For Americans living abroad, navigating health insurance options can be a complex challenge. At the 2025 US Expats Financial Conference, Joe Cronin, president of International Citizens Insurance, shared valuable insights in his expat health insurance presentation, discussing solutions for US expats.
Why International Health Insurance Matters
Many expats face a critical decision when moving abroad: whether to self-insure, purchase local insurance in their host country, or invest in international health coverage. While self-insurance might seem economical in countries with affordable healthcare, it carries significant risks if serious illness strikes or if you require treatment at facilities beyond your budget.
Local insurance plans, while typically less expensive than international options, come with notable limitations. These plans generally only provide coverage within the host country, restricting your ability to seek treatment in your home country or neighboring nations with potentially better medical facilities. Additionally, local plans often involve longer wait times and limited access to private hospitals.
Key Benefits of International Health Insurance
International health insurance plans offer several advantages that address these limitations:
- Comprehensive Worldwide Coverage: These plans provide benefits in any country, including your country of citizenship.
- Wider Provider Access: They offer access to a broader range of doctors and hospitals, both public and private, with shorter wait times.
- 24/7 Emergency Assistance: Support is available in your language to help find the best facilities for your care.
- Direct Payment Relationships: Insurance companies maintain relationships with providers for direct payment of medical costs, reducing out-of-pocket expenses.
- Customizable Coverage Options: Plans can include medical evacuation, vision, dental, and repatriation benefits that may not be available in local plans.
The primary drawback of international plans is cost—they are typically more expensive than local options. However, costs can be managed by selecting different coverage levels, higher deductibles, or excluding certain benefits.
What’s Typically Covered
Most international health insurance plans include or offer as optional benefits:
- Inpatient Care: Coverage for hospital stays of at least one night
- Outpatient Care: Coverage for doctor’s office visits, physical therapy, and other non-hospitalized care
- Medical Evacuation: Transportation from remote areas to qualified hospitals
- Repatriation: Return of you or your remains to your home country
- Health and Wellbeing Benefits: Coverage for routine exams, checkups, and sometimes mental health services
- Vision and Dental: Often available as add-ons
- Maternity Benefits: Coverage for pre and postnatal care, though typically excluded for the first year of the policy
Coverage Areas and Customization
When selecting a plan, you’ll need to choose an area of coverage. For US citizens moving to Europe, common options include worldwide coverage or worldwide excluding the United States. Since healthcare costs are higher in the US, excluding US coverage can significantly reduce premiums.
Some plans offer more specific coverage areas, such as Europe-only plans or coverage limited to your country of residence and citizenship. The right combination of benefits varies by individual circumstances and preferences.
Pre-existing Conditions
All international health plans require medical underwriting where applicants complete a questionnaire about their medical history. The treatment of pre-existing conditions varies by insurer, but typically results in one of four outcomes:
- Acceptance with full coverage for minor conditions
- Approval with exclusion of the specific condition
- Coverage with additional charges or limitations for the condition
- Denial of application for significant pre-existing conditions
Cost Considerations
Premium costs vary widely, from as low as $1,000 to over $30,000 per year, with the average policy costing around $5,500-$6,000 annually per person. Factors affecting costs include:
- Age (older applicants pay more)
- Number of people on the policy
- Coverage level selected
- Deductible amount
- Destination country
- Optional add-on benefits
Travel Insurance as an Alternative
Travel insurance may be a suitable alternative for some expats, particularly those:
- On tighter budgets
- Abroad for shorter periods
- Needing to meet visa requirements temporarily
- Planning to transition to local plans within 3-6 months
- Maintaining domestic health insurance and traveling back and forth regularly
However, travel plans typically provide limited benefits compared to international health plans. They generally only cover emergencies rather than routine care, exclude pre-existing conditions, offer limited coverage in your home country, and are renewable for shorter periods (1-3 years).
Visa Requirements
Many countries require expats to have private insurance as part of their visa applications. Insurance requirements vary by country and visa type, with some requiring unlimited coverage benefits or zero-deductible plans. Insurance companies can typically provide policy certificates or visa letters to document that appropriate coverage is in place.
Claims Process
When seeking medical care abroad, insurers recommend contacting their 24/7 assistance hotline as soon as you think you might need to see a doctor. They can help find appropriate care, including qualified doctors at facilities with direct payment relationships and practitioners who speak your language.
If you visit a provider without a direct payment arrangement, you may need to pay upfront and submit a claim for reimbursement. Claims can typically be submitted electronically with reimbursement within 5-30 days.
Finding the Right Plan
With numerous options available, expats benefit from consulting with specialized insurance brokers who can provide personalized guidance based on individual circumstances. Professional brokers offer expertise across multiple plans, insight into underwriting guidelines for pre-existing conditions, and ongoing support with renewals, payments, and claims resolution.
The most important consideration is ensuring you have some type of coverage—because everyone gets sick eventually, and being prepared provides invaluable peace of mind during your international adventure.