What Expat Health Insurance Actually Is in 2026

When you’re getting ready to move abroad, one of the first things you have to sort out is health coverage, and it’s also one of the most confusing. The public cover you have at home mostly stops at the border, whether that’s US Medicare or the UK NHS, and neither follows you when you move. Travel insurance is built for a two-week trip, not a life. So what is the thing that actually covers you when you live in another country, and what does it cost? That’s what this page explains, in plain terms, before it names any brands. What your home country leaves you with differs by where you’re leaving, so the origin sections below cover the US and UK cases; the rest of the page is the same whoever you are.

At a glance

Expat health insurance (usually sold as international or local medical insurance) is a policy that covers you for routine and emergency care while you live outside the United States long-term. It isn’t travel insurance, and it isn’t the same as your old US plan. Two facts matter most before you shop. First, the public healthcare you have at home usually doesn’t follow you abroad (US Medicare doesn’t cover you overseas, and UK NHS entitlement ends when you stop being resident), so you can’t lean on it as a retiree; the origin sections below have the detail. Second, price is driven mostly by your age and by whether the plan includes coverage inside the United States. No insurer publishes a flat price. Every premium is quote-based, so treat every number on this page as a labeled band, not a sticker price.

The three plan types, side by side

Most coverage for Americans abroad falls into one of three buckets. The annual cost bands below are individual, quote-based, and drawn from a single education source (Greenback, reading Pacific Prime market data). They tell you the rough shape of each market, not what you personally will pay.

Source: Greenback comparison table (quote-based, single source). Verdict: if you’re actually relocating, the real choice is international versus local. Short-term travel insurance is for the trip before the move, not the life after it.

What your age does to the price

Age is the single biggest driver of an international premium. The table below is one broker’s average annual premiums across roughly 2,000 of its own sales (International Citizens Insurance). These are sales averages, not a study, and they skew high because many of the buyers included US coverage. Read them as the slope, not the price: the 65-and-over average is about six times the youngest band.

Source: International Citizens Insurance broker averages (quote-based, single source, skews high). Verdict: your own quote depends on far more than age, but if you’re pricing a move in your 60s, budget in the five figures per year and get real quotes early.

What it actually is, and what it is not

International health insurance is medical cover for people living outside their country of citizenship for the long term. Unlike a trip policy, it pays for routine and preventive care, prescriptions, and chronic conditions, not just the ambulance after an accident. That distinction is easy to miss, and it’s the one that matters.

Versus travel insurance. Travel or trip insurance is built for short stays, usually 30 days to 6 months, and covers emergencies and acute problems. It doesn’t cover routine checkups, ongoing prescriptions, or pre-existing chronic conditions, and it rarely satisfies a visa. Expat insurance is the opposite: long-term, comprehensive, and usually visa-qualifying. Example: a burst appendix on a two-week vacation is a travel-insurance claim. Managing blood pressure and getting an annual physical while you live in Lisbon is an expat-insurance job. Verdict: if you plan to sleep in another country for months, not days, travel insurance is the wrong product.

Versus the public cover you leave behind. The state or employer cover you have at home rarely follows you when you live abroad. Most US domestic plans pay little or nothing outside the United States, and Original Medicare generally doesn’t cover care outside the US apart from a few rare near-border emergencies (attributed to Greenback, reading Medicare.gov; confirm the exact rule against Medicare.gov or CMS before you rely on it). UK NHS care is residence-based and ends when you stop being ordinarily resident. The origin sections below spell out each case. Verdict: don’t assume the cover you have now travels with you. It generally doesn’t.

Versus the local or public system. As a foreign national you’re often not entitled to free or subsidized public healthcare right away. Public systems are typically reserved for citizens, permanent residents, and immigrants after a waiting period, though the details vary a lot by country. Some residents can or must enroll in the national system, sometimes with the cost deducted from salary. The nuance worth holding onto: this is bounded. A dual citizen, for example, may be able to access a public system that a visa-holding foreign national can’t. Local private insurance, meanwhile, covers only that one country, not your travel or a trip home. Verdict: check the specific country’s rule. Don’t assume you’re either locked out of public care or automatically entitled to it.

Area of cover: the price lever most people miss

After age, the biggest thing you control is your area of cover. This is the geographic footprint of the plan, and the standard options are worldwide, worldwide excluding the USA, or a region such as Europe. Because US medical costs are so high, adding the United States to a plan is expensive, and dropping it’s the clearest way to cut a premium.

How much? One education source (Greenback) puts the reduction at roughly 20% to 40% for excluding US coverage. A worked broker example makes it concrete (International Citizens Insurance, updated 2026-07-09, quote-based, single scenario): a US couple aged 62 and 60 retiring in Costa Rica, on an IMG Silver plan with a $1,000 deductible, was quoted about $7,794 per year excluding the US (and a handful of other high-cost countries) versus about $10,322 per year for full worldwide cover including the US. That’s roughly a third more to keep the US in.

The catch on the individual side is that the two sources we have disagree on what US-inclusive cover actually averages, and they disagree for a reason. International Citizens Insurance reports an average around $10,879 for the US as a country of residence, from its own sales. Greenback, reading a Pacific Prime 2024 report for a 36-year-old with inpatient and outpatient cover and no deductible, reports about $15,296. The two numbers come from different ages, different methods, and different books of business. We keep both rather than blend them into a single false number. Verdict: if you don’t expect to spend real time back in the States, excluding the US is the highest-leverage way to lower your premium. If you do, price it both ways and decide with the two quotes in front of you.

What drives your premium

Insurers underwrite each applicant, so your quote is built from several inputs, not a rate card. The ones that move the number most:

• Age. The dominant driver, as the age table shows.
• Area of cover. Worldwide including the US is the costliest. Excluding the US cuts roughly 20% to 40% (Greenback, quote-based).
• Deductible and coinsurance. A higher deductible (say, moving from $0 to $1,000 or $2,500) lowers your premium because you carry more of the first-dollar cost.
• Level of cover and add-ons. Higher medical limits and extras such as dental, vision, or maternity raise the price.
• Medical history. Pre-existing conditions can change your premium, your exclusions, or your eligibility (see the FAQ).
• Country of residence and number of members. Where you live and how many people are on the policy both matter.

Cost mechanics worth knowing before you read a quote (attributed to Cigna): the premium is what you pay, usually monthly. The deductible is the annual amount you cover before the plan pays. Coinsurance is a split of eligible costs, such as 20/80, up to a ceiling. A copay is a flat fee per visit or prescription. Example: choosing a $2,500 deductible instead of $0 lowers the premium but means you pay the first $2,500 of eligible care yourself each year, which only makes sense if you can absorb that. Verdict: the two levers you actually control at quote time are your deductible and your area of cover. Age and health, you can’t.

The provider roster: who is best for whom

There’s no single best expat health insurer, and this page won’t name one. The right plan depends on your age, your health, where you’re going, and whether you need US cover. What follows is an editorial best-for read of the market, brand-agnostic, with no rankings and no preferred partners. Every one of these is quote-based, and none publishes a flat price. Get quotes from two or three that fit your situation.

• Cigna Global. Modular international cover you can build a la carte, accepts applicants at any age, and cover can continue for life. A strong fit for older applicants and families who want to add or drop components. Best for retirees and anyone who wants to shape the plan piece by piece.
• GeoBlue / BCBS Global Solutions. Built around the Blue Cross Blue Shield network and US-standard care, with unlimited annual and lifetime limits and pre-existing conditions often covered when you have prior continuous coverage. New applicants are generally capped around age 74. Best for US citizens who want US-quality care and occasional coverage back home.
• IMG. Tiered plans (Bronze, Silver, Gold, Platinum) with flexible deductibles and areas of cover, and it will underwrite some risks other insurers decline. Best for budget-to-mid buyers and anyone wanting a catastrophic or entry-level option.
• Allianz Care. Premium modular plans, a strong financial-strength rating, and a moratorium underwriting option that skips the medical questionnaire. Best for families and buyers who want premium cover with faster underwriting.
• William Russell. Premium expat plans covering areas such as hospital care, mental health, and maternity. Best for relocating families who want a boutique premium insurer.
• SafetyWing. Nomad-origin, lower-cost, subscription-style cover, and the most recognized name among younger movers and digital nomads. Best for younger, under-65 nomads and budget-first movers. Less of a comprehensive retiree product.
• Genki. Europe-led subscription insurance, favored for longer stays. Best for EU-based younger expats.
• Bupa Global. A long-established premium global health insurer. Its current US-facing plan availability isn’t confirmed in our research, so verify what is offered to US movers before relying on it. Best for high-end comprehensive cover, pending that check.

Verdict: match the plan to your profile, not to a headline. A 30-year-old nomad and a 64-year-old retiree should almost never be shopping the same shortlist.

The visa hook: several countries require insurance

For a lot of movers, this stops being optional the moment a visa is involved. Several residence visas require proof of private health insurance before they will approve you. Confirmed examples from our source (Greenback) include Germany, France (long-stay, must cover hospitalization), Spain’s non-lucrative and retirement visas, the UAE and Dubai, some long-stay and retirement visas in Thailand, and Portugal’s D7 and digital-nomad visas. Some countries don’t legally require it but recommend it (Mexico), and some fold you into a mandatory national system instead (Japan requires resident enrollment in national health insurance).

We are deliberately not quoting a minimum coverage amount for any of these, because the exact thresholds and approved-provider rules weren’t pulled from official consulate sources for this page. The safe, accurate statement is that these visas require private health insurance, full stop. If a specific residence visa is your route, this is where insurance and immigration meet, and it’s covered alongside the country requirements in the retirement visas hub. Verdict: if you’re applying for one of these visas, treat insurance as a gating requirement, not a nice-to-have, and confirm the current minimums on the official government page before you buy.

Moving from the US

For a US mover, the headline is Medicare. Original Medicare generally doesn’t cover care outside the United States, apart from rare near-border emergencies, so turning 65 does not solve your coverage abroad. You can still weigh keeping Medicare Part B (reported at about $202.90 a month for 2026, with a permanent 10% surcharge for each 12-month late-enrollment period, attributed to Greenback reading CMS; confirm the current figure) in case you return to the US, but for care where you actually live you budget for private international or local insurance. If you want the option of treatment back in the States, that is the worldwide-including-USA area of cover, which is the single most expensive choice.

Moving from the UK

For a British mover, NHS care is residence-based, so it ends when you stop being ordinarily resident in the UK. Two cards people expect to lean on do not fill the gap. A GHIC (or the older EHIC) covers necessary treatment on visits to the EU, not the care of someone who lives there, so it is a tourist card, not a residence solution. And the S1 route, under which the UK funds a State Pensioner’s care in an EU state system, only reaches the EEA, Switzerland and a few reciprocal-agreement countries; outside those, there is no UK-funded cover to inherit. The practical result is the same as for anyone else: private international or local insurance from the point you move, and if your visa mandates cover (Spain’s non-lucrative visa and Portugal’s D7 both do), it is a gating requirement, not a nicety.

Decision framework

Use this as a starting point for which part of the market to price first, not as advice about a specific policy.

Frequently asked questions

Does Medicare cover me if I live abroad? Generally no. Original Medicare doesn’t cover care outside the United States, apart from rare near-border emergencies (attributed to Greenback, reading Medicare.gov; confirm against Medicare.gov or CMS). If you’re retiring abroad, plan on private international or local cover, not Medicare. You can still weigh whether to keep paying the Medicare Part B premium in case you return, which was reported at about $202.90 per month for 2026 with a permanent 10% surcharge for each 12-month late-enrollment period (attributed to Greenback; confirm the current figure against CMS).

What is the difference between travel insurance and expat health insurance? Travel insurance covers emergencies on short trips, typically 30 days to 6 months, and doesn’t cover routine care, prescriptions, or chronic conditions. Expat or international health insurance is long-term and comprehensive, covers routine and preventive care, and usually satisfies a visa. If you’re living somewhere, not visiting, you need the expat product.

Do I need expat health insurance if my new country has public healthcare? Often yes, at least at first. As a foreign national you’re frequently not entitled to public care right away, and some countries require private cover as a visa condition regardless. That said, it’s country-specific: some residents can or must enroll in the national system, and a dual citizen may have access a visa holder doesn’t. Check the specific country’s rule rather than assuming.

How much does expat health insurance cost, and how much more for someone in their 60s? Every premium is quote-based, so treat these as bands. By plan type (individual, quote-based, single source): local roughly $1,500 to $6,000, international roughly $3,000 to $9,000+, short-term travel roughly $500 to $2,000. By age, one broker’s sales averages run from about $4,399 for 18 to 24 up to about $27,772 for 65 and over, roughly a six-fold jump across the age span. Those averages skew high and aren’t a study. Your own number depends on your area of cover, deductible, and health as much as your age.

Will a plan cover my pre-existing conditions? Sometimes, depending on the insurer and how it underwrites. Full medical underwriting generally covers pre-existing conditions unless they are specifically excluded. Moratorium underwriting skips the questionnaire but typically only covers a pre-existing condition after a continuous period (often 24 months) with no symptoms or treatment. Some insurers, such as GeoBlue/BCBS, can apply prior continuous coverage to reduce a waiting period. Underwriting outcomes range from full cover to an exclusion, a higher premium, or a decline, and ACA protections don’t apply abroad. Disclose everything, because non-disclosure can void a claim.

Is US coverage included, and how much does adding it cost? It’s optional, and it’s the most expensive area-of-cover choice. Excluding the US can lower a premium by roughly 20% to 40% (quote-based, single source). In one broker’s worked example, a couple aged 62 and 60 in Costa Rica was quoted about $7,794 per year excluding the US versus about $10,322 including it. On individual US-inclusive cost, two sources disagree (about $10,879 versus about $15,296) because of different ages and methods, so price your own situation both ways.

Which countries require proof of health insurance for a visa? Several residence visas require private insurance, including Germany, France, Spain’s non-lucrative and retirement visas, the UAE and Dubai, some Thailand long-stay visas, and Portugal’s D7 and digital-nomad visas (attributed to Greenback). We aren’t stating a minimum coverage amount, because those thresholds weren’t confirmed against official sources for this page. Verify the current requirement on the official government page for your visa.

What is the best expat health insurance? There’s no single best, and any page that names one is usually selling it. The right plan depends on your age, health, destination, and whether you need US cover. Get quotes from two or three insurers that fit your profile, and compare on area of cover, deductible, and how they handle any pre-existing conditions.

Sources and methodology

Source links (verified 2026-09-11):

• Medicare coverage outside the US (Medicare.gov): https://www.medicare.gov
• CMS 2026 Medicare Part B premium (newsroom): https://www.cms.gov/newsroom
• Cigna Global: https://www.cignaglobal.com
• GeoBlue / BCBS Global: https://www.geobluetravelinsurance.com
• Allianz Care: https://www.allianzcare.com
• IMG Global: https://www.imglobal.com

UK sources for the “Moving from the UK” section (checked 2026-09-22):

• gov.uk, “Healthcare when living abroad”: NHS entitlement is residence-based and ends on a permanent move; the S1 and GHIC positions.
• NHS, “Apply for healthcare cover abroad (GHIC and EHIC)”: the GHIC covers visits, not residents.

Checked 2026-09-07 (US figures) and 2026-09-22 (UK section). This page is a category explainer for people moving abroad. It draws on published education and comparison pages and their cited market data, not on live quotes run for this article.

Important limitation: no insurer publishes a flat price for expat health insurance. Every premium here is quote-based and labeled by its source. Where two sources disagree, we present both and do not average them.

A few specifics here are worth confirming at the source before you rely on them: the exact insurance minimums for Spain’s non-lucrative visa and Portugal’s D7, whether Bupa Global currently sells to US applicants, and the 2026 Medicare Part B premium.

Last updated

Last updated: 2026-09-22. Reviewed by Expat Future editorial.

Claim ledger

Every figure below is quote-based. No insurer publishes a flat price for expat health insurance.

Not medical or financial advice

This article is general education, not medical, insurance, tax, or financial advice. Coverage rules, prices, visa requirements, and Medicare figures change and vary by insurer, country, and individual circumstances. Confirm current details with the insurer, a licensed broker, and the relevant official government sources, and get personalized advice before you buy a policy or make a coverage decision.