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Medicare benefits should be extended to those Americans eligible who live outside the United States. Americans abroad who are eligible for Medicare benefits in the US should be able to sign up without premium penalties for late enrollment upon return to the US.

Americans working overseas should be allowed to credit foreign taxes paid against the supplement 3.8% NIIT tax. The NIIT tax directly funds the Affordable Care Act which Americans overseas cannot access.

Executive Summary

TheTriCare program available to military personnel overseas has shown the feasibility of extending Medicare coverage abroad. TriCare is available to retired U.S. military personnel and their dependents. Eligible recipients submit forms to overseas processing centers and have most of their medical bills reimbursed by the U.S. Government. The problems of establishing rules and control procedures have already been addressed and resolved. It would, therefore, be possible to integrate a Medicare component into the existing overseas health care benefit system, if the government so desired. See ACA’s position here

Medicare benefits are not available to citizens outside the United States. Premiums are increased for those who sign up later than when first eligible, and some American health insurances require the insured to pay Part B premiums even when living abroad. This encourages citizens to travel back to the US for expensive treatments, which would cost far less in their countries of residence.

To fund the Affordable Care Act, Congress passed a supplemental 3.8% Net Investment Income Tax (NIIT) tax on some net investment incomes of individuals, estates, and trusts above certain threshold. This new tax cannot be offset by foreign tax credits which results in pure double taxation to fund a program that Americans overseas cannot access or use. See full position paper here.