International

Retirees Living Overseas
• Visit the Aetna International Traditional Choice® Indemnity Plan page for information about the HDHP and non-HDHP plans available to retirees living outside the U.S.
• Retirees who live overseas are not eligible for the Aetna® Medicare Advantage with Prescription Drug (MAPD) Plan.
• If you move back to the U.S., you’re required to have Medicare Parts A and B, so you will be automatically enrolled in the MAPD plan.

AETNA – Overseas Care & OCONUS Care in US
Editor Note: Information regarding how the Aetna International Plan works with Medicare eligible retirees has been compiled with the assistance of HQ Benefits and Aetna.

MAPD Emergency Care Overseas

Medicare Advantage members have worldwide coverage for emergency care. When we get claims for out-of-the-country services, we allow 100% billed charges for all services covered, minus members’ cost share that applies.

• We do not cover part D drugs obtained outside of the country (this also applies to part D drugs obtained on a cruise ship)
• Member must pay charges upfront and submit charges and proof of payment for services rendered. We prefer that the services be translated.
• Member may contact customer service for a direct member reimbursement form.

CONUS Emergency Care Overseas

Only emergency services are covered outside of the United States (US). Member would be responsible for payment at the time of the service and will submit for reimbursement via claim form. Coverage would be at the out of network level.

OCONUS Care in US

There is coverage beyond emergency care for OCONUS in the US.  In the US, OCONUS members may have to pay up front and submit for reimbursement as the OCONUS plan is an Indemnity plan (not a network plan so no contractual requirements for providers to file and no copays like on Choice POSII, etc.). There are no discounts as the OCONUS plan isn’t a US network plan so Reasonable & Customary (R&C) applies. Any billed amounts above R&C are not paid by the plan and do not go toward the deductible or Out of Pocket Maximum (just like the Indemnity plan in the US) Allowed amount (R&C) goes toward OCONUS plan deductible and coinsurance. OCONUS plan has the same pharmacy copays as the Choice POSII plan (on the Aetna International SOB) that apply in the US but they must fill at RX network provider.

If OCONUS member is 65+ but doesn’t have Medicare, the plan assumes Medicare primary so the plan coverage is only the second payor coordination (very little plan payment).

If OCONUS member and has elected Medicare and seeks care in the US, Medicare would be primary payor, provider will file with Medicare first and the Aetna International plan would be secondary payor.

Note: If living overseas and have the Aetna International Plan, make sure you review the Aetna provided information regarding the Plan at https://www.nafhealthplans.com/explore-benefits/aetna-traditional-choice-indemnity.

Medicare and Living Abroad

Editor Note: Additional information directly from Medicare is available on our website at https://aafesretired.org/wp-content/uploads/2026/05/Medicare-Coverage-Outside-the-United-States.pdf

Medicare generally does not cover healthcare services received outside the 50 states and US territories. While you can maintain Medicare Part A and B while living abroad, you must pay premiums for Part B, and coverage is limited to rare, specific emergencies (e.g., a foreign hospital closer than a US hospital).

Key Takeaways for Living Abroad

• Limited Coverage: Medicare generally won’t pay for health care or prescription drugs outside the US.
• Part B Premiums: You must keep paying Part B premiums to stay enrolled, which may not be cost-effective if you live permanently abroad.
• Emergency Exceptions: Medicare may cover inpatient care in a foreign hospital if an emergency occurs in the US and the nearest hospital is in Canada or Mexico.
• Enrolling While Abroad: You can enroll via the Social Security Administration (SSA) or by contacting the Federal Benefits Office at the nearest US Embassy.
• Penalties: If you do not enroll in Part B when first eligible, you may face late penalties if you return to the US and need to enroll in Part B coverage. There is a lifetime penalty for not signing up for Medicare Part B when first eligible. The penalty adds 10% to your monthly premium for every full 12-month period you were eligible but did not enroll. You will pay this higher premium for as long as you have Part B. Note: Enrollment in parts A and B is required to enroll in Aetna coverage should you move to the US.
• Consider Local Insurance: Many expats purchase local private coverage or use the public health system of their host country.
• Medicare Part A: US expats should generally enroll in Medicare Part A at age 65 if they qualify for premium-free coverage (based on 10+ years of US work history). Because Part A is typically free, it acts as a no-cost safety net for inpatient hospital care if you return to the US. However, Medicare generally does not cover healthcare expenses incurred outside the US.
• Address Requirements: Medicare requires a US mailing address for enrollment; a P.O. Box is sometimes acceptable.