If you are intending to work and reside in the Leeward islands of Antigua and Barbuda, you will need to consider the issue of your health insurance. The country, formerly a British colony, currently has a two tier system consisting of public and private health insurance, but is in the process of overhauling the public scheme.

Under the aegis of the Ministry of Health, it is transitioning via the National Strategic Plan for Health from the Medical Benefits Scheme to a National Health Insurance Program. Life expectancy was 75.2 years for men and 80.5 years for women in 2015 – high in comparison to some other nations – and the rate of infant mortality has significantly declined in recent years, a tribute to the quality of healthcare in the region.

In 2016, the Cabinet of Antigua and Barbuda approved the National Strategic Plan for Health 2016-2020. This is designed to improve public health, introduce new vaccination programs (such as HPV vaccinations) and increase awareness of issues such as nutrition.

In 2015, a national policy for the prevention and control of chronic noncommunicable diseases (NCDs) was also introduced, including activities for NCD prevention, aimed particularly at young people and focusing on obesity, diet, exercise, and the reduction of smoking and alcoholism.

Under the new scheme, maternal and reproductive health services will be offered free of charge at all community health clinics, and will also be available in the private sector. 100% of women will be covered, and all births will be attended by trained personnel in hospital.

Currently, the country has a social security scheme providing benefits to the insured when there is a loss or reduction of earnings due to sickness, pregnancy, disability, retirement, and death. The health system itself is mainly funded through public taxation (a payroll tax of 7%) and levies in support of the Medical Benefits Scheme, currently under transition into a national health insurance program.

As an expat in Antigua, you will be entitled to state healthcare if you have a residency permit (you will be eligible for this after four years of residency). Prior to this, you will either need to arrange private cover yourself, or have group insurance from your employer.

If you are between the ages of 16 – 69 and are unemployed for three months or more, you can register as a voluntary contributor.

Your employer should arrange cover for you, either with the state system if you are eligible, or in the form of private group insurance.

Otherwise, you can go to the health office (this is on Nevis Street in St John’s and is part of the former Medical Benefits Scheme) and register yourself if eligible.

If you are a national, you will need:

• valid passport or birth certificate and a valid government issued photo ID
• Social Security Card

If you are a non-national, you will need:

• valid passport
• Social Security Card

Registered members are required to make a minimum of six months’ contributions in order to be entitled to claim benefits from the scheme. Once the required amount of contributions has been made, you will be issued with a smartcard, to make claims and fill prescriptions.

Health services in Antigua and Barbuda are delivered at the primary, secondary, and tertiary levels in both the public and private sectors. For primary care, Antigua is divided into six medical districts with a network of 25 public health clinics, and there is one clinic in Barbuda. Around 98% of the population live in Antigua, hence the difference. Clinics are located within 3.2 km of the main urban centres. Primary care provides services such as:

• medical clinics
• maternity care and child health
• community mental health
• dental care
• screening for NCDs
• prevention and control of communicable diseases

Secondary and tertiary health services are provided at the Mount St. John’s Medical Centre, a 187-bed facility in Antigua, and an eight-bed facility in Barbuda. Mount St. John’s is in accordance with international medical standards, and has accreditation from the Caribbean Medical Council Association. It provides:

• casualty care
• maternity care
• radiology
• pharmacy
• pathology
• surgery
• intensive care
• a children’s ward
• a premature baby unit

In addition it runs health promotion and prevention programs for diabetes, hypertension and antenatal care. It has a blood bank, and provides medical treatment for dialysis, nephrology, oncology, reconstructive surgery, and physiotherapy and rehabilitation. Mount St. John’s is not free to non-nationals: if you need treatment here, you may need to pay depending on your residency status.

The national insurance scheme covers 11 diseases:

• asthma
• cancer
• cardiovascular diseases
• certified lunacy
• diabetes
• epilepsy
• glaucoma
• hypertension
• leprosy
• Parkinson’s
• sickle cell anaemia

If you are visiting the islands, hotels often have GPs attached; if you are a resident, you should not have any difficulty in finding a local primary care provider. Overall the quality of healthcare is good, although you may find that equipment is more basic than you would find back home, and some more serious conditions may not be treatable on the islands. For this reason, you may want to consider a private policy with a medical evacuation clause.

There are a number of pharmacies, including at least one that is open 24 hours a day.

Healthcare on the islands is expensive if you are paying out of pocket, so it is advisable to arrange some form of coverage, whether public or private.

You will be covered if you have residency, but it is advisable to take out comprehensive private coverage rather than relying on the public healthcare system here.

As an international student, you should take out private health insurance: if you have to undergo hospital treatment, you will have to pay upfront and this can be expensive. Contact your educational institution to see if they have in-house cover or can recommend an insurer.

No, your dependents will not be covered by your insurance, but they can apply to the national scheme to register independently.

Basic dental treatment is covered under the public scheme, but for more advanced care such as crowns or implants, you may wish to take out private cover.

Contributions to the scheme are made directly from payroll and require a mandatory 4% salary deduction from everyone who is employed, matched by a 5% contribution from their employers.

Approximately 15,000 Antiguan residents currently have private health insurance, mainly group insurance provided through their employers. Facilities are good, but not always up to the standard of American hospitals, for example, and some illnesses may not be treatable under the Antiguan system. Thus many expats opt for private health insurance with a medical evacuation clause and choose to be treated in Miami or the Cayman Islands.

The private sector in Antigua is not extensive but will cover a full range of primary and secondary care, plus elective cosmetic and dental surgery. The Adelin Medical Center on Fort Road, St. John’s, is the only private hospital on the islands and offers:

• general medicine
• ENT
• ophthalmology
• obstetrics
• gynaecology
• paediatrics
• endoscopic surgery
• orthopaedics
• dentistry
• x-rays
• physiotherapy

Currently, Antigua is not a destination for medical tourism, however a new hospital in Coolidge was approved in 2019, which is designed to offer treatments to overseas patients, mainly in cosmetic surgery.

Most medical personnel are English-speaking, due to the British links of the islands.

This will depend on factors such as your age and any pre-existing conditions, and the kind of package you opt for (obviously, a more expensive insurance package will give you more a extensive range of treatment and facilities). As so many variables have an effect on the cost of international private medical insurance it becomes very difficult to give accurate estimates without knowing the full details of the coverage required.

However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.

The main international providers offer private health insurance, including:

• Allianz
• Cigna
• Expat Financial
• Foyer Global Health

Since Antigua and Barbuda have historical links with Britain, you should experience no linguistic difficulties if you speak English.