The Best Health Insurance Options for American Expats (2026)

One of the first questions Americans ask when planning a move abroad is "What do I do about health insurance?" The short answer: your US plan almost certainly won't cover you overseas, and even if it did, you'd be paying US prices for coverage you can't use. You need a new plan.

The good news? Health insurance abroad is almost always cheaper and often better than what you're used to in the US. Here's a complete breakdown of your options.

Why US Insurance Doesn't Work Abroad

Most US health insurance plans — including marketplace (ACA) plans, employer plans, and even many PPOs — limit coverage to the United States. Some PPO plans offer limited emergency coverage abroad, but it's typically restricted to true emergencies, carries high out-of-pocket costs, and won't cover routine care, prescriptions, or planned procedures.

Additionally, if you're claiming the FEIE and living outside the US full-time, maintaining a US health insurance plan can actually create complications with your tax status. You're better off with coverage designed for where you actually live.

The Three Types of Expat Health Coverage

1. Local Public Healthcare

Many countries offer public healthcare to legal residents, either free or at very low cost:

• Portugal (SNS): Free for residents. Good quality in cities, longer wait times for specialists.
• Spain (SNS): Free for residents. Excellent quality overall.
• Mexico (IMSS): Available for ~$400/year. Adequate for basic care; most expats supplement with private insurance.
• UK (NHS): Free for residents. Long wait times but no cost at point of care.
• Thailand: Public hospitals are cheap but crowded. Most expats use private care instead.

Public healthcare is a great baseline, but many expats add private coverage for faster access and broader choice of providers.

2. Local Private Insurance

Buying private health insurance in your country of residence is often surprisingly affordable:

• Mexico: GNP Seguros, AXA Mexico, or Seguros Monterrey — $50-$200/month for comprehensive coverage including private hospitals.
• Portugal: Multicare or Medis — $50-$150/month for private hospital access and specialist visits.
• Thailand: AIA, Bupa Thailand, or Pacific Cross — $80-$250/month depending on age and coverage level.
• Colombia: Sura or Colsanitas — $40-$120/month for full private coverage.

Local plans are the cheapest option for comprehensive coverage but only work in one country. If you travel frequently or might relocate, consider international insurance instead.

3. International Health Insurance

These plans are designed for people who live abroad and may move between countries. They offer worldwide coverage (sometimes excluding the US), are accepted at hospitals globally, and typically include evacuation coverage. They cost more than local plans but provide the most flexibility.

Top International Providers Compared

SafetyWing Nomad Insurance

Best for: Digital nomads and budget-conscious expats

• Monthly cost: Starting at $56/month (age 18-39)
• Coverage: Up to $250,000 per incident
• Deductible: $250 per incident
• US coverage: Includes limited US coverage (up to 30 days per 90-day period)
• Strengths: Month-to-month billing (no annual commitment), easy online signup, covers multiple countries automatically
• Weaknesses: Lower coverage limits, doesn't cover pre-existing conditions, not suitable for major planned procedures

SafetyWing is the go-to for nomads who are relatively young and healthy. It won't replace comprehensive insurance, but it provides solid protection against unexpected emergencies at an unbeatable price.

Sign up for SafetyWing →

Cigna Global

Best for: Expats who want comprehensive, traditional coverage

• Annual cost: $2,000-$6,000/year depending on age, coverage level, and whether you include the US
• Coverage: Up to $2,000,000 lifetime (Silver plan) or unlimited (Gold/Platinum)
• Deductible: $0-$5,000 (you choose)
• US coverage: Available as an add-on (increases cost significantly)
• Strengths: Large provider network, excellent customer service, wellness benefits, maternity coverage available
• Weaknesses: More expensive, annual commitment, pre-existing condition waiting periods

Cigna Global is the gold standard for expat health insurance. If you want the peace of mind of knowing you're covered for virtually anything, anywhere in the world, this is the plan.

Aetna International

Best for: Families and expats in corporate roles

• Annual cost: $2,500-$7,000/year depending on plan and add-ons
• Coverage: Up to $1,650,000 per condition per year
• Deductible: Varies by plan
• US coverage: Available as add-on
• Strengths: Strong family plans, good maternity benefits, dental and vision add-ons, large hospital network
• Weaknesses: Premium pricing, complex plan structures

Aetna International is popular with families and corporate expats. Their family plans and maternity coverage are among the best in the industry.

GeoBlue (Xplorer Plan)

Best for: Americans who want US-based customer service and may return to the US periodically

• Annual cost: $3,000-$8,000/year
• Coverage: $5,000,000 annual maximum
• Deductible: $250-$2,500 (you choose)
• US coverage: Included through the Blue Cross Blue Shield network
• Strengths: Access to the BCBS US network, no pre-existing condition exclusions after 6 months, excellent for people who split time between the US and abroad
• Weaknesses: Higher premiums, primarily designed for Americans (not as global as Cigna)

GeoBlue is the best option if you want seamless coverage in both the US and abroad. The Blue Cross Blue Shield network gives you access to virtually every hospital in the US without the massive surcharges other international plans impose.

How to Choose: What to Look For

When comparing plans, focus on these factors:

• Geographic coverage: Does it cover you in all the countries you plan to visit or live in? Is the US included (important if you visit family)?
• Inpatient vs. outpatient: Some budget plans only cover hospitalization. Make sure outpatient visits, prescriptions, and diagnostics are included if you want them.
• Pre-existing conditions: Most international plans exclude pre-existing conditions, at least initially. Check the waiting period and terms carefully.
• Deductible structure: A higher deductible lowers your premium. If you're in a country with cheap healthcare (like Mexico or Thailand), a high-deductible international plan makes sense — you pay for routine care out of pocket and save the insurance for catastrophic events.
• Emergency evacuation: Critical if you're in a country with limited medical facilities. Most international plans include this; local plans usually don't.
• Mental health coverage: Historically excluded or limited by many international plans. This is improving, but check the fine print.
• Maternity: If relevant, verify coverage and any waiting periods (often 10-12 months).

The Medicare Problem

If you're under 65, Medicare isn't an immediate concern, but it's worth understanding the long-term implications of living abroad:

• Medicare does not cover you outside the US. Period. There is no international Medicare coverage.
• Medicare Part B premiums increase if you don't enroll during your initial eligibility period (typically at age 65). If you're abroad and not enrolled, you'll pay a penalty of 10% for every 12-month period you could have had Part B but didn't. This penalty lasts for life.
• If you plan to return to the US and use Medicare in retirement, consider enrolling in Part B even while abroad. Some expats maintain Part B specifically to avoid the late enrollment penalty.
• If you plan to stay abroad permanently, Medicare may not be relevant to you at all. Your international or local health insurance will be your lifelong coverage.

This is a decision worth discussing with a financial planner who understands expat retirement planning.

Our Recommendation by Situation

Situation	Best Option	Approximate Monthly Cost
Young nomad, no health issues	SafetyWing	$56-$100
Settled expat, one country	Local private insurance	$50-$200
Expat wanting global flexibility	Cigna Global	$170-$500
Family abroad	Aetna International	$400-$800
Split time US/abroad	GeoBlue Xplorer	$250-$650
Retiree abroad, healthy	Cigna Global + local public	$200-$400

Final Advice

Do not go without health insurance abroad. Even in countries with cheap healthcare, a serious accident or illness can cost tens of thousands of dollars. The monthly premium — whether it's $56 for SafetyWing or $400 for Cigna Global — is cheap compared to a single emergency hospital stay.

Get coverage before you arrive in your new country, not after. Many plans have waiting periods for certain conditions, and you don't want to discover a gap in coverage when you need it most.

Your health is the one thing that makes everything else possible. Protect it.