Expat Health Insurance: The Checklist They Don't Give You at the Border
Last Verified: April 2026
Your employer's health plan does not travel with you. Your Medicare does not work in most countries. Your travel insurance is not health insurance — it is emergency coverage with a duration cap, and the difference matters when you are looking at a bill in a foreign country three months into a move you did not fully think through on the insurance side.
The good news: health coverage for expats is more available, more affordable, and more functional than most Americans expect. The gap between covered and not covered is mostly paperwork and a few decisions made at the right time. Here is the checklist.
What Your US Coverage Actually Does Abroad
Most Americans assume their health insurance works internationally in some limited way. It mostly does not. Employer-sponsored plans typically cover emergency treatment outside the US — sometimes reimburse at reduced rates — and exclude everything else. The definition of "emergency" in your policy is doing more work than you realize. It usually means immediate stabilization, not the follow-up, the specialist, the prescription, or the physical therapy you need six weeks later.
Medicare Parts A and B do not cover services outside the United States except in three narrow situations: Canadian transit between Alaska and the continental US, a ship within six hours of a US port, or a US territory. Medicare Advantage plans occasionally include some international coverage. Check yours specifically. Do not assume.
Travel insurance — the product you buy before a trip — covers medical emergencies, trip cancellation, and lost luggage. It was designed for two-week vacations. It has duration caps (90–180 days in most policies), a list of excluded conditions, and a ceiling on total payout. For a short trip it is adequate. For a relocation, it is the wrong product.
The Four Coverage Options
International health insurance — Cigna Global, Aetna International, AXA, and IMG Global are the main players — is the product designed for people who relocate permanently or semi-permanently. It follows you across borders, covers inpatient and outpatient care, and typically includes prescription coverage. You choose a deductible level to manage the monthly premium. Expect $100–300/month for a healthy adult under 45, depending on coverage level and whether US treatment is included in the plan.
Nomad-specific plans — SafetyWing and World Nomads are the most common — sit between travel insurance and full expat coverage. SafetyWing's Nomad Insurance runs around $56–60/month and covers emergencies, some outpatient care, and evacuation. It works well for most nomads under 40 with no significant pre-existing conditions. It has gaps that matter if you have ongoing medical needs.
Local private insurance is the underrated option for anyone staying in one country for six months or more. Colombia's prepagada plans, Uruguay's mutualistas, Mexico's private clinic networks, and Portugal's private insurance market all offer solid coverage at prices that make international plans look expensive. You often need local residency status to access these — which is another reason to get the visa.
The hybrid approach — a local plan as base coverage plus a travel insurance add-on when you leave that country — is what many long-term expats in lower-cost healthcare markets end up with. It is the most cost-effective structure once you know what you are doing.
What to Actually Read in Any Policy
Pre-existing conditions clause. This is where most surprises live. Some plans exclude pre-existing conditions entirely. Some exclude them for the first 12–24 months. Some cover them with a waiting period. Know which one you have before you need it.
Geographic exclusions. Many international plans offer a lower-premium option that excludes the United States — because US medical costs are the outlier. A hospital stay that runs $2,000 in Spain costs $30,000 in the US. If you plan to return home for extended periods, verify you are covered there or get a supplemental plan.
Emergency evacuation. If your plan does not include medical evacuation coverage, add it. An evacuation from Southeast Asia to a higher-level care facility runs $50,000–100,000. This is the number that changes people's financial lives when they did not have it.
Mental health coverage. Most international plans include it. Check the visit limits, the types of providers covered, and whether telehealth counts. This matters more during an extended international move than most people anticipate.
Prescription coverage. Not all plans include it, and formularies vary. If you take regular medication, verify the medication is covered — and separately verify it is available under the same name or a generic equivalent in the countries you are moving to.
The Medicare Trap
This section is for anyone at or near Medicare eligibility age. The trap works like this: you move abroad and drop Medicare Part B to stop paying the premium ($185/month in 2026). When you return to the US, you are subject to a 10% premium penalty for every 12-month period you were not enrolled. That penalty is permanent.
There are strategies around it — some people keep Part B active and simply do not use it abroad. Some add a medical tourism rider. Some use the IRMAA exemption process. The right answer depends on your health status, how long you plan to be abroad, and whether you intend to return permanently.
This is one of two or three situations in expat planning where "talk to a professional who specializes in this" is not a hedge — it is the actual recommendation. The penalty math compounds fast and the mistake is permanent.
When Local Plans Win
Six months in one country is the inflection point. Below six months, international plans are usually the right call. Above six months, check what the local private market offers.
In Colombia, a top-tier prepagada plan runs $80–150/month and covers specialists, surgery, inpatient, and outpatient care at quality private hospitals in Medellín and Bogotá. In Portugal, private health insurance for a healthy adult runs $60–120/month. In Mexico, private clinic care is accessible and affordable enough that some long-term expats carry international coverage only for catastrophic events — which is a risk-tolerance decision, not a recommendation, but it is what the numbers support.
The variable that changes this calculation: the complexity of your medical needs, pre-existing conditions, and whether a language barrier would prevent you from navigating a local healthcare system independently.
The Pre-Departure Checklist
Before you leave:
- Confirm what your current US plan covers internationally — then cancel or pause it correctly.
- Set your new coverage start date to the day before departure, not the day you arrive.
- Get a 90-day supply of any prescription medications you take regularly.
- Carry a printed and digital copy of your insurance card and policy number.
- Download your insurer's emergency contact number to your phone — not just the website.
- Know the name and address of the nearest reputable hospital in your first city.
- Understand how claims work in your plan — some require you to pay and submit for reimbursement; others have direct billing arrangements with providers.
Get covered before you land. The paperwork takes less time than you think it will. Going uninsured on day three in a foreign city because you meant to handle it before you left is not a situation you want to solve from inside it.
Table of Contents
TL;DR
- Your US employer plan and Medicare do not provide meaningful international coverage. Plan for that.
- International health insurance ($100–300/month) is the default for most expats. Nomad plans work for simpler situations.
- Read the pre-existing conditions clause before you sign anything. That is where the surprises are.
- Check whether your plan excludes the US for treatment — it matters when you fly home.
- Medical evacuation coverage is not optional. Add it if it is not included.
- At 6+ months in one country, price the local private market — it often wins on both cost and coverage.
- Start coverage the day before departure. Not after you land.
Summary
Expat health coverage is available, affordable, and far less complicated than the US system most Americans are leaving. The gap between covered and not covered is mostly a few decisions made at the right time. Get the right product for how long you are staying, read the pre-existing conditions clause, and start coverage before you land.
Sources
- Centers for Medicare & Medicaid Services — Medicare Coverage Outside the United States, 2026 — medicare.gov
- Centers for Medicare & Medicaid Services — Medicare Part B Late Enrollment Penalty, 2026 — medicare.gov
- SafetyWing — Nomad Insurance coverage details and pricing, 2025 — safetywing.com
- Cigna Global — International health insurance plans and coverage levels — cigna.com
- Numbeo — Health Care Index by Country, 2025 — numbeo.com
- International Citizens Group — Expat health insurance comparisons and country guides, 2025 — internationalinsurance.com
