YFApproximately 9 million American citizens reside permanently abroad, many of whom have elderly parents still living in the United States. A significant portion of these seniors are Medicare-eligible and regularly return to the U.S. to access healthcare benefits—particularly those residing in nearby regions referred to as the “near abroad.” While these individuals would prefer to remain with their families overseas, they are often unable to afford local healthcare coverage, especially due to pre-existing medical conditions that make them ineligible for local insurance or subject to prohibitively high premiums.

Survey data shows that 36% of Americans living abroad would like their parents to join them overseas. However, 66% of these parents suffer from chronic, long-term health conditions, making access to local insurance infeasible.

To address this challenge, we propose the establishment of a pilot program within HHS to allow approximately 150,000 beneficiaries across 10–15 countries to access their earned Medicare benefits while residing abroad.

Policy Considerations

• Cost Savings – Estimated savings per beneficiary could reach $100,000. With full program implementation involving 2–4 million participants (based on reputable polling data), projected government savings could range from $200–$400 billion. This pilot would allow the U.S. to export long-term liabilities at a fraction of their actuarialized domestic cost, while honoring obligations to beneficiaries.

• Alleviating Medical Infrastructure Bottlenecks – Over the next decade, 15+ million Americans will reach Medicare eligibility, placing severe strain on existing U.S. medical infrastructure, including staffing and hospital capacity. Without relief, delays in care comparable to those experienced during the COVID-19 pandemic are likely. The pilot offers a strategic means to mitigate this impending burden.

• Expanding Beneficiary Choice – Permitting seniors to retire abroad while maintaining access to Medicare increases the range of care settings in which they can utilize their earned benefits. This enhances personal autonomy and satisfaction without compromising the integrity of the Medicare program.

• Family Reunification – Many seniors wish to live near family members residing overseas, but cannot do so due to lack of Medicare portability and the unaffordability of foreign insurance—especially for hospitalization, which is already covered under Medicare Part A. This pilot would remove that financial barrier.

• Language and Cultural Considerations – As first-generation Americans age, many lose proficiency in English, making native-language caregivers essential for proper medical care. Facilitating access to culturally and linguistically appropriate care can improve outcomes and quality of life.

• Support for Veterans – Numerous U.S. veterans wish to retire abroad, often in countries where they served or have familial ties. This is particularly relevant for veterans managing PTSD. Additionally, Tricare benefits do not fully mirror Medicare, creating coverage gaps that this pilot can address.

• Importing Global Best Practices – The pilot offers a platform to study and adapt cost-effective healthcare models from allied countries. For example, Israel’s “Hospital at Home” program and monthly home visits for non-ambulatory seniors have significantly reduced healthcare costs. Similarly, Korea’s integration of acupuncture demonstrates effective alternative care. Tracking such innovations under the pilot can inform scalable applications in the U.S.

• Strengthening Diplomatic Ties – Partnering with key allies on healthcare delivery through this pilot will enhance diplomatic relationships, promote healthcare innovation, and support mutual goals of cost efficiency and quality care.

• Executive Overview
• Pilot: $3.7 - 6.9 Billion Cost Saving
• Frequently Asked Questions
• Proposed Pilot
• Legislative Milestones (pages 97-98)
• FY 21 Appropriations Managers Report – Signed by President Trump
• FY22 Appropriations Managers Report – Signed by President Biden
• HR5299 Introduced in the House of Representatives in the 118th Congress by Congressman Espaillat
• Cost Comparison
• 4 Case Studies
• Survey Questionnaire of Americans Overseas
• Analysis of Survey Results
• Survey Results Cross-tabbed
• Letters of Support available upon request.

Naturalization is a privilege earned through affiliation with a country. In the US, this is achieved through applying for a Green Card, followed by a residency requirement, and finally, taking an exam. The process to citizenship is long by design. There exists a “fast track” today through military service. An enlist, who is not a citizen, is eligible for citizenship after a year of service. Our goal is to enable this track to be mirrored for other, to be defined, forms of service to the Nation. Estimated governmental savings in excess of $10 billion. More information available: Executive Overview.

20% of all women are assaulted at some point during their lives in all Western countries. The #metoo movement is a resonance of this fact. While calling out assailants is important, it is much more beneficial to create programs that train girls to avoid situations and, when required, act to protect themselves. GSI’s founder funded a pilot program of 90 girls within a school setting, to take self defense classes. Within less than a year: 2 students were assaulted and repelled their attackers and 6 girls avoided serious situations. GSI has worked with a municipality to start to roll-out a self defense program citywide. The costs of the classes were far less than the costs of the care had the 2 girls become victims. Estimated governmental savings in excess of $120 billion. This program could be implemented in the United States through a Junior ROTC program in High School—helping drive positive interactions with the Armed Services and increasing overall enlistment as the course graduates obtain their high school degrees. More information available: Pilot Program - Executive Overview.