The Nomad guide to international health insurance

Dateline: Tbilisi, Georgia

It’s a basic fact of life that — every once in a while — we all get sick, hurt, or have some other condition that requires medical attention. Being an expat does not change this reality. In fact, being an expat adds an extra twist to the whole adventure that is personal healthcare.

Just this past March, I got sick while staying in Poland. I made the bad decision of going to a socialized government hospital where the service was terrible. Since I’m not a Polish citizen, I had to pay, but that didn’t improve the socialized system at all. Everyone else was staying there for free, so what did the hospital staff care about providing quality service?

It was the worst experience of my life. No one knew where I was supposed to go and automatically assumed I had a monkey virus after they heard I’d been in Malaysia. Then, after ending up in the infectious disease hospital, they demanded that I stay for three whole days. I can guarantee that if I’d been in a Malaysian hospital I would have been in and out in two hours, not sitting around for three days like an idiot.

That experience highlighted for me all that is wrong with socialized healthcare. And the United States is quickly going in that direction. Prices for Obamacare continue to go up and yet — despite increased government spending — life expectancy in the US is not only the worst in the West (as in, jaw-droppingly worse), but it’s also going down.

The good news in all of this is that my experience in Poland is the exception to overseas healthcare, not the rule. Another good piece of news is that expats who live overseas don’t have to sign up for Obamacare. Instead, you can choose better healthcare services and insurance options on a global level.

High-cost Insurance … and for what?

Before working for me, one of my new team members, Ania, was living in Washington DC. Her employer paid the majority of her health insurance and she felt fortunate she only had to pay $50 a month for her policy.

While that sounds great, you can go to the emergency room in many countries for just $50 and get complete care. Unlike in the western, socialized world — like in Poland or the US — they’ll actually give you the best quality care and get you out the door.

Places like Malaysia and Thailand offer world class medical service for a fraction of the price you’d find in the US. A few years ago I wrote about how a hospital visit in Malaysia literally saved me $2,000. And an appointment with an internal medicine specialist in Thailand cost me roughly $37. You can barely get an insurance plan in the US these days with a co-pay that low — not to mention the poorer quality of service.

Truth be told, when it comes down to near-death experiences or increasing my medical freedom, I’d prefer to be in Malaysia over pretty much anywhere else.

The pay as you go option

But all of this merits an important question: How should you insure yourself when living overseas? For me, I’d rather just pay as I go for the majority of my medical expenses. And I believe that self pay is the direction many wealthier people are going to go in the US. It makes even more sense for a perpetual traveler because prices are so much lower in pretty much anywhere outside the US.

I’d rather self-pay in a place that I choose like Thailand, Malaysia, Singapore, Brazil, Panama, or maybe even Mexico, India or Dubai. (Sadly, even though Europe is a nice place to be, I wouldn’t go there for medical care… maybe the Balkans for dental care). For someone who can afford to self pay, I just don’t get the point of health insurance.

Where I do see the need is to cover catastrophic situations. The biggest concern of all would be covering the possibility of getting cancer. That’s my priority. I’m all about catastrophic coverage. Also, if you’re traveling or living overseas as a family, it may also make sense to have maternal medical insurance — especially if you’re looking into birth tourism.

Other than that, you can literally just walk into a pharmacy and buy many medications without a prescription in places like Southeast Asia, Mexico, and even some countries in Western Europe. Or, in the Philippines, dental exams are free and fillings can be done for $25 per surface while the cost for crowns, root canals, dentures and implants are as much as 75% lower than in the US.

My friend Pete Sisco even had laser teeth whitening done in Thailand for $200 by a highly qualified (English speaking) professional at a time when the same service cost over $800 in the United States.

With prices that low, you can easily skip out on the high costs of private insurance, high deductibles, long waits for appointment dates and in the waiting room, sky-high fees, and the superficial two-minute consultations that are all part of “the system” in the US. And you’ll probably gain in the quality of the service department as well.

International health insurance plans for Nomads

Now, if you’re just starting out and don’t have a lot of cash, it’s probably a bigger priority for you to have some type of insurance. And even I have insurance for the catastrophic events. So what are the options for international health insurance for the perpetual traveler?

There are more providers than we could possible cover in one article, but let’s take a look at some of the best…

Allianz Worldwide Care

Allianz Worldwide Care offers plans that cover day-to-day medical expenses such as doctor’s visits, as well as planned surgery, emergency treatment, maternity cover, outpatient care and dental plans. They also cover chronic and congenital conditions and many pre-existing conditions.

They also over travel insurance, but mostly for those taking short trips abroad for vacation or business. The service covers unexpected medical emergencies or accidents, as well as missed flights, lost luggage or other travel-related emergencies.

Rates vary widely depending on the individual – for example a man in his 50s moving to the Middle East might get a very different quote in comparison with a woman in her 20s moving to South America.

Bupa

Bupa is the insurance provider I use and have been very happy with. I pay about $300 a year, although I can’t remember if I said I was a resident of Georgia or the US when I signed up.

Their international medical insurance plans cover health checks, wellbeing, maternity, evacuation, cancer treatment, dental and optical. Of course, the cancer cover is what stands out to me. They provide for cancer treatment and continue support after treatment ends.

Bupa has a network of over 1.2 million medical providers around the globe, from Latin America to Greater China and the Middle East to Africa, Southeast Asia and Europe. They also offer small business and corporate medical insurance, travel insurance, and short term international insurance for those traveling up to eleven months.

Cigna

Cigna is another international insurance provider that is popular among expats. They offer three levels of cover — Silver, Gold and Platinum — but each includes inpatient care, mental health care, day case surgery, cancer treatment, and accommodation costs. The Gold and Platinum policies also cover maternity care.

From there you can add on outpatient care, health and wellbeing, medical evacuation, as well as vision and dental. They also offer employer plans for any company size.

Health Care International

Health Care International offers access to 350,000 physicians and nursing staff in over 160 countries, with access to more than 7,000 facilities worldwide. They provide emergency transport to the nearest medical center or repatriation services. They also have insurance plans for small and medium businesses, as well as corporate plans.

Health Care International also offers travel insurance, which includes lost luggage, missing airline tickets, delayed or cancelled flights, medical emergencies, and lost passports, possessions and money. More extensive policies cover personal accidents, winter sports, legal expenses and even hijack.

There are various travel insurance policies you can choose from, from an annual multi-trip travel plan to a single trip travel plan for trips up to 90 days. You can choose plans on an individual, family or corporate basis.

Integra Global

Based out of the UK, IntegraGlobal has service offices in Europe, North America and Asia. They offer all the basics of international health insurance, including routine check-ups, wellness, preventive exams, and vaccinations.

Like many of the other providers on this list, they also offer group plans for core protection of employees on overseas assignments. Integra’s group plans cover hospitalization and inpatient treatment, 24/7 emergency medical assistance and evacuation, as well as outpatient cover for Rx, specialist fees and physiotherapy.

International Medical Group (IMG)

International Medical Group (IMG) may be a good option for those looking to live in only one region of the world, as they have the option of signing up for coverage based on your geographical area of need.

You can choose from several plans, customize your length and area of coverage, and choose the type of deductible and form of payment you will use. IMG also offers various travel medical insurance plans.

Seven Corners

Seven Corners is primarily a travel medical insurer, although they do provide plans for people working abroad for more than a year. You can renew the long-term option for up to three years. Like IMG, SevenCorners allows you to choose your area of coverage for up to 45 days of travel per trip.

World Nomads

World Nomads is solely a travel insurance provider. They offer coverage for medical help and evacuation, trip cancelation, gear cover (for items such as cameras and laptops), 24/7 emergency assistance, and lost, stolen or damaged goods.

Their greatest feature is that you can buy a policy when you are already overseas. Prices are calculated based on the travel destination, country of permanent residence, dates of travel and the number of travelers, among other things. You can generate a quote online by clicking here.

Expat country-based insurance plans

Now, we’ve spoken before about the fact that there’s no one way to live as a nomad. While the perpetual traveler or base cities strategies may warrant the use of an international insurance policy, the expat strategy may not.

For example, Ania, who I mentioned earlier, plans to live in Georgia full time to ensure that our office there is always shipshape. Consequently, she is currently considering insurance policies within Georgia. There are several international-standard medical facilities throughout the country. Many of them have expatriate and/or English-speaking doctors and staff who have provided high-quality medical attention to expatriates in Georgia for many years.

There are also numerous quality options for health insurance in the country. Plus, even though Ania has yet to choose a provider, she has been impressed at how inexpensive healthcare is in Georgia compared to the US. Her mother received treatment at a Georgian medical facility and the oxygen masks, infusion and x-rays cost her under $100.

Another team member in Mexico has already gone through the process of finding a Mexican-based insurance provider. Before working for Nomad Capitalist she had hoped to receive insurance through her employer, but the process was always on hold. Her employer never seemed to have the proper paperwork in place. Finally, she had had enough and began looking for a private insurer.

She was able to find the perfect match that allowed her full coverage in Mexico and — with a simple phone call notifying whenever she was going to visit her family — coverage in the United States as well. She provided the insurance company with her permanent residency card, passport and birth certificate and she was fully insured.

How about you? What insurance provider do you use? If you use one of the companies we’ve featured here, what do you think of it? What other providers would you recommend? And what other strategies would you suggest for expats, perpetual travelers and digital nomads looking for international health insurance?

Andrew Henderson
Last updated: Dec 26, 2019 at 9:41PM

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10 Comments

  1. Jessica

    Hi Andrew! Great article, super informative. Do you maintain any sort of US coverage? Since my travel is unpredictable and my family is still in the US, I never know when I’ll be back in the country. This past year i returned for 5 months and took care of annual checkups and prescription refills stateside. The other scenario is if something happens to me abroad and I need / choose to return to the US for care. I have been using an international health plan that includes US coverage for the past year, but it expires soon and the premium is way higher than I want to continue to pay. I’m considering going the catastrophic / high-deductible low-premium plan route, but would love your insight! Thanks!

    Reply
    • Nomad Capitalist

      I haven’t been to the US in quite some time now, and when I do go it’s not for very long, so I can’t say I’m much of an expert on that particular area. I personally go through Bupa, but it is an international plan and I’m pretty sure it doesn’t include US coverage. Like I mentioned in the article, I’m a fan of catastrophic coverage and tend to think that I can get just as good (and usually much better) service for a lower price overseas.

      Reply
  2. Ralf

    The whole topic of health insurance is of great interest to us as a nomadic family. We don’t have any health issues, don’t buy any medicine or pharmaceutical drugs, in fact, we don’t use the medical sytem at all. So, all the standard coverages we are so tuned into in our western systems are not necessary for us.
    Of great thought is certainly an emergency/catastrophy situation of any kind that can throw your finances and in many cases ruin them. That’s the protection I have seen many are seeking – just an emergeny protection. As Andrew mentions, most nomads and the like can pay for checkups and minor medical proceedures in various countries without major problems. So far, I have not really found an insurance that purely does that (emergency protection). Please, if anyone knows about such insurance, post a comment here.

    What throws me most though, is the “residence” the insurances ask for. That leaves it doubtful for all perpetual nomads who mostly don’t really have a residence any more. I am hesitant to put a most suitable place of residence down. Insurance consultants can’t help much, as they don’t know and can’t deal with that fact, that there is no permanent address or residence. Knowing insurances major business task is to avoid payments for claims, this could be the point of error in case of any crises. I have paid many insurances in the past and found out later, that these would most likely not have paid out claims, due to some “small print” issue or other minor irregularity. I believe, international health insurances have not yet cought up on the non-residence lifestyle of so many. Thousands are spent every year by those folks and they could be in for a nasty surprise in case of a (hopefully not) medical event.

    It would be great to see some more research and information on this topic, as it is easy to sign the dotted line, make payment and feel “secure” as long as nothing happens.

    Andrew, thanks for this article.

    Reply
    • Irina Loncar

      Thanks for your comment Ralf.

      Reply
    • Stan

      Ralf, we are in the same situation as you. I would love to share some input. Maybe we should get in contact.
      Stan

      Reply
    • Dave

      Ralf, have you found a solution? I’m looking into the same issue

      Reply
      • Amy

        Same – family living abroad in different countries for a year. What is our residence?? What about emergency medical insurance? It seems as if travel insurance is the best fit for emergencies, but they don’t cover onset of a chronic disease (i.e.. cancer).

        Reply
  3. Philip Broughton-Mills

    Are you sure you pay only $300 per *year* with Bupa? They’re quoting me $300 per *month*, and I’m just an average guy.

    Reply
  4. Lucca

    Integra Global is a total joke. I am still waiting for the payment of my claims almost one year later.

    Reply
  5. Richard X

    You insurance article is interesting, but you miss the point. It is illegal in most every country to be a digital nomad on a tourist visa or visit visa, anything other than a full one-year work visa – you are legaly complicit in your article. Post so much as a blog article from your laptop at the airport, and you can be deported, jailed, and fined heavily. I was caught, I know, my friends deported.

    The fact is, that in Asia they dont enforce the law and dont care, but – a sharp-eyed immigration officer can google your name, find your blog, and suddenly he has $2,000 in his back pocket towards his kids and his new car. He is motiated, very motivated. My friends paid their fine in Starbucks, one paid in a car park. You dont get a receipt!

    Not paying means being deported. Time in a cockroach-infested cell, handcuffs to the airport, handcuffs on the flight home (you can no nowhere other your home city). When you get back you wil be questioned or arrested, and they will contact the country that deported you to find out why. Are you a murder suspect? You will then need to get a new passport, through a lawyer and interview at the passport office, and they will ask why you broke laws abroad. You may not get your passport back, and you may end up on a no-fly list (America).

    If you do pay, you are now in serious danger. Paying a fine to an immigration official is illegal, and you will get 5-10 years in prison. The anti-corruption police in Asia love to find a fine-payer and make an example of them.

    If you wonder why not many of these stories make the web, it’s because the people paying want to stay travelling, and they have friends in the country in question. If they detail their story online they are risking a lengthy prison sentence, their in-country sponsor jailed.

    The number of digital nomads in Asia is growing exponetially, and the idiots all have their names and photos on their website, stating that they “are in Bali designing websites”. They may as well have a neon sign over their heads when they go through immigration.

    Nomad capitalist? Next year’s prisoner…

    Reply

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