad, except in rare cases.

Who qualifies

Medicare usually does not cover health care outside the U.S. There are exceptions. It may pay for inpatient hospital, doctor and ambulance services in a foreign country in rare cases, when the person is eligible: for example when the person lives in the U.S. and the foreign hospital is closer to home than the nearest U.S. hospital that can treat the condition.

Page: Medicare.gov: Travel outside the U.S..

Waiting time

Not applicable on the page.

Page: Medicare.gov: Travel outside the U.S..

Contribution or fee

The page says you pay all costs in most cases. Medicare drug plans do not cover prescription drugs bought outside the U.S. Medigap policies may cover emergency care abroad.

Page: Medicare.gov: Travel outside the U.S..

Private cover meanwhile

The page suggests travel insurance as a way to get more coverage, and says travel insurance does not necessarily include health insurance.

Page: Medicare.gov: Travel outside the U.S..

Medicare.gov says Medicare usually does not cover health care outside the United States, with a few exceptions, and that in most cases you pay all costs. The exceptions it lists concern a person who is in the U.S. or who lives in the U.S., not a person who lives abroad. Drugs bought outside the U.S. are not covered by Medicare drug plans. The page does not describe what happens to a person who has moved to live in another country.

For how this plays out for a retiree in France, see Medicare in France.

Pages read: Medicare.gov: Travel outside the U.S.. Read on 28 October 2026.

France

Puma, after 3 months for people with no professional activity.

Who qualifies

A person who works or lives in France in a stable and regular way. A person from outside the EEA and Switzerland must hold a residence document. A person with no professional activity waits 3 months in France before rights open, and the rights stay open if the person lives in France at least 6 months of the year.

Page: Service-Public F34308: What is the protection universelle maladie (Puma)?.

Waiting time

3 months of residence for a person with no professional activity. Some people meet the condition at once, for example people who receive certain disability allowances, and refugees.

Page: Service-Public F34308: What is the protection universelle maladie (Puma)?.

Contribution or fee

Article L160-1-1 of the Social Security code, in force since 31 December 2025, makes coverage conditional on a financial participation for a person who lives in France in a stable and regular way, has no professional activity in France and is not liable for the CSG, CRDS and health insurance contribution under an international convention. The amount is left to a decree of the Conseil d'État. We found no decree.

Page: Légifrance: Code de la sécurité sociale, article L160-1-1, Service-Public F34308: What is the protection universelle maladie (Puma)?.

Private cover meanwhile

The Service-Public page does not say.

Page: Service-Public F34308: What is the protection universelle maladie (Puma)?.

Service-Public says the Puma gives the right to health coverage to a person who works or lives in France in a stable and regular way, and that a person with no professional activity waits 3 months after arriving. A person from outside the EEA and Switzerland needs a residence document. Service-Public adds that the law of 30 December 2025 provides for a financial participation from some Puma beneficiaries, with a decree expected on the amount. Légifrance shows the article in force with no amount. Our tracker of the health contribution follows the decree.

Follow the decree on the health contribution tracker, and read the healthcare contribution checker and the guide to the Puma healthcare contribution for how the charges fit together.

Pages read: Service-Public F34308: What is the protection universelle maladie (Puma)? (Vérifié le 13 mai 2026), Légifrance: Code de la sécurité sociale, article L160-1-1 (In force since 31 December 2025). Read on 28 October 2026.

Spain

Convenio especial with the regional health service, after 1 year of residence.

Who qualifies

Economically inactive foreigners who need health insurance to reside in Spain. The person must show effective residence in Spain for at least one continuous year immediately before applying, be registered in the municipal register (padrón), and have no access to public health protection by any other title.

Page: Ministerio de Sanidad: Convenio especial de prestación de asistencia sanitaria, BOE: Real Decreto 576/2013, requisitos básicos del convenio especial (texto consolidado).

Waiting time

One continuous year of effective residence immediately before the application. After a convenio ends for some reasons, a new one cannot be requested for one year.

Page: Ministerio de Sanidad: Convenio especial de prestación de asistencia sanitaria, BOE: Real Decreto 576/2013, requisitos básicos del convenio especial (texto consolidado).

Contribution or fee

A monthly fee of 60 euros if the person is under 65 and 157 euros if the person is 65 or over, set by Royal Decree 576/2013. The decree lets the autonomous communities raise the fee when they add complementary services to the convenio. The ministry says there are no copayments or waiting periods, and that outpatient pharmacy, outpatient orthoprosthetics and non-urgent transport are paid 100% by the patient.

Page: BOE: Real Decreto 576/2013, requisitos básicos del convenio especial (texto consolidado), Ministerio de Sanidad: Convenio especial de prestación de asistencia sanitaria.

Private cover meanwhile

The pages do not name a private policy for the year before the application. The ministry says the convenio is aimed at foreigners who need to take out health insurance to reside in Spain.

Page: Ministerio de Sanidad: Convenio especial de prestación de asistencia sanitaria.

The Ministry of Health says the convenio especial gives access to the national health system to economically inactive foreigners who need health insurance to reside in Spain. It requires one continuous year of residence immediately before applying, registration in the padrón, and no other public health cover. Royal Decree 576/2013 sets the fee at 60 euros a month under 65 and 157 euros a month from 65, and allows the autonomous communities to raise it when they add services. We read the national pages. The convenio is signed with the regional health service, and we did not read a regional page.

Pages read: Ministerio de Sanidad: Convenio especial de prestación de asistencia sanitaria, BOE: Real Decreto 576/2013, requisitos básicos del convenio especial (texto consolidado) (Última actualización 27 July 2013). Read on 28 October 2026.

Portugal

SNS registration for people with a residence permit.

Who qualifies

The ERS page says SNS beneficiaries include nationals of third countries with permanent residence, or in temporary stay or residence, whether or not their situation is regularised, under the legal regime that applies. The number of user (número de utente) is obtained by registering in the national user registry (RNU) when a person goes to an SNS health unit.

Page: ERS: Acesso de cidadãos estrangeiros à prestação de cuidados de saúde no SNS (perguntas frequentes).

Waiting time

No waiting time is stated on the pages we read.

Page: ERS: Acesso de cidadãos estrangeiros à prestação de cuidados de saúde no SNS (perguntas frequentes).

Contribution or fee

No contribution or fee is stated on the ERS page. It says that registration does not mean the SNS bears all costs. A foreigner with permanent residence and a valid residence authorisation gets the registration type under which the SNS is expected to bear the costs. A foreigner without a valid residence document gets a type under which the costs fall on the person or on a third party, with listed exceptions (maternal and child health, minors, vaccination and others). The page does not say which type a holder of a temporary residence permit gets.

Page: ERS: Acesso de cidadãos estrangeiros à prestação de cuidados de saúde no SNS (perguntas frequentes).

Private cover meanwhile

Not stated on the pages we read.

Page: ERS: Acesso de cidadãos estrangeiros à prestação de cuidados de saúde no SNS (perguntas frequentes).

The ERS says that, under the Basic Health Law and Decree-Law 52/2022, SNS beneficiaries include third-country nationals who have permanent residence or are in temporary stay or residence. Registration in the national user registry, made at a health unit, gives the user number. A foreigner with permanent residence and a valid residence document gets the registration type under which the SNS is expected to bear the costs. The SNS 24 page on access by foreigners, updated 3 July 2026, covers EU, EEA and Swiss citizens only.

Pages read: ERS: Acesso de cidadãos estrangeiros à prestação de cuidados de saúde no SNS (perguntas frequentes) (12 August 2026), SNS 24: Acesso a cuidados por cidadãos estrangeiros (Atualizado a 3 July 2026). Read on 28 October 2026.

Italy

Voluntary registration with the SSN for holders of an elective residence permit.

Who qualifies

A foreigner regularly staying in Italy for more than three months who has no right to compulsory registration must insure against illness, accident and maternity through a private policy, or register voluntarily with the SSN by paying an annual contribution. The ministry lists holders of a residence permit for elective residence who do no work among those who can register voluntarily.

Page: Ministero della Salute: Assistenza ai cittadini dei Paesi extra UE in Italia.

Waiting time

No waiting time is stated on the ministry page. The registration covers the calendar year, cannot be split and has no retroactive effect.

Page: Ministero della Salute: Assistenza ai cittadini dei Paesi extra UE in Italia.

Contribution or fee

An annual contribution, paid by form F24 to the region. Law 213 of 30 December 2023, article 1 paragraph 240, replaced the minimum contribution of article 34 paragraph 3 of the immigration code with 2,000 euros a year, set minimums of 700 euros and 1,200 euros for the cases of paragraph 4 (a) and (b), and let a yearly decree of the Minister of Health adjust them. The ministry page gives no amount and does not say which sum applies to a person on an elective residence permit.

Page: Gazzetta Ufficiale: Legge 30 dicembre 2023 n. 213, article 1 paragraphs 240 and 241 (supplement 40, GU n. 303 of 30 December 2023), Ministero della Salute: Assistenza ai cittadini dei Paesi extra UE in Italia.

Private cover meanwhile

A private health policy, as the alternative to voluntary registration.

Page: Ministero della Salute: Assistenza ai cittadini dei Paesi extra UE in Italia.

The Ministry of Health says a foreigner who stays regularly in Italy for more than three months and has no right to compulsory registration must have a private policy or register voluntarily with the SSN for an annual contribution. Holders of an elective residence permit who do not work can register voluntarily. The registration gives the same services as an Italian citizen and does not give the European health card. The Gazzetta Ufficiale text of Law 213/2023 sets the contribution figures. The ministry page gives none.

Pages read: Ministero della Salute: Assistenza ai cittadini dei Paesi extra UE in Italia (Aggiornato il 23 December 2024), Gazzetta Ufficiale: Legge 30 dicembre 2023 n. 213, article 1 paragraphs 240 and 241 (supplement 40, GU n. 303 of 30 December 2023) (30 December 2023). Read on 28 October 2026.

Germany

Statutory or private insurance, with a duty to be insured.

Who qualifies

Every person who lives in Germany must take out health insurance. A person with no other entitlement is compulsorily insured in the statutory scheme (GKV) if the person was last insured there or belongs to the statutory system. Otherwise the person has access to private insurance (PKV) and must take it out. The page does not name non-EU nationals or retirees.

Page: Bundesministerium für Gesundheit: Ratgeber Gesetzliche Krankenversicherung.

Waiting time

No waiting time is stated on the page.

Page: Bundesministerium für Gesundheit: Ratgeber Gesetzliche Krankenversicherung.

Contribution or fee

The page gives no amount. It says statutory contributions follow the financial capacity of the members, and that the services are the same for all.

Page: Bundesministerium für Gesundheit: Ratgeber Gesetzliche Krankenversicherung.

Private cover meanwhile

The page states a duty to be insured for every person who lives in Germany.

Page: Bundesministerium für Gesundheit: Ratgeber Gesetzliche Krankenversicherung.

The Federal Ministry of Health says everyone who lives in Germany must be health insured. A person with no other entitlement is compulsorily insured in the statutory scheme only if the person was last insured there or belongs to that system, and otherwise has access to private insurance and must take it. The page says nothing specific about non-EU retirees and gives no amounts.

Pages read: Bundesministerium für Gesundheit: Ratgeber Gesetzliche Krankenversicherung. Read on 28 October 2026.

Netherlands

Basic insurance for residents, and the Wlz for long-term care.

Who qualifies

Whoever lives or works in the Netherlands must take out the basic insurance (basisverzekering). A person can only take it out when living in the Netherlands, which the official term calls an ingezetene, and the Social Insurance Bank (SVB) decides whether the person is one. For long-term care (Wlz), a person living in the Netherlands is mostly insured, but being registered at a municipality is not enough, and the SVB looks at how long the person stays and why the person came.

Page: Rijksoverheid: Is een zorgverzekering verplicht?, SVB: Wonen in Nederland (Wlz).

Waiting time

No waiting time is stated. A person who is not yet an ingezetene cannot take out the basic insurance, and the SVB decides on residence for the Wlz.

Page: Rijksoverheid: Is een zorgverzekering verplicht?, SVB: Wonen in Nederland (Wlz).

Contribution or fee

The premium of the basic insurance is not on the Rijksoverheid page we read. The compulsory deductible (eigen risico) for 2026 is 385 euros for a person aged 18 or over. For the Wlz, the CAK calculates the own contribution: for care at home it uses 10% of income and part of assets, and for a stay over 4 months in an institution a higher contribution applies.

Page: Rijksoverheid: Wanneer betaal ik een eigen risico voor mijn zorg?, Rijksoverheid: Hoeveel eigen bijdrage voor zorg uit de Wet langdurige zorg (Wlz) betaal ik?.

Private cover meanwhile

Not stated on the pages we read.

Page: Rijksoverheid: Is een zorgverzekering verplicht?.

The Rijksoverheid says everyone who lives or works in the Netherlands must take out the basic insurance, that only residents can, and that the SVB decides whether a person is a resident. It gives the 2026 compulsory deductible, 385 euros. For the Wlz the SVB says a person living in the Netherlands is mostly insured but that registration with a municipality is not enough, and that it looks at the length of the stay and the reason for coming. It says it cannot answer on its website whether a given person is insured.

Pages read: Rijksoverheid: Is een zorgverzekering verplicht?, Rijksoverheid: Wanneer betaal ik een eigen risico voor mijn zorg?, SVB: Wonen in Nederland (Wlz), Rijksoverheid: Hoeveel eigen bijdrage voor zorg uit de Wet langdurige zorg (Wlz) betaal ik?. Read on 28 October 2026.