A recent survey of American Citizens Abroad (ACA) members found 57% support extending Medicare to cover medical services received outside the United States. Thirty-four percent backed full reimbursement, 23% backed partial. AudienceNet and NP Agency conducted the survey for ACA in October 2025 with 833 US citizens living overseas. It was published May 19, 2026.
Support ran highest among respondents aged 60 to 69, at 60%. Men favored it more than women, 63% to 49%. About one in five plan to use Medicare benefits now or in the future.
The finding lands against the opposite policy direction. The One Big Beautiful Bill Act, enacted July 4, 2025, narrowed Medicare eligibility for many non-resident Americans and set their benefits to terminate 18 months after enactment.
What the survey is, and isn’t
ACA is a Washington nonprofit that lobbies on tax, banking and voting access for Americans living overseas. Its membership skews older, male, and politically engaged. The 833 respondents were 66% aged 50 and older, 57% male, and 84% registered to vote in US elections.
Western Europe accounted for 54% of respondents. Asia-Pacific followed at 16%, North America at 13%, and the remaining 17% spread across the Middle East, Africa, Nordic countries and Latin America.
The findings describe ACA’s engaged base. They don’t generalize to the estimated nine million Americans abroad.
Delays in accessing US medicines
17% of respondents said they had encountered or observed delays in accessing new US medicines where they live. That share rose to 27% among respondents in Australia, New Zealand and Asia. Among those reporting delays, the survey asked what caused them. Multiple answers were allowed.
| Attributed cause | Share citing |
|---|---|
| Bureaucracy or administrative inefficiency | 52% |
| Safety or efficacy concerns | 52% |
| Slow negotiation or approval timelines with manufacturers | 38% |
| Cost-cutting or budget limitations | 27% |
| Delays in health technology assessment | 26% |
| Deliberate protectionism favoring domestic products | 16% |
| Political or ideological opposition to US policies or products | 15% |
| Complex or unclear pricing and reimbursement processes | 15% |
| Lack of regulatory capacity or expertise | 11% |
Open-ended responses identified two distinct experiences: waitlist friction in capacity-constrained national systems including the UK’s NHS and Canadian provincial systems, and lag between FDA approval and local availability for newer medicines. One respondent said a drug approved by the FDA in August 2025 was not expected to be available in Switzerland before 2027.
Innovation findings tilt industry-favorable
Eight in 10 respondents said maintaining US leadership in pharmaceutical research and development is important. Seventy-seven percent agreed US patients benefit when the US leads in medical innovation. Sixty percent agreed private companies and market competition drive innovation more than government regulation, and 54% agreed strict price controls slow new treatment development.
Several questions in this section read as industry-aligned, with prompts about patent protection and government price controls phrased toward pharmaceutical industry policy positions. The survey methodology doesn’t address whether responses reflect independent views or response patterns shaped by question wording.
68% percent agreed the US should fund vaccines for its citizens worldwide during a global health crisis.
What this tells us about American emigrant policy preferences
Original Medicare doesn’t cover services received outside the US except in narrow border-emergency circumstances. Rep. Adriano Espaillat’s H.R. 5299, which proposed a 10-year Medicare international coverage demonstration in 2023, did not advance. OBBBA moved policy the other direction.
ACA’s engaged base wants Medicare extended. Congress just compressed it. The preferences track patterns visible elsewhere in the AE data, including American retirees citing domestic cost pressures and the healthcare-driven appeal of destinations like Spain and Cyprus.
