The short answer
If you live permanently in Switzerland and already have mandatory Swiss KVG, Medicare Part B generally gives you almost nothing in return for a standard 2026 premium of $202.90 per month. Dropping it, though, is a one-way-door decision: if you later move back to the US and re-enroll, you owe a permanent 10%-per-year late-enrollment penalty for every full 12-month period you went without Part B. That makes this a quiet math problem, not a simple yes/no.
What Medicare Part B actually covers outside the US
Medicare generally does not cover care outside the US. For this purpose, outside the US means anywhere besides the 50 states, DC, Puerto Rico, the US Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Switzerland is not on that list. So when you visit a doctor in Zurich or need a hospital stay in Geneva, Part B pays nothing toward those bills. You keep paying KVG because it is mandatory Swiss basic health insurance, and that is the double-coverage tension.
Part A is a different box
Most people get premium-free Part A after 40 quarters of Medicare-covered employment. Because Part A is free and can be kept without the late-enrollment penalty clock that applies to Part B, the keep-it question for Part A is mostly trivial. The hard decision is Part B.
The three enrollment windows at 65
Your choice is shaped by three windows. Miss the first and don't fit an exception, and the penalty clock starts.
- Initial Enrollment Period (IEP)
- 7 months: 3 months before your 65th-birthday month through 3 months after.
- Special Enrollment Period (SEP)
- 8 months after employment-based group coverage ends. Only applies if you or your spouse are still working with a qualifying group plan. Whether a Swiss employer plan counts is fact-specific, confirm with a cross-border specialist.
- General Enrollment Period (GEP)
- January 1, March 31 each year; coverage starts July 1. Used when you missed IEP and don't qualify for SEP. Late-enrollment penalty applies.
The penalty math you're actually choosing between
The Part B late-enrollment penalty is 10% of the standard premium for each full 12-month period you could have had Part B but didn't. It is permanent, you pay it for as long as you keep Part B. For example, if you skip Part B for two full years and then enroll, Medicare.gov's example is a 20% penalty. On the 2026 standard premium of $202.90, that means $243.48 per month before any future premium changes.
10%
per full 12-month period you delay Part B late enrollment
The penalty does not reset
This penalty is attached to your Part B record. Moving back to the US later does not erase it, and it is recalculated based on how long you went without Part B, not on how long you lived abroad.
IRMAA: the income-based surcharge that can change the math
If your modified adjusted gross income is high, Part B gets more expensive. IRMAA for 2026 starts above $109,000 for single filers and $218,000 for joint filers, rising in steps up to very high income tiers. The 2027 projected thresholds are $112,000 and $224,000, and the lookback uses your tax return from two years earlier. The key detail for this decision: if you do not enroll in Part B, you do not pay IRMAA at all. The surcharge only matters if you decide to keep or later get Part B. If a future US return is on your mind, the timing choices get even more specific, read our piece on Moving Back to the US from Switzerland: Medicare Part B Timing and the Pillar 2 IRMAA Trap.
A calm decision framework for Americans in Switzerland
You are already paying KVG every month, and Part B adds $202.90 (2026) for essentially no care in Switzerland. So the question is not whether Part B is worth it while you live in Switzerland, it is not. The question is how much the option to re-enroll penalty-free is worth to you. That value depends on your age, health, likelihood of returning to live in the US, and whether you or your spouse have US employer group coverage that would preserve a Special Enrollment Period later. If you are under 65 and already mapping the transition, see Moving Back to the US Before 65: Swiss KVG to Medicare Bridge.
When dropping is usually straightforward
If you have lived in Switzerland for years, plan to stay, and have no US employer coverage, many people in your situation choose not to enroll in Part B at 65. That is a rational response to paying for coverage you cannot use. But it is not a universal answer, if your plans are uncertain, the one-way penalty changes the calculus. This is exactly the kind of personal math worth confirming with a cross-border specialist before the Initial Enrollment Period closes.
How US Expat Wealth can help
We specialize in the cross-border money and insurance decisions Americans in Switzerland face, including Medicare timing, Swiss KVG, and the PFIC and tax traps that come with them. This decision is personal; our role is to help you see the full landscape so you can decide with confidence, not guess.