Healthcare

For US citizens living abroad, healthcare is one of the most consequential planning decisions—and one of the most misunderstood. The single biggest surprise for most expats is that Medicare almost never travels with them: original Medicare (Parts A and B) generally pays nothing for care received outside the United States and its territories, with only a handful of narrow exceptions. Because Americans can rarely rely on the coverage they paid into for decades, securing private international coverage before relocating is essential rather than optimional. The practical choice usually comes down to two very different products. Travel medical insurance is cheap (roughly $50–$100/month) but short-term and emergency-focused—designed to stabilize you and get you home, not to manage your health long-term. International (expat) health insurance costs more (typically $300–$500/month) but provides comprehensive, renewable coverage including routine care, chronic-disease management, and—after waiting periods—pre-existing conditions. Major global insurers such as Cigna Global, Allianz Care, IMG, and GeoBlue dominate this market, with premiums driven heavily by age, country of residence, and whether US coverage is included. The good news is that many popular expat destinations offer high-quality care at a fraction of US prices. Portugal, Spain, France, Thailand, and Mexico are repeatedly ranked among the best for expats, combining universal or affordable public systems with internationally accredited (often JCI-certified) private hospitals. Still, two issues demand early attention: pre-existing conditions, which insurers handle through full medical underwriting or moratorium clauses, and prescription access, since US prescriptions are generally not valid abroad and controlled substances face strict import limits or outright bans in some countries.

Key Points

• 1Original Medicare (Parts A & B) generally pays nothing outside the US—'outside' meaning anywhere beyond the 50 states, DC, Puerto Rico, the US Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Rare exceptions cover only emergencies where a foreign hospital is closer than the nearest US hospital, certain Canada-to-Alaska travel, or care on a ship within 6 hours of a US port. Part D drug plans also can't cover prescriptions bought abroad.
• 2Some Medigap (Medicare Supplement) plans—C, D, F, G, M, and N—offer foreign travel emergency coverage: after a $250 annual deductible they pay 80% of eligible emergency costs during the first 60 days of a trip, up to a $50,000 lifetime maximum (2025 figures). This is emergency-only and not a substitute for living abroad.
• 3International (expat) health insurance averages about $300–$500/month. Cigna Global plans average roughly $460/month (~$5,520/year), with basic coverage starting near $100–$150/month; premiums rise sharply with age, country of residence, and adding US coverage. A 40-year-old on Allianz Care typically pays $350–$600/month.
• 4Travel medical insurance ($50–$100/month) is short-term and emergency-focused—it aims to stabilize and repatriate you, permanently excludes pre-existing conditions, and is the wrong tool for stays of a year or more. Expat health insurance covers routine, preventive, and chronic care on a renewable basis.
• 5Pre-existing conditions are handled two ways: full medical underwriting (you disclose history; the insurer prices or excludes conditions) or moratorium underwriting (conditions are excluded until you go ~2 years symptom-, treatment-, and advice-free). Major conditions like cancer or hypertension are often permanently excluded, and travel insurance never covers them.
• 6US prescriptions are generally invalid abroad—overseas pharmacies can't fill them and US pharmacies can't ship overseas. Most countries cap personal medication imports at a 30–90 day supply; controlled substances (opioids, stimulants, ADHD/anti-anxiety meds) are heavily restricted or outright banned in countries like the UAE, Japan, and Zambia. Carry a doctor's letter, generic drug names, and check import rules 4–6 weeks before traveling.
• 7Top expat healthcare destinations pair quality with low cost: Portugal's SNS offers universal coverage to legal residents; Spain ranks among the world's top 10 (Numbeo) with the world's 2nd-highest life expectancy; and Thailand and Mexico host JCI-accredited private hospitals delivering Western-standard care, often with English-speaking, internationally trained doctors, at a fraction of US prices.