Expat Health Insurance: How to Get Coverage When You Move Abroad (2026 Guide)

Health insurance is the single most underestimated challenge of moving abroad. Most Americans assume their existing coverage will somehow follow them overseas — or that they will “figure it out” after they land. The reality is much harsher. Medicare provides virtually zero coverage outside the United States. Most employer-sponsored plans terminate the moment you establish foreign residency. And travel insurance, which many expats rely on as a stopgap, is not designed for people who actually live abroad.

A single medical event without proper coverage can be financially devastating. We are not talking about a $200 doctor visit — we are talking about a $180,000 cardiac bypass in Singapore or $300,000 per year for cancer treatment in Germany. Even in countries with “cheap” healthcare, serious procedures carry serious price tags if you are paying out of pocket.

This guide covers every option available to you: global health insurance, local plans, national healthcare systems, digital nomad insurance, and the specific pitfalls Americans face with Medicare, COBRA, and HSAs. Whether you are a remote worker, retiree, or long-term traveler, getting health insurance right before you leave is non-negotiable. Your destination matters too — browse our European destinations, Asian destinations, or Americas destinations to compare healthcare quality alongside cost of living and visa ease.

Why You Need Expat Health Insurance

The gap between what Americans think their coverage handles and what it actually covers abroad is enormous. Here are the cold facts:

Medicare does not work internationally. Parts A, B, C, and D generally provide no coverage for healthcare received outside the United States. There are narrow exceptions for emergencies near the Canadian or Mexican border and on certain cruise ships within six hours of a US port, but for practical purposes, your decades of Medicare contributions become useless the moment you board your outbound flight. For a deeper look at Medicare and retirement healthcare abroad, see our retire abroad healthcare comparison.

Employer plans usually drop you. Most US employer-sponsored health plans restrict coverage to the United States and its territories. Even plans that offer limited “emergency travel” benefits typically cap coverage at 30–90 days and exclude pre-existing conditions. Once you establish residency in another country, your employer plan will almost certainly terminate your enrollment.

Medical costs abroad can be catastrophic without insurance. While routine care is often cheaper overseas, serious conditions carry substantial costs everywhere. A cardiac bypass in Singapore runs approximately $180,000. Cancer treatment in Germany can exceed $300,000 per year. Even in affordable countries like Thailand, a week-long ICU stay can cost $20,000–$50,000. Without insurance, you are one bad diagnosis away from a financial crisis.

Travel insurance is not health insurance. This is the mistake that catches the most people. Travel medical insurance is designed for short trips of 30–90 days. It excludes pre-existing conditions, has low coverage caps ($50,000–$100,000 typical), and will not renew indefinitely. It is meant for a broken arm on vacation — not for managing diabetes, getting surgery, or having a baby abroad.

Types of International Health Coverage

There are five distinct categories of health coverage available to people living abroad. Each serves a different profile, budget, and duration of stay. Understanding the differences is the first step toward making the right choice.

Global health insurance from providers like Cigna Global and Aetna International is the gold standard for long-term expats. These plans work like comprehensive US health insurance but with worldwide coverage. They include hospitalization, outpatient care, prescriptions, and often dental and vision. The downside is cost: premiums increase significantly with age and if you include US coverage.

Local health insurance is purchased in your destination country from local insurers. It is significantly cheaper than international plans but only covers treatment within that country. If you are settled in one place and not planning to return to the US for medical care, this can be an excellent value.

National healthcare systems are available to legal residents in many countries. This is often the best deal available — countries like Portugal, Spain, and Costa Rica offer quality public healthcare at little or no cost once you have residency.

Digital nomad insurance from providers like SafetyWing and World Nomads fills the gap for people who move frequently and do not have permanent residency anywhere. These plans are affordable and flexible but have lower coverage limits and more exclusions than true international health insurance.

Best Expat Health Insurance Providers

The international health insurance market has matured significantly. Here are the six providers most commonly recommended in expat communities, each serving a different niche:

Cigna Global

The premium choice for expats who want comprehensive, no-compromise coverage. Cigna Global offers plans in three tiers (Silver, Gold, Platinum) with coverage in 200+ countries. Hospital networks are extensive, and direct billing means you often do not pay upfront for hospital stays. Premiums run $200–$800/month depending on age, coverage level, and whether you include the US. Including US coverage roughly doubles the premium. Best for: families, retirees with health concerns, and anyone who wants the closest equivalent to top-tier US insurance.

Aetna International

A strong option for Americans who want continuity with a familiar US brand. Aetna International provides global coverage with a robust network, particularly strong in the Americas and Asia. Their plans include mental health coverage — often excluded or limited by competitors. Premiums are comparable to Cigna at $200–$700/month. The claims process is efficient and the customer service reputation is solid. Best for: Americans who value brand recognition and US network continuity.

Allianz Care

The European powerhouse. Allianz Care excels in Europe, the Middle East, and Africa with deep hospital networks in those regions. Their plans are modular — you choose a core plan and add optional modules for outpatient, dental, vision, and wellness. Premiums range from $180–$600/month. Customer service is consistently rated highly by expats in Europe. Best for: expats based in Europe or the Middle East who want flexible, modular coverage.

SafetyWing

The budget option that changed the game for digital nomads. SafetyWing's Nomad Insurance starts at just $45/month for ages 18–39, making it the most accessible international coverage available. It works on a subscription model — you can start and stop anytime. Coverage includes hospitalization, outpatient care, and limited dental for emergencies. The catch: coverage caps are lower ($250,000 per period), pre-existing conditions are excluded, and it is designed more as a safety net than comprehensive insurance. Their newer Nomad Health product offers fuller coverage for those who need more. Best for: young digital nomads and budget-conscious remote workers.

World Nomads

Designed for active travelers rather than long-term residents. World Nomads excels at covering adventure activities — scuba diving, motorcycle riding, hiking — that most standard travel insurance excludes. Plans cover trips up to 12 months and can be extended while you are traveling. Premiums vary by destination but typically run $100–$250/month. The limitation is the travel insurance structure: pre-existing conditions are excluded, coverage caps are modest, and it is not designed for people who have settled in one country. Best for: travelers doing extended trips with adventure activities.

GeoBlue

GeoBlue is backed by the Blue Cross Blue Shield network, making it uniquely appealing to Americans who want integration with the US healthcare system. Their Xplorer plan provides comprehensive international coverage while maintaining access to the BCBS network when you visit the US. Premiums range from $180–$500/month. The US coverage integration is smoother than with most international insurers, which matters if you return home frequently. Best for: Americans who split time between the US and abroad or want seamless US coverage on return visits.

Countries with Free or Low-Cost Healthcare for Expats

One of the biggest advantages of moving to certain countries is gaining access to their national healthcare system. In these destinations, establishing legal residency qualifies you for public healthcare that ranges from completely free to a modest monthly contribution. This can eliminate or dramatically reduce your need for private insurance.

Spain — Legal residents can access the public healthcare system (Sistema Nacional de Salud) through the convenio especial, which costs approximately EUR 60/month for under 65 and EUR 157/month for those over 65. The quality is excellent — Spain's system consistently ranks among the world's best. See our Spain country profile for full residency details.

Portugal — Once you obtain residency and a tax number (NIF), you can register at a local health center for access to the Serviço Nacional de Saúde (SNS). Primary care is free; specialist referrals carry co-payments of EUR 5–20. Many expats supplement with affordable private insurance (EUR 50–100/month) for faster access to specialists. Explore Portugal's full profile.

Thailand — While Thailand does not offer public healthcare to foreign retirees, the private healthcare system is exceptionally affordable. A GP visit costs just $10–$30, specialist consultations run $30–$80, and the country has 68 JCI-accredited hospitals. Many expats combine low-cost out-of-pocket care with a catastrophic insurance plan. See our Thailand profile.

Costa Rica — Legal residents must enroll in the Caja Costarricense de Seguro Social, which provides universal coverage for $80–$200/month based on declared income. The Caja covers everything from primary care to surgery. Quality is good, though wait times for elective procedures can be long. Check out our Costa Rica overview.

United Kingdom — The NHS provides healthcare free at the point of use for legal residents. Most visa categories require paying the Immigration Health Surcharge (currently GBP 1,035 per year) as part of the visa application, which then grants full NHS access including GP visits, hospital care, and prescriptions (prescriptions are free in Scotland, Wales, and Northern Ireland; GBP 9.90 per item in England).

France — After three months of legal residency, you can enroll in Protection Universelle Maladie (PUMa), which reimburses 70% of standard medical costs. Most residents add a mutuelle (top-up insurance at EUR 50–150/month) for full coverage. France's system is ranked #1 by the WHO.

Japan — All residents, including foreigners, must enroll in the National Health Insurance (NHI) system. Premiums are based on income and municipality (typically $100–$300/month). The system covers 70% of medical costs, with the patient responsible for a 30% co-pay. Japan's healthcare quality is outstanding, with a high-cap system that limits annual out-of-pocket expenses.

How to Choose the Right Plan

There is no single “best” expat health insurance plan. The right choice depends entirely on your specific situation. Here is a decision framework based on the five factors that matter most:

Length of stay. If you are abroad for less than six months, travel medical insurance or a digital nomad plan like SafetyWing may suffice. For stays of one year or more, you need either a global health plan, local insurance, or enrollment in the public healthcare system. Short-term solutions become expensive and inadequate the longer you stretch them.

Destination country. If you are moving to a country with strong public healthcare (Spain, Portugal, France, Costa Rica, Japan), enrolling in the national system should be your first move. You can supplement with private insurance for faster specialist access. If you are moving somewhere without public access for foreigners (Thailand, Malaysia, Panama), international or local private insurance is essential. Use our country matching quiz to find destinations that align with your healthcare priorities.

Pre-existing conditions. This is the single biggest differentiator. If you have pre-existing conditions, countries with universal healthcare systems that cover them from day one (Portugal, Spain, France, Costa Rica) offer enormous advantages over private insurance, which typically imposes 12–24 month waiting periods or permanent exclusions. Cigna Global and Allianz Care offer the best pre-existing condition coverage among private insurers, but at higher premiums.

Budget. Monthly premiums range from $45 (SafetyWing) to $800+ (comprehensive Cigna Global with US coverage). A realistic middle-ground for most expats is $150–$350/month for solid international coverage without US inclusion. In countries with public healthcare, your total cost could be as low as $60–$200/month.

US coverage. Do you need to maintain the ability to receive treatment in the US? If yes, expect premiums to roughly double. Many expats exclude US coverage from their international plan and maintain Medicare Part A (which is free for most) as a safety net for US visits. This is the single biggest cost lever when choosing a plan.

What Americans Specifically Need to Know

The US healthcare and tax system creates several unique traps for Americans moving abroad. Understanding these before you leave can save you thousands of dollars and significant headaches.

The ACA individual mandate does not apply abroad. If you qualify for the Foreign Earned Income Exclusion under the physical presence test (330+ days outside the US in a 12-month period), you are exempt from the individual mandate requirement. You do not need to maintain ACA-compliant coverage while living overseas. For a full walkthrough of tax implications, see our expat tax guide.

COBRA is a poor solution. COBRA allows you to continue your employer-sponsored coverage for up to 18 months after leaving your job. The problems: you pay the full premium (typically $600–$2,000/month for an individual), the plan was designed for US providers and may not cover overseas treatment, and it expires after 18 months with no option to extend. COBRA is a bridge, not a strategy.

Medicare Part B premiums do not pause. If you are enrolled in Medicare Part B and move abroad, you continue owing monthly premiums ($174.70 in 2024) even though you cannot use the coverage overseas. You can disenroll — but if you later re-enroll, you face a 10% late enrollment penalty for each 12-month period you were not covered. Many expats keep Part A (free for most) and make a strategic decision on Part B based on how likely and how soon they plan to return to the US.

HSA contributions stop with foreign coverage. You cannot contribute to a Health Savings Account if you are covered by a foreign health insurance plan or enrolled in a foreign public healthcare system. You can still use existing HSA funds for qualified medical expenses — including expenses incurred abroad — but new contributions are off the table once you have non-US coverage. Plan your HSA strategy before departure.

Putting It All Together

Health insurance is not the most exciting part of moving abroad, but it is arguably the most important. A medical emergency without coverage can drain your savings in days. The good news is that the options available today — global insurers, affordable nomad plans, and public healthcare systems in dozens of countries — make it entirely possible to get coverage that is both comprehensive and affordable. In many cases, you will end up paying less for better coverage than you had in the United States.

Start by deciding where you are going. A country with universal healthcare access (Spain, Portugal, France, Costa Rica, Japan) solves most of the problem for you. A country without public access (Thailand, Malaysia, Panama) requires more planning but offers excellent private options at reasonable prices. Layer on the right insurance for your situation — whether that is a premium Cigna Global plan, a budget SafetyWing subscription, or simply enrollment in the local public system.

If you are still deciding where to move, our country matching quiz evaluates destinations across healthcare quality, cost of living, safety, and visa accessibility. You can also compare specific countries side-by-side using our comparison tool, or read our healthcare comparison for retirees for a deeper dive into medical systems by country. For the financial side of your move, our guides on expat banking and expat taxes cover the other critical pieces of your relocation plan.