At the 2026 US Expats Financial Conference, Joe Cronin, President of International Citizens Insurance, walks through insurance solutions for international citizens and US expats in 2026. International Citizens Insurance is a leading brokerage established in 2004, with offices in Boston and Tampa, offering clients access to a wide range of international health and travel insurance plans, from short-term travel cover to long-term comprehensive global policies for individuals, families, groups, and students living outside their home country.
The following transcript was generated by AI and may contain inaccuracies.
Hugo: Hello and welcome to day one of the 2026 US Expats Financial Conference, sponsored by Expat Focus, Wise, Global Citizen Solutions, and Advanced AI Services. We have a fantastic schedule for you consisting of 17 sessions over four days, covering multiple aspects of financial information for Americans living abroad, with perspectives from some of the world’s leading experts in their fields.
Today is the first day of the conference, and this is our third session of the day. I’m delighted to be joined by Joe Cronin, who’ll be discussing insurance solutions for international citizens and US expats in 2026. Joe is an innovative leader in international financial services, health insurance, expatriate services, and digital marketing.
He’s responsible for all aspects of International Citizens Insurance, with a focus on operations. InternationalInsurance.com is a subsidiary of International Citizens Group, Inc., a global services firm dedicated to building a community to support global citizens and promote international travel. Joe has lived in Australia previously and visited over 25 countries on every continent except Antarctica.
This information is for general educational purposes only, and you should always seek your own personalised financial advice. Joe will be answering your questions after the presentation, so please add them in the Q&A popup at the foot of your screen throughout. We’ll try to answer them all at the end, time permitting. So without further ado, over to you, Joe.
Joe: Thank you, Hugo. Welcome everyone, and thank you for joining us today. My name is Joe Cronin and I’m President of International Citizens Insurance, a leading brokerage offering clients access to a variety of international insurance plans, with offices in Boston and Tampa, Florida.
Over the next 20 minutes or so, I’ll introduce our company, the services and the plans that we offer, and try to address some of the common questions regarding international health insurance. At the end, we’ll have time for questions and a more general discussion.
I’ll start with a brief introduction to our company. International Citizens Insurance was established in 2004 and is now one of the largest expat health insurance brokerages in the world. We offer a wide range of products to fit different coverage and budget needs, including short-term travel insurance as well as long-term comprehensive plans.
Our clients are individuals, families, groups, students, or anyone who lives outside of their home country. Today our focus is on individual international health plans, but we’re happy to talk about a variety of other options as well. As brokers, our team of licensed insurance agents provide personalised advisory services to our clients via phone, email, or text to help them find the right plan.
We are a dedicated resource for our clients from the initial research phases through choosing and purchasing a plan. We remain available to assist you for the full policy period and can help with claims, plan questions, renewals, or anything else life throws at you — not everything, but regarding your insurance.
Now let’s move on to some of the common questions we get from our clients. Do I need an international health insurance plan? This is the most frequent and very important question. Not having the right insurance is a gamble on yourself to stay healthy. Some people self-insure hoping that nothing major will happen. For others, the desire to protect yourself and your family against unknown risk, and the peace of mind that comes with it, makes buying insurance the best choice.
Many clients feel the cost of healthcare in their host country is low enough that they can self-insure and cover all expenses out of their own pocket. Others choose to buy the local plan offered by their host country. Finally, those seeking something more affordable often purchase a low-cost travel insurance plan.
All are reasonable options and will potentially save you money in the short term. But for those who self-insure, there are risks: you may have a severe illness and the costs are more than expected, or you want treatment in a facility that you can’t afford. If you’re considering self-insuring, we usually recommend a plan with emergency-only inpatient care, also known as a catastrophic plan. These plans won’t cover most expenses, but provide benefits when you’re admitted to a hospital for a major illness.
For others considering buying a local insurance plan, you need to check the requirements and the eligibility for those plans. Some include being a full-time resident of that country and/or having to pay taxes to qualify — not everyone is eligible. More importantly, local plans come with limitations. For example, they only cover you in your host country. You can’t seek treatment at home or in another country where they may have better doctors or hospitals. A more common complaint is that local plans have long wait times, especially for non-emergent situations. For those considering travel insurance as an alternative, we’ll discuss some of the pros and cons of travel plans in a few minutes.
So then, what are the primary advantages to buying an international health insurance plan? First and foremost, the plans provide comprehensive worldwide benefits in any country, including your country of citizenship. They provide access to a wider range of doctors and hospitals, public and private, with less wait time. They offer 24/7 emergency medical assistance in your language to help you find the best facilities for your care, or facilities that the insurance company can pay directly. Finally, they provide more comprehensive health benefits, with some plans including medical evacuation, vision, dental, and repatriation that may not be available in a local or travel plan.
Additionally, there’s the issue of renewability, and we’ll cover that a little when we talk about how comprehensive health plans compare to short-term travel insurance plans. Of course, one consideration with international health insurance is cost. They’re more expensive than the travel plans and often more expensive than the local plans. The price of these plans can be managed though, by choosing different levels of coverage, selecting higher deductibles, or not including optional benefits such as vision and dental.
What is covered with these international health insurance plans? There are six major benefits most insurers include, as well as optional ones. Inpatient care is simply defined as any time you get admitted to a hospital for an extended period of time, typically for at least one night. Outpatient care is for treatment outside of the hospital, typically in a doctor’s office, for things like physical therapy, a rolled ankle needing an X-ray, or cutting a finger and needing some stitches. The medical evacuation benefit will get you to a hospital, or from one hospital to another. Repatriation is returning you to your home country.
Health and wellbeing coverage is included for routine exams, checkups, or tests. It can include other benefits such as mental health services, vision and dental benefits — typically an optional add-on — which would provide for routine or preventative care, exams, glasses, contacts, or dental cleanings. Finally, maternity benefits cover pre- and postnatal care along with delivery. Maternity benefits are typically excluded in the first year of coverage, so if you’re considering having a baby, you’d want to purchase a plan at least a year in advance.
In general, the plans come with core or basic coverage packages and allow you to pick and choose optional add-ons. We recommend that you study the plan and table of benefits to understand what comes with your core coverage, along with coverage limits and which benefits are optional when selecting your plan. Take your time, research the plans, and use all the resources available to you, including our advisors. There’s no additional cost to work with us or to talk with our agents, and they can give you the pros and cons of a particular plan or compare a variety of plans to each other.
All the plans will ask you to choose an area of coverage for your policy — specifically, where you want to be able to get treated. Typically, your choices will either be worldwide, or worldwide excluding the US. As healthcare costs are higher in the US, you can save money by choosing to exclude the US from your coverage, but you would forego the benefits of getting care in the United States. We also have some specialty plans that provide coverage for Europe only, or in select countries.
In terms of what combination of benefits is right for you, every person and every situation is unique. For some, just having inpatient coverage is fine, as outpatient care and health checkups in your host country are very affordable. In other countries where healthcare costs are higher, you might want a more comprehensive plan. We think this is where our agents can make the most difference with our clients. Picking the right combination of benefits at the time you purchase means you’ll have the right plan in place when you need it the most.
Just as important, you also need to be aware of what is not covered. Every insurance plan has a list of exclusions — benefits or treatments that are not covered under the policy. This list will be provided to you at the time you purchase your policy. You can ask for a copy of the policy certificate in advance and review all exclusions prior to purchase. Examples of typical exclusions might be injuries sustained while committing an unlawful act, birth control drugs, or treatment for undisclosed pre-existing conditions.
In regards to pre-existing conditions, they’re treated differently by all insurers regardless of the plan. All clients go through a process of medical underwriting at the time of the application, where each applicant completes a questionnaire regarding their medical history. If you have no major pre-existing conditions, your application can be approved without further review. Applicants with a medical history may have to provide additional information, such as a recent physical exam, in order to get approval.
Depending on the information provided and the severity of any pre-existing conditions, the underwriters will do one of four things. If it’s minor, they’ll accept the application and cover the condition as any other illness. They may approve your application but exclude benefits relating to that condition. They may cover the condition with a rate-up — a price increase, an additional charge for that specific coverage — and/or put in place additional limits on claims related to that pre-existing condition. Or finally, depending on the condition, they can deny your application.
We encourage everyone to read the policy certificate and any exclusionary riders. All plans can be cancelled within a free-look period of typically 10 to 14 days, with a full refund of premium.
Speaking of premium — budget. What does this all cost? Budget concerns are obviously an important factor in designing a plan for your specific situation. You need to be able to afford the plan as part of your overall budget. The good thing for US citizens is that global plans are typically less expensive than a US health insurance plan. Part of the reason for this is the medical underwriting that happens during the application — typically, healthier people are more likely to be approved.
Some things to consider: the average policy cost that we sell to our clients is right now about $6,500 per year per person. The least expensive plan might cost $1,200 per year, and we’ve sold plans for $20,000 or $30,000 a year. Cost is dependent on a variety of factors, including your age, the number of people on your policy, the level of coverage you choose, and your deductible. Sometimes the country where you’re moving to will have an impact on your pricing as well.
You typically have the option to choose different plan levels. For example, some insurers offer Bronze, Silver, Gold, and Platinum levels, while other plan levels might be Basic or Premier. Bronze-level plans will have fewer benefits or lower limits on the benefits provided, while Platinum-level plans will have the most benefits with the fewest limits. Silver and Gold-level plans will fall in between in both benefits and costs. You can also choose to include or exclude optional add-on benefits.
So with that cost relative to some of the travel insurance you may have found or researched online — is travel insurance a good alternative? It is, for some people. For people in certain circumstances, it’s a good option. The primary benefit of these plans is coverage for emergency medical situations. You’re covered should you get sick or injured, up to a preset limit chosen at the time of purchase. Additional travel insurance benefits, like coverage for lost luggage, are included.
They work well for someone who is on a tighter budget, is travelling for the shorter term, or needs a plan to meet a visa requirement in a country they’re moving to before they get on a local plan. You might need travel insurance if you’re keeping a domestic US health insurance plan and travelling back and forth from your host country on a regular basis, if you’re younger and/or more cost-conscious, or if you’re planning on getting a local plan in the next three to six months.
The downside of the travel insurance plans is that they provide little or no benefits for outpatient care, health and wellness checkups, or vision and dental. Typically, pre-existing conditions are excluded from travel insurance plans. Coverage in your home country of citizenship is limited if you decide to travel home during that period of coverage.
And then there’s the renewability difference. A global health plan is typically renewable every year that you want to remain on the plan, whereas travel insurance plans can typically be extended for one, two, maybe even up to three years. However, at the end of that period of coverage, if you purchase insurance again, any illness or pre-existing condition that happened while you were on the initial policy term will not be covered when you purchase a new plan, as it will be considered a pre-existing condition. With international health plans, if you purchase one and you get sick, get treated, and get better, they will continue to cover you if that illness recurs later.
There’s definitely a place for good travel insurance plans, and we offer many. As with most decisions, there are pros and cons to each. We do feel strongly that you should have some type of coverage, should you get sick — and we all get sick. Regardless of the plan type you choose, you’re going to need help to get treated when you’re in a foreign country. Your insurer can provide that help.
All insurers provide 24/7 medical assistance hotlines. The number is on your insurance card and you should call it as soon as possible. Let them know that you’re seeking care, and they can provide a few different benefits with that. They’re there to help you through the process and find the best care, including qualified doctors at facilities they have a relationship with so they can pay the provider directly. They can also find doctors who speak English or are close by.
If you go to a provider that does not have a direct-pay relationship with the insurer, you would typically pay the bill and submit a claim to the insurance company to be reimbursed for any eligible charges. Claims can be submitted electronically, and you’ll typically be reimbursed within five to 30 days after your completed claim is received. Make sure you save all your documents so that you have everything you need when filing that claim. The insurance companies do want you to get quality care as soon as possible — it costs them more if you have a lingering issue and don’t get it treated early. Use the resources as often as possible to get the most out of your plan.
The last time I did this presentation, people were asking about international life insurance. That’s not the focus of this conversation, but we do offer international life insurance plans. One consideration is that for US citizens, if they have a life insurance plan, it may not cover them if they die while overseas or living in a foreign country. So you just need to check the coverage that you have on a life insurance plan and then decide if an international life insurance plan is the right fit for you.
So that’s a quick overview. I hope it was helpful. Thank you all for joining us — I’m sure it was a lot of information. I would much rather have a conversation with everybody than be up here talking the whole time, and our team is available to provide more specific guidance and assistance any time. Really, no two clients are alike. Hugo and I were talking earlier about the really diverse nature of the people who are moving abroad. We work with people who move to Europe, to South America, to Asia, to Canada — everybody’s different, and it makes our job really interesting. Thank you, and I’m happy to answer any questions.
Hugo: Thanks very much, Joe — excellent presentation. So for our audience, please do drop any question you have about international health insurance, life insurance, or any of the points Joe’s just been talking about in the Q&A window near the foot of your screen.
So we have one question so far: as a federal retiree, I have a health insurance policy with worldwide coverage, but for travel abroad I need a medical evacuation policy. Is it possible to get just that?
Joe: You can. There are medical evacuation policies you can get. Typically you would buy it not for an individual trip, but for a year, and then it would provide those evacuation services. We work with Medjet as one example of an evacuation plan.
The reality is, if you’re going on a single trip for two weeks from the US to Europe, you can buy a travel medical policy that includes emergency medical evacuation, but it also includes a variety of other travel insurance benefits such as repatriation cover, trip interruption cover, and lost luggage cover. It’s really not that expensive, so you might want to consider buying a travel medical policy as opposed to just a one-off evacuation policy.
The travel insurance companies are really experts in dealing with medical crises abroad. I’m not sure who provides the worldwide coverage for the federal retiree plan, but they may not have the expertise or the network of hospitals and doctors globally that a travel insurance plan might have.
Hugo: Following on from that, with a federal plan, if you move abroad, is that going to affect the conditions of the plan, do you think, even if it’s worldwide? I was wondering whether a federal plan with worldwide coverage is intended for trips abroad rather than living abroad. Do you think it still covers the ability to move abroad or retire abroad, for example?
Joe: Yeah. Typically those plans would provide limited emergency medical coverage for a period of time up to a preset maximum. So you might have $50,000 in benefits for a period of up to 30 or 45 days abroad. If you’re going for three months, or if you want more coverage than what’s offered in the federal plan, then again, you might consider a travel medical plan.
Hugo: Another question: how are RXs covered? Also, are the medications typically the same brand internationally as in the US, or do they fall under generic coverage? I take a regular monthly RX and I want to make sure I’m covered when I move.
Joe: Right. Your medical history would be reviewed at the time of the application, and they would either cover it as any other condition — so not a problem, you’d get coverage for your medications — or coverage for that could be excluded, or it could be included with a rate-up. Each situation is different. The insurance companies would review your medical history and make a determination of what level of benefits would be covered for that pre-existing condition where medications are required.
Internationally, the medications are different in every country and handled differently in every country. There probably would be a lot of generic options, or they would be called something different. You probably want to research what those medications would be in the country you’re considering moving to.
Hugo: Next, somebody asks: I’m interested if you sell policies for those who live elsewhere — Spain, for example — and need to return to the US for a short period of time, such as two to three weeks. I guess they’re asking whether you’re covered both when travelling back to the US and when living abroad.
Joe: Right. These plans are global. We sell plans to US citizens who are moving to Spain, and they want to have full comprehensive coverage in Spain, back in the United States, and worldwide. There are people who live in Spain for three months, in Canada for three months, and in the US for six months — we sell policies that will cover all of that.
We also have policies, if you want to save some money, where you can exclude coverage from the US and receive just limited coverage back in the US for emergency medical situations. Or you could buy a travel insurance plan just for your period when you travel back to the US for a few weeks.
Hugo: Next question: is it possible for an American with Medicare Part A who is resident in the UK to obtain Blue Cross Blue Shield as complementary coverage for any medical expenses in the US only?
Joe: I’m assuming they want to buy a domestic Blue Cross Blue Shield plan?
Hugo: I guess so, if it’s for expenses in the US only. Yeah.
Joe: So generally, the domestic US plans are not a core focus for us. If they’re on Medicare, they would have coverage in the US. If they wanted additional benefits, I assume they would buy supplemental coverage to the medical plan domestically.
Hugo: That makes sense.
Joe: Sorry, before you go on — someone in this situation may purchase… we sell the Blue Cross Blue Shield global plans. They could buy that plan and have worldwide coverage with that. They’d have coverage in the UK, worldwide, as well as in the US. In that case, they’d be covered internationally and domestically.
Hugo: Thanks. Next question: are Medigap policies useful for the first 60 days of travel abroad?
Joe: Clients need to review the coverage they’re getting with any Medicare or Medigap plans. Some of them are providing international coverage, but you need to also look at whether it’s sufficient. Will it cover up to 60 days of travel? Sometimes it’s 45 days. And does it provide enough coverage? Off the top of my head — I’m not an expert on Medicare or Medigap policies — but there’s a maximum limit on what the Medicare policies provide while you’re travelling abroad.
Hugo: And can US Medicare be placed on hold during a six-month residence abroad?
Joe: Hmm, I don’t think so. Again, not my area of expertise — I had to take some Medicare classes to get my insurance license. If I had to guess, I would say probably not, but I don’t know one hundred percent.
Hugo: Are we talking about Medicare contributions?
Joe: I assume that’s what they would want — to stop having to pay them while they’re doing that. I’m pretty sure you can do it, there just may be penalties to restart.
Hugo: I think certain Social Security taxes, if you’re with a US employer, don’t stop, or if you’re self-employed. I’m not sure if Medicare is part of that — that wouldn’t stop because they apply to US citizens rather than residents. We’ve got experts on some other sessions over the course of the conference, so that may be a question relating to Social Security taxes. I think it’s effectively a tax, the Medicare contributions, so maybe a question for one of the tax guys.
Does anybody else have any more questions for Joe on insurance for expats? One of the things, of course, is that a lot of visas for living in other countries require some kind of insurance. Is that one of the scenarios where expats or people planning to move abroad often contact you — relating to the visa requirements?
Joe: Yes. We work with clients moving to over a hundred different countries, and every country is different. Within any given country, the type of visa you might apply for — whether it be a golden visa, a work visa, or a digital nomad visa — they very possibly will have different requirements for participating in or purchasing international coverage before that visa is issued.
You need to do the research to understand what those visa requirements are, and then bring those visa requirements to one of our advisors. They’re not visa experts, but if you tell them what needs to be included as insurance so that you can get your visa, they can find that solution for you.
Hugo: Yeah, I think it’s something a lot of expats need for that reason. A lot of Americans moving abroad need it because I know a lot of European countries require it when you arrive, and for a period of time before you can access local systems. Of course, the advantage of international insurance is the evacuation and emergencies cover.
Joe: Yeah.
Hugo: It looks like there aren’t any more questions — oh, here’s another. I’m planning on moving to France. Do you sell policies that are short-term, or could be cancelled once I transfer to national healthcare?
Joe: Short answer is yes. We have both comprehensive plans and short-term travel medical plans. You could purchase a travel plan for just six or nine months, or we have some comprehensive global medical plans that can be cancelled in six to nine months as well.
Hugo: Well, thank you very much. Not too many questions today, but it is a topic that affects a lot of people moving abroad. Thank you very much, Joe, and thank you to our audience. If you’d like more information, you can contact Joe via the website, which is internationalinsurance.com.
Otherwise, we have two more sessions today, which are expert panel sessions for fielding questions for Americans moving to or living in either Costa Rica or Spain. So if you haven’t already, you can register for those. We have three more days of sessions, and we hope to see you again very soon.
Joe: One final thing — if people do want to reach me directly, my direct email is [email protected]. So feel free to reach out, and thank you all for your time.