2026 Annual Global Retirement Index
International Living’s most recent Annual Global Retirement Index was published in December 2025, taking a deep dive into the best places for expat retirement in terms of healthcare. Top of the list this year is Greece. Expats who are resident there describe healthcare in Greece as affordable and relatively inexpensive. Second on the list comes Panama, noted for high-quality hospitals and English-speaking medical staff. Third is Costa Rica, which expats report has good-quality medical care that is substantially cheaper than its equivalents in the USA.
Spain: Doctors’ Strike to Start
Spanish doctors have already been undertaking strike action due to ongoing disputes over the Estatuto Marco (the Framework Statute for healthcare professionals), and industrial action will continue because of a perceived lack of progress in negotiations with the Health Ministry over working conditions, including staff shortages, and the statute itself.
Doctors confirmed a two-day nationwide strike scheduled for January 14 and 15, while a separate indefinite strike has been announced by some health unions (including those representing doctors) to begin on January 27 and continue every Tuesday “while necessary.”
Strikes will take place across Spain, with particular focus on Catalonia, Madrid, the Basque Country, and Galicia. Expect disruption to primary care services if you are resident in Spain (emergency care should be unaffected), and be aware that non-urgent operations and routine procedures may be cancelled or postponed.
US: Americans Increasingly Looking Abroad for Health Care
A recent West Health–Gallup poll suggests that around half of Americans surveyed have serious concerns about the cost of their healthcare. US nationals are increasingly looking abroad for healthcare, or even relocating entirely.
American medical costs have always been steep, but recent projections by policy researchers suggest that without extended enhanced premium tax credits, an estimated 4.8 million more people could become uninsured in 2026. Some projections indicate that increases to premium costs and regulatory changes could cause an estimated 80,000 people to drop marketplace coverage. Americans have been abandoning ACA plans because premiums and deductibles have spiked sharply for 2026, and sticker shock is also a factor driving Americans to look further afield to address their healthcare needs.
International Living recently suggested 5 countries where expats can get world-class healthcare without US-level costs:
- France
- Portugal
- Spain
- Panama
- Costa Rica
In France, third-country nationals are able to access French national healthcare after three months of residency. French state healthcare is of a high standard, and apps and websites such as Doctolib allow patients to access English-speaking medical personnel. The state will typically cover up to 80% of medical fees, making costs much cheaper than in the USA.
In Portugal, there is a similar story, and expats say that doctors take their concerns particularly seriously, resulting in high-trust relationships between doctors and patients.
Spain has low-cost, highly effective private healthcare, which can run as low as $75 per month without co-pays, yet covers a wide range of treatments. As with France, English-speaking medical personnel are widespread, particularly in high-density English-speaking expat areas such as the Costa del Sol.
Panama’s health system has modern hospitals at a fraction of the price of the nearby USA, while Costa Rica provides coverage for a monthly income-dependent fee: there, medical costs run at about one-third of prices in the USA. In addition, medication tends to cost less.
Thus, both close to home and further afield, Americans have considerable choice when it comes to medical tourism and reducing their steep healthcare fees.
Superflu to Hit the Netherlands
The so-called superflu that has been causing problems in the UK is due to reach the Netherlands in the next few weeks, Dutch health authorities warn. Nearly 3,000 people were hospitalised every day with severe symptoms of flu in Britain in early December, with flu expert Ted van Essen telling the press:
“In recent years, the only time we haven’t had a flu epidemic was during the coronavirus pandemic, because of all the measures in place. But you can bet there will be another epidemic this winter.”
He warns that people seem to be more susceptible to this strain of the flu, which brings the usual miserable symptoms, normally cured by a few days in bed, but which can cause serious respiratory difficulties in the vulnerable and can lead to pneumonia. Elderly people are often offered a pneumonia vaccine on the NHS in the UK, and in the Netherlands both the pneumococcal vaccination and the flu vaccine are available as well. If you are an expat in the Netherlands, it may be worth considering getting the vaccination.
Germany Health Insurance Rates to Rise
In Germany, health insurance contribution rates (Zusatzbeitrag) are likely to rise in 2026, on average from 2.5% to 2.9%. The country’s biggest provider, Techniker Krankenkasse, is raising its rate from 2.45% to 2.69%, and other insurers are following suit. Remember that if this is likely to affect you and your premiums will be rising, you can switch insurers before 31 January 2026.
Jordan Relaxes Regulations for Medical Tourists
Jordan is increasing temporary residency permits from one to three months in an aim to boost tourism overall, but also to extend the length of stay for people embarking on medical tourism in the kingdom. If you are not travelling on a work visa, you will automatically be granted a three-month stay. The authorities believe that extending the length of stay will make Jordan more appealing to medical tourists and increase spending.
Meanwhile, Uzbekistan is increasingly entering the world medical tourism market, with 80,000 foreigners seeking medical treatment in the Central Asian country in 2025. Most came from other Central Asian countries, but a small number were visitors from the USA.