Healthcare Basics

International health insurance: local or expat insurance

International health insurance for expats: how should you choose between local health insurance or an international health insurance plan? When is expat medical insurance necessary?

International health insurance

By Expatica

Updated 15-3-2024

At what point do you need to consider international health insurance? How do you choose between so many expat medical insurance plans? Our guide helps you make an informed choice.

There are numerous things to consider when moving abroad, not least those relating to your health and wellbeing. Finding the appropriate level of health coverage is essential for expats. But with so many options, it can be difficult to know which package is adequate for expatriate healthcare. How many countries do you need to be covered in? Is local insurance adequate or do you need private health insurance?

Certainly, many countries have well-developed healthcare systems that cover free or subsidized local healthcare for both local and foreign residents. State-run insurance and healthcare schemes, as well as local private insurance plans, often provide expats with an adequate basic level of healthcare coverage. However, if you find yourself frequently traveling between countries then international health insurance may be required to fill the gaps that local healthcare cannot cover.

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Local versus international health insurance

Local healthcare coverage is primarily designed to offer you medical insurance in your designated country and comes in the forms of:

  • free state health cover, common in countries such as the United Kingdom and Spain;
  • through state health insurance providers, such as in Belgium, France or the Netherlands;
  • through a private health insurance provider, which offers access to local private facilities and shorter waiting times for treatment.

Many expats find that local healthcare coverage is adequate, as the costs are generally lower than international health insurance packages. Some local healthcare systems, however, do have their limitations, in which case a local private plan can be useful.

Doctor taking notes

An international health insurance plan, however, provides you with coverage wherever you go. This includes in your country of residence, your home country, and any countries you travel to abroad. It may also offer additional services in the country you live in, such as a wider choice of hospitals, access to English-speaking doctors, and extra treatments such as dental and maternity care.

However, it is important to note that for some features (e.g., maternity coverage), you will need to have been covered for a minimum amount of time, while state health cover will sometimes cover you once you are registered.

Do you need international health insurance to travel abroad?

Some local private health insurance plans will cover you while traveling abroad. Typically, this only lasts for a limited amount of time and is only for urgent medical treatment. If you travel frequently or spend extended periods abroad, a local plan is often not adequate for expatriate healthcare.

In essence, international health insurance covers you wherever you go; this means that you don’t have to buy coverage every time you travel to a new country. A comprehensive package can cover a range of eventualities, including sudden illness, treatment of injuries, evacuation, and repatriation.

It should be noted, however, that if you are a citizen from the European Economic Area (EEA – the European Union plus Iceland, Liechtenstein, and Norway) or Switzerland based in Europe, then the European Health Insurance Card (EHIC) entitles you to receive expatriate healthcare in all EEA countries and Switzerland. This does not, however, entitle you to free treatment; rather, you will receive state healthcare at the same price as a national of that country. The EHIC, however, typically only covers emergency or necessary treatment.

Avoid a coverage gap: switching policies when moving abroad

If you are moving to a new country, ensure that your current health insurance package remains valid until the day you depart.

In many cases, health insurance companies will request that you cancel your policy in writing, either by post or online. There may be some cost involved in the cancellation, particularly if you have any outstanding payments or cancel before the allowed time. Some policies may have restricted cancellation dates, such as three months before your package expires or on 31 December of each year.

If you receive state healthcare cover, then the cancellation process will vary according to the country you are in. For example, in the Netherlands where state healthcare is mandatory for all residents, your insurance automatically ends once you cease to be employed in the country.

Unless you already have international health insurance coverage, the next step is arranging healthcare coverage in the country you are moving to. This may involve either state or private insurance.

However, in some cases, this can cause a gap in your coverage. It may take time before you can cut through the red tape to access local health insurance abroad. There may also be restrictions on how long you need to be paying social security before you are eligible for certain free medical treatments.

Some expats opt to take out international health insurance before moving abroad to avoid this lapse. It also eliminates the need to arrange health insurance immediately after arrival, so you can have time to first deal with the pressing aspects of relocation.

International health insurance cost

Most international health insurance companies allow you to narrow your cover to specific regions. These tend to consist of either Europe only or worldwide coverage that either includes or excludes the United States. This is primarily due to the high cost of medical care in the United States; as a result, insurance companies offer considerable discounts if you exclude the United States from your coverage. You can of course opt to include the United States in your package, albeit at a higher price.

Doctor consulting with a patient

Even if the majority of your travel is within Europe, you may want to consider worldwide medical insurance so you are covered if you ever have to travel farther afield at short notice. You can find cheap international health insurance that excludes doctor visits or outpatient care but instead focuses on inpatient care and other emergency treatments.

Another large price influence is the deduction level. The higher the amount you are willing to pay towards your healthcare greatly reduces your insurance payments (for example, paying the first €500 per year or more of all your claims). This can be one way to get cheap international health insurance.

Your international health insurance cost is typically calculated on numerous factors, such as:

  • your age;
  • medical history;
  • area of coverage required.

What does international health insurance cover?

Generally, the core package offered by international health insurance companies covers more or less the same treatments you’d receive from local coverage, such as:

  • hospital care
  • surgery
  • emergency dental treatment
  • general consultation fees
  • cancer treatment

You can, however, personalize your medical insurance with extra features to ensure your needs are covered. This can include everything from physiotherapy and psychiatric treatment to the cost of prescription medicine, vaccinations, and eye tests. Women can opt for maternity cover, which is generally included in premium international health insurance packages.

A doctor and a patient looking at a laptop

Traveling to regions where local health services are less developed can be a concern, particularly for those with pre-existing medical conditions. In such cases, look for insurance plans that include medical evacuation, allowing for transfers to larger medical facilities.

Insurance comparison

By searching ‘international health insurance comparison’, a number of websites pop up offering policy details from different insurance companies.

Doing an international health insurance comparison can increase your chances of finding cheap international health insurance, although this should be carefully balanced against what expatriate healthcare you really need to make sure it is useful.

Insurance companies

When evaluating the different international health insurance companies, the first step is to read international health insurance reviews to get an idea of the quality and involvement of their customer services.

Some of the largest international health insurance companies offering coverage plans to expats include:

Time and planning are required to properly assess the additional services on offer when choosing between local and international health insurance. Physiotherapy or psychiatric treatment may not be on your list of top priorities; however, these are the types of treatments that can prove costly if you urgently need them abroad. Supplement insurances are particularly useful if there are certain treatments you expect to use or have an ongoing condition.

Details to look for in a health insurance plan

It’s easy to focus on keeping your health insurance cost as low as possible. However, it’s equally important to ensure your most-pressing health needs are covered so your insurance is useful to you. Consider all aspects of your lifestyle. For example, if you intend to participate in sporting activities or scuba diving then it’s important you have a detailed overview of which activities your health insurance policy covers. In the event that you sustain a severe sports injury and they aren’t specifically listed in your insurance contract, you may well find yourself liable for all treatment costs. That would defeat the purpose of taking out a local or international health insurance plan in the first place.

Some points that are particularly important to check include:

  • The deductible and co-payment amount.
  • Coverage for medical evacuation and repatriation.
  • What differences exist in coverage between local private and international health insurance plans.
  • If there is 24/7 support, if it is worldwide (and free), and in your native language.
  • If the plan has a cooling-off or cancellation period.
  • Exclusions for pre-existing conditions.
  • How easy is the bill settlement and reimbursement system.
  • The size of the network of hospitals, doctors and medical facilities you can choose from.