Thailand: Private Health Insurance for All Expats
Recent reports suggest that Thailand may soon insist on expats taking out full private health insurance, in order to reduce reliance on the national healthcare system and unpaid medical bills, which are the main driver of this initiative. Hospitals, especially those in border regions, are having to absorb the costs of treating foreigners who are then unable to pay their medical fees.
Public Health Minister Pattana Promphat told Nation Thailand:
“The goal is to ensure meaningful coverage while keeping premiums reasonable so as not to discourage travel.”
The country is also seeking to establish itself as an international healthcare hub, with an emphasis on medical equipment, drug security and future health technologies.
Changing Demographics Among Digital Nomads
Health insurance professionals are noting changes in the demographics of digital nomads. Rather than the 20-something backpacker, today’s digital nomad may be a 50+ early retiree or empty nester, and they are more likely to be relocating for economic reasons to a cheaper location. They are also more likely to be aware of health issues, and therefore the need for more extensive insurance coverage, than their younger counterparts.
In particular, brokers need to look at the so-called ‘grey area’ between travel and residence, as this can trip up policyholders. This especially applies to American expats, who are likely to have insurance coverage in the US. There can be tax penalties in some states for policyholders who let their coverage drop without a viable exemption. California, Massachusetts and New Jersey, for instance, all require the maintenance of MEC (Minimum Essential Coverage), and in some cases, those tax penalties can be quite steep. In California, for 2025/26, the penalty stands at $950 per adult and $475 per child, or 2.5% of gross income over the filing threshold.
If you’re an American expat who has moved for cost-of-living reasons, the last thing you need is a penalty of nearly $1K or more. So if you think this might be an issue, consult a tax adviser in your home state when you are navigating your health insurance, as you could fall prey to the so-called ‘coverage gap’, in which you are underinsured in your host nation but overinsured back home.
Some brokers may suggest that you retain your home coverage (if, for instance, you’re a US citizen living in Costa Rica or Mexico) but take out emergency and/or evacuation cover, although this depends on where you are. Insurance experts warn of ambiguities in both policies and status. For instance, policyholders might seek medical help at a local hospital but be unaware that costs are often higher for foreigners, and that their own policy provider might not necessarily have a direct-billing agreement with a private clinic.
Moreover, experts warn that the policy shift from emergency care (appropriate when younger) to long-term chronic conditions is taking some time to develop, so be aware of any exclusions, such as issues with hypertension that might not be covered by your current policy. Telehealth apps are proving useful, and care is usually good, but the gridlock comes with claims and payments, so it pays to go through your health insurance options carefully with your broker, both at home and abroad.
Hantavirus Latest
Hantavirus has featured prominently in the news recently as a result of an outbreak on a cruise ship. The CDC notes that:
- hantaviruses are a family of viruses that can cause serious illness and death
- these viruses cause diseases such as hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS); symptoms are initially similar to flu
- they are spread mainly by rodents
- the Andes virus is the only type of hantavirus that is known to spread from person to person; this spread is usually limited to people who have close contact with the ill person.
Although this sounds alarming, health experts have been reassuring the general public that this is not another Covid scenario: hantavirus is well understood and there is relatively little risk. You would, they say, need to sit next to an infected person for several hours on a flight to be at risk of contracting the illness, and even then that risk is slim.
However, this is still a serious illness. At the time of writing, three passengers have died from the Andean form of hantavirus and four have been medically evacuated from the MV Hondius, which had been visiting remote wildlife areas. Tracing is underway in the UK, but authorities stress that we are not facing another pandemic.
‘Thousands’ of Doctors ‘Unable’ to Work in Spain
Spain is currently facing a workforce crisis due to the restrictions placed on the number of doctors who can enter the Spanish medical system. MIR (Médico Interno Residente) is Spain’s national ranking exam for specialist training. According to the rules, higher-ranked candidates choose specialties and hospitals first, and only those who secure a residency place can formally enter most specialist careers.
The MIR system limits the number of places to 9,000 people, but this year, 15,000 students sat the exam. Thus, despite union criticism, there are now thousands of newly qualified doctors unable to enter the medical profession at a time when Spain is facing a healthcare crisis. Ironically, Spain is now under increasing pressure from an ageing demographic that includes expats and tourists, but is systemically unable to allow a higher number of doctors to progress.
Critics say that universities expanded medical student numbers faster than residency capacity, governments underplanned training places, hospitals lack funding or supervision capacity for more residents, and bureaucracy and budget constraints artificially limit entry into the workforce. Patients are warned of longer waiting times and difficulty in obtaining GP appointments. Although these medical students are now qualified, the bottleneck means that they are not able to undertake specialist training. Some can still take up short-term contracts as ordinary doctors in clinics, but the concern in Spain is that many will go abroad, where both the money and the career progression are more attractive and effective.