National health insurance in the Bahamas only dates from 2017. Healthcare has been an issue in the islands, with many residents having been bankrupted by high healthcare charges. Healthcare inequalities are considerable. The National Health Insurance Authority reports that the Bahamas is one of the least efficient nations in the world in terms of value-based care. Currently around 10% of the population, about 42,000 people, have signed up for the national health scheme, which is voluntary. A means of funding the scheme out of payroll taxes was proposed, but not enacted.

Non-communicable diseases (NCDs) such as cancer, high blood pressure and diabetes place a considerable strain on the healthcare system in addition to illnesses such as diphtheria. HIV remains a problem.

There are around 80 primary care providers in the islands and two private hospitals: the Doctors Hospital, which has a Medical Center division, and Lyford Cay. There has been increased spending on healthcare in recent years and the situation is starting to improve.

Expats report that the ambulance service is unreliable and you may have to arrange transport to the hospital yourself. The US Embassy in the Bahamas warns that trauma care is a particular problem. The Bahamas do not have local life flight helicopters and medical transport may be via boat, fixed-wing aircraft, or — if available — US Coast Guard craft. Traffic congestion in Nassau makes transport difficult, and on many islands ambulances have little or no advanced life support and stabilization equipment.

If you are living on one of the smaller islands such as the Exumas, you may need to think carefully about your options, including flying into Florida (Miami or Fort Lauderdale) for treatment. Make sure any insurance that you have covers treatment in the USA.

Prescription medication should be readily available although costs vary: some drugs are more expensive than in the States and some are cheaper. The Bahamas have a range of pharmacies, for instance in shopping centres, and expats report that they have had no difficulties in accessing their medication.

All legal residents of the Bahamas will be eligible. To obtain residency, you must come into one of the following categories:

• be the spouse of a Bahamian citizen for at least five years
• have a Bahamian mother
• demonstrate financial independence and home ownership in the Bahamas
• work for the Bahamian government for at least ten years
• be a religious or medical professional for at least 20 years
• work in the Bahamas for over 20 consecutive years

The NHIA is proposing a common open-enrolment period for all Bahamians and legal residents for both private insurance and NHI. They are aiming to simplify the risk equalization process, by creating a common 12 month period. You should still register in these programmes outside of the enrolment period if you have experienced a qualifying life event, such as starting a new job. The period is likely to begin on May 1st of every year and conclude 45 days later on June 15th.

You will not be excluded from NHI if you have a pre-existing health condition.

Registration is straightforward: you will need your NIB Smart Card. If you have your Smart Card, you can enroll in the programme online via the official website, and select a primary care provider from the list available.

In its initial phase of coverage, NHI is due to cover primary healthcare services. If eligible, you will not have to pay at the point of delivery for primary care: this includes no copays, deductibles or new tax when enrolled, either in the public or private sector.

As a retiree, you will be covered if you are a legal resident and you should not have to make contributions. This is under the current legislation, which is still in its infancy. Most expat retirees choose private insurance with a medical evacuation clause.

As an international student, you will need to arrange private coverage for your stay in the Bahamas. Contact your educational institution to see if they have in-house cover or can recommend an affiliated insurer.

Your family will be automatically covered if they are also legal residents.

No, it is not covered: you will need to take out private dental insurance or pay out of pocket.

Since the scheme is so recent, contribution rates have not yet become firmly established, but the National Health Authority was aiming to impose a 2% payroll contribution for companies with more than 100 employees from July 2020. For companies with fewer than 100 employees, it was proposed that they should make a contribution of $21 per employee per month to cover national health contributions, with no deductions from employee salaries. This is due to be rolled out properly in 2021, but if it affects you, keep an eye on developments: the NHIA has also suggested that the eligible wage deduction should eventually be lowered from 2.0% of income to 1.5% of income.

Retirees, children and unemployed people are eligible for NHI benefits, but will not have to make contributions.

If you already have a health insurance plan through group agreements and employment contracts, you will not lose your coverage, but should see your coverage strengthened and improved, for example with co-pays being abolished.

There are many issues with state healthcare in the Bahamas, and most expats opt for private health insurance as a result.

The private sector in the Bahamas is also being affected by the new legislation. The NHIA says that based on feedback from the private insurance industry, a national fee schedule will be established for all Standard Health Benefit services. Providers in both the public and private sectors will be contracted under this agreement at fair reimbursement rates for beneficiaries under both private insurance and NHI. If a provider does not register under this national fee schedule, they will not be eligible for reimbursement for the required basic Standard Health Benefit offering from approved insurers. By request of the insurance industry, a detailed care pathway has been provided to private insurers for provision of their own cost estimates.

If you do have private insurance and need hospital treatment in the Bahamas, then you may need to pay a deposit and might also need to pay your full costs upfront before seeking reimbursement. Emergency treatment can be expensive.

Many expats resident in the Bahamas choose policies which have a medical evacuation clause and which cover treatments in the USA.

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 cover the Bahamas, including:

• Cigna
• Expat Financial
• Foyer Global Health
• Generali Global Health
• Pacific Prime

Since the Bahamas is English speaking, you should experience no language difficulties.