Healthcare

For US citizens moving abroad, healthcare planning is one of the most consequential — and most misunderstood — parts of relocation. The foundational fact is that Original Medicare essentially stops at the border: outside the 50 states and US territories, Medicare pays nothing for hospital care, doctor visits, or prescription drugs except in three narrow situations (an emergency in the US where a foreign hospital is closer, living in the US near a closer foreign hospital, or transiting Canada between Alaska and another state). Expats must therefore build coverage from scratch, choosing between local national health systems, local private insurance, or international private medical insurance (IPMI) from carriers like Cigna Global, Allianz Care, IMG, and Bupa Global. The good news is that comprehensive international coverage typically costs far less than US health insurance. Pacific Prime's international health insurance cost reporting puts individual premiums in a wide band of roughly $2,500 to $28,000+ per year depending on age, coverage area, and deductible, with a typical Cigna Global client paying around $460 per month and a healthy 40-year-old often landing in the $350–$600 monthly range. Excluding the US from a plan's area of coverage is the single biggest lever for cutting premiums, often reducing them by half or more. Many expats also discover that care itself is inexpensive and high quality: destinations like Thailand, Spain, Portugal, and Mexico rank at or near US levels on healthcare quality indices while charging a fraction of US prices out of pocket. The planning traps are in the details. Travel insurance is not a substitute for expat health insurance — it covers emergencies on short trips, not ongoing primary care, chronic disease management, or elective treatment. Pre-existing conditions face medical underwriting on virtually all individual international plans, so applicants with cancer history, heart disease, or diabetes may face exclusions, premium loading, or declined applications. Prescriptions require advance planning since Part D never reimburses drugs filled abroad and controlled substances are tightly restricted at most borders. Finally, most expats must decide whether to keep paying Medicare Part B premiums (standard $185/month in 2025) while abroad to avoid the permanent 10%-per-year late-enrollment penalty if they return to the US.

Key Points

• 1Original Medicare pays $0 for care outside the US and its territories except in three rare situations (foreign hospital closer during a US emergency, closer foreign hospital to a US residence, or Canada transit between Alaska and another state) — and Part D never covers prescriptions filled abroad (medicare.gov).
• 2Medigap plans C, D, F, G, M, and N include foreign travel emergency benefits: 80% of billed charges for emergency care beginning in the first 60 days of a trip, after a $250 deductible, capped at $50,000 lifetime — useful for travelers but inadequate as primary expat coverage.
• 3International (expat) health insurance runs roughly $2,500–$28,000+ per year per Pacific Prime's cost reporting; Cigna Global plans start near $150/month for basic coverage and average about $460/month (~$5,520/year), while a typical 40-year-old pays $350–$600/month with Allianz Care.
• 4Travel medical insurance (e.g., IMG's short-term plans) is cheap and typically guaranteed-issue but covers only emergencies with the goal of stabilizing you to return home; expat/IPMI plans are medically underwritten, renewable annual policies that function as true primary insurance including routine, chronic, and elective care.
• 5Most countries allow travelers to carry a 30–90 day personal supply of medication with the original prescription and a doctor's letter, but controlled substances (opioids, ADHD stimulants, some antidepressants) are heavily restricted or banned in some countries, and refilling abroad usually requires a local physician to rewrite the prescription.
• 6Healthcare quality in popular expat destinations matches or beats the US on the 2025 Numbeo Health Care Index — Thailand scores 77.5 and Spain 77.3 (10th best globally), with Portugal beating the OECD average on 7 of 10 vital indicators and Mexico scoring 72.5 — typically at 25–50% of US private-pay prices.
• 7Pre-existing conditions face either full medical underwriting (condition-by-condition disclosure with possible exclusions or premium loading) or moratorium underwriting (conditions from the prior 2–5 years excluded until a symptom-free period, commonly 2 years, has passed); major conditions like cancer or heart disease are often permanently excluded on individual plans.
• 8Many expats keep paying Medicare Part B ($185/month standard in 2025) while abroad because dropping it triggers a permanent 10%-per-year late-enrollment penalty and a wait for the General Enrollment Period if they later repatriate — a key cost-benefit decision for retirees unsure about a permanent move.