Healthcare

Healthcare is one of the most critical considerations for US citizens living abroad, and the landscape differs dramatically from the domestic system. Unlike in the United States, where employer-sponsored insurance or ACA marketplace plans dominate, expats must navigate a patchwork of international private insurance, local public healthcare systems, and limited US government benefits. Medicare, the cornerstone of healthcare for Americans over 65, generally does not cover services received outside the United States, leaving retirees abroad particularly vulnerable if they don't secure alternative coverage. International health insurance for expats typically costs between $2,000 and $12,000 per year depending on age, destination, deductible, and whether US coverage is included. Major providers like Cigna Global, Allianz Care, and IMG offer customizable plans with networks spanning 1.5 to 2 million providers worldwide. Many popular expat destinations—including Portugal, Mexico, Thailand, and Spain—offer high-quality healthcare at a fraction of US costs, with private hospital visits often costing 50-80% less than equivalent care in the States. Prescription access varies significantly by country, with many nations allowing over-the-counter purchase of medications that require prescriptions in the US. However, controlled substances like ADHD medications and certain sleep aids may be restricted or illegal in some countries. Expats should plan ahead by obtaining notarized prescriptions, carrying adequate supply with generic names listed, and researching destination-specific drug regulations through embassy resources before departing.

Key Points

• 1Medicare generally does not cover healthcare services outside the United States, per medicare.gov. Over 600,000 Medicare-eligible Americans live abroad without this coverage. Expats cannot enroll in Medicare Advantage or Part D prescription plans while living overseas.
• 2International expat health insurance costs $2,000-$12,000+ per year depending on region: Southeast Asia ($2,000-$4,000/year), Latin America ($2,500-$5,000/year), Western Europe ($3,500-$7,000/year), and plans including US coverage ($7,000-$12,000+/year). Cigna Global plans start at approximately $150/month with averages around $460/month.
• 3Travel insurance and expat health insurance serve fundamentally different purposes. Travel insurance covers emergency-only care for trips under 6 months, while expat insurance covers routine care, preventive visits, prescriptions, and chronic conditions for long-term residents abroad.
• 4Pre-existing conditions require careful planning: most international insurers medically underwrite applications and may exclude conditions, charge higher premiums, or impose 6-24 month waiting periods. Cigna Global and GeoBlue Xplorer currently lead the market for pre-existing condition coverage.
• 5Popular expat destinations offer excellent healthcare quality at lower costs. Portugal's national health service charges €5-€20 for consultations. Mexico's private hospitals rival US facilities with bilingual doctors. Thailand ranks among the top 10 globally on Numbeo's Healthcare Index (score: 77.5).
• 6Prescription access abroad requires advance preparation per travel.state.gov guidance. Carry medications in original containers with notarized prescriptions listing generic names. Some medications legal in the US (ADHD drugs, certain sleep aids) may be controlled or illegal in other countries.
• 7Services like the Expatriate Prescription Service deliver medications to over 200 countries, accepting valid prescriptions regardless of country of origin. Many international health insurance plans cover prescriptions written by local doctors abroad.