A Guide To Health Insurance Options Abroad

For anyone considering moving overseas—but especially older folks—health insurance is a critical consideration.

If you think that Medicare will cover your health care costs outside of the United States, think again. It only applies under limited circumstances in Canada and Mexico. This fact is so often missed that the government even prints it in U.S. passports.

The good news is that you have many options when it comes to health insurance overseas, and health care systems in other countries can be more affordable and of better quality than the United States’.

They also tend to be easier to understand and navigate compared to the U.S., where even the experts scratch their heads at the many plans and their respective rules, sources of funding, and enrollment dates.

Here’s an overview of international health insurance options for older Americans looking to move overseas.

International Policies

International policies provide medical coverage for people living or traveling outside their home country for extended periods (usually one year at a time).

They’re easy to use. You choose a policy with terms and coverage that suit your health needs and lifestyle.

These policies generally cover sickness and accidents, including emergency treatment, inpatient care, cancer treatment, and outpatient surgery.

You’ll pay a premium (monthly or annually) to keep the policy active and select a deductible. The lower the deductible, the higher the premium.

International health insurance policies are annually renewable, and you can keep them for as long as you want.

The benefit of an international health insurance policy is that it can give you portable coverage. You’re covered in your country of residence as well as anywhere else you might travel (including the United States, if you want it).

The downside is that they can be more expensive than the other options on this list, especially as you get older. You can get into most international policies up until age 73.

Local Policies

Local policies are another option for insuring yourself when you move overseas, providing cover exclusively in the country where you’re living. This can be a good option if you plan to spend the majority of your time in that country and not travel internationally much.

You can take out a policy with a state or private health insurance provider, giving you access to local private facilities. In some countries, state health coverage is subsidized or even free.

Many countries have well-developed health systems that are better ranked than the United States in terms of quality, so a local policy can be a great, affordable option.

The downside to this option is that it’s limited in terms of age. If you’re not in the system by a certain age, you can’t access it. In most of the Americas, for instance, the age cap is 60 to 65.

Hospital Policies

In some countries, you can pay a monthly fee at a local hospital or care network to cover whatever health needs may arise.

Fees are usually modest for this type of coverage, which provides access to a hospital and all its facilities. You go there for primary care, specialty care, and hospitalization. Different hospitals have different schemes for deductibles.

This option works well and is cost-effective if you’re spending most of your time in the same place and happy receiving all care within the same network.

If you travel often, this option isn’t going to work for you. Another downside is that if you get too expensive for the hospital, they can cut you off.

Make sure to review the contract and sign-up documents for whatever policy you take on overseas. The rules are different for foreign insurance (whether it’s health, auto, home, or another type of insurance).

Many countries lack an insurance commission to regulate the sale and marketing of policies. You can make one claim and have your policy cancelled, and that can be perfectly legal. It pays to check the fine print that you might have felt safe ignoring in the U.S.

Travel Policies

If you’re going overseas for a limited amount of time (anywhere from a week to a year), you can take out a travel health insurance policy before you leave to cover any medical needs that arise during your trip.

Travel policies are generally affordable, available for a couple dollars per day. The downside is that they do not cover pre-existing medical conditions.

No Policy

Health care overseas can be so inexpensive that opting for no health insurance policy and instead paying out of pocket for medical needs can be a reasonable option.

The idea is that you “self-insure,” putting whatever you would have paid for health insurance into a bank account and letting that money grow. This can develop into an extra nest egg for any health insurance or care that you need down the line.

Going naked is not for everybody, especially older folks with pre-existing or serious conditions.

Should You Keep Medicare?

The big question for Americans approaching age 65 who are interested in living overseas is whether to keep Medicare.

Medicare can act as “catastrophic coverage” for expats who live within striking distance of the United States. Then again, it comes with significant costs, since the U.S. has the most expensive health care in the world.

Part A comes with your Social Security, and there’s no premium associated with it, so there’s no reason to turn it down.

Part B comes out of your Social Security, and the Monthly Premium for 2024 is $174.70. You can opt in or out of Part B, but you’ll have to pay a penalty if you don’t sign up when you’re eligible.

My advice is to keep Medicare—Parts A, B, and maybe D (if you’re currently on prescription medication). You can always drop one of these at a later date if you decide that you’re comfortable receiving all of your medical care in your new country of residence.

You could also maintain Medicare and purchase a standalone medical evacuation plan in lieu of taking out an international, local, or hospital policy. This lets you self-insure but also gives you the added protection of being evacuated to the United States to the hospital of your choice.

Health Insurance Options Abroad: Other Considerations

Health care and insurance are complicated subjects. Everyone’s health outlook is different, and it’s impossible to predict what the state of their health will be down the line.

You need to consider them early in the process of relocating. You can unwittingly exclude yourself from an option by waiting too long and aging yourself out of it, or by assuming you can buy the policy in another territory.

There’s no one-size-fits-all plan. One or a combination of health insurance options may work best for you, depending on your situation. The best approach is to speak to an industry professional and get a bespoke overview of costs and accessibility.

Regardless of your age, you’ll be able to find an option that suits your needs and receive high-quality medical care overseas.

Until next time,

Kathleen Peddicord

Founding Publisher, Overseas Opportunity Letter

Editor’s note: A version of this article appears in Forbes.