Expat health insurance: Costs, best plans, and coverage in 2026

Expat health insurance is a type of private medical cover for people living abroad for an extended period.

According to William Russell's 2026 pricing data, the average premium for an individual purchasing a policy runs around US$3,020 before discounts and about US$2,517 in a discounted sample scenario. Plans that include US treatment reach $28,000+ per year. Pricing is quote-based and depends on age, destination, area of cover, deductible, and add-ons.

Many long-stay visas – including those for Spain, Germany, Portugal, and Thailand – require proof of health insurance, but the exact rule depends on the country and visa type.

This article covers what expat health insurance is, what it costs, which providers cover US expats, and how the IRS treats your premiums on your US return.

Expat health insurance – key facts (2026)

• Average annual cost (individual, plan excluding US): around US$3,020 before discounts and about US$2,517 in a discounted sample scenario (William Russell, 2026). Pricing is quote-based and depends on age, destination, area of cover, deductible, and add-ons.
• Plans including US treatment: $10,000–$28,000+/year (indicative estimates only). Including US treatment usually raises premiums substantially, so compare live quotes for the same age, area of cover, deductible, and add-ons.
• Plans excluding US treatment: $500–$6,000+/year (indicative estimates only; actual premiums depend on age, destination, deductible, and benefits).
• Self-employed deduction: 100% of premiums on Schedule 1 (Form 1040), Line 17
• Visa insurance rules are country- and visa-specific; do not use one global minimum as a guide for every destination.
• Commonly compared providers include Cigna Global, Allianz Care, AXA, Bupa, and SafetyWing.
• ACA: For federal taxes, the ACA penalty is currently $0 – there is no federal shared-responsibility payment for TY2025. Some states still have their own coverage mandates, so check state rules if you file there.

What is expat health insurance?

Expat health insurance is designed for people who wish to live, work, and maybe even retire in another country – for example, a US citizen who moves to Spain.

The main difference from local health insurance:

• Access to providers who speak your language. A language barrier can be risky when it comes to health issues.
• Coverage that doesn't depend on your visa status. Under some residence permits, you may have limited or no access to the local public system.
• Documentation for visa applications. Many long-stay visas require proof of insurance before approval.

In short, expat coverage gives you portable, English-language care and helps you meet visa rules without leaning on the local healthcare system in your first months abroad.

Why do expats need health insurance?

The first reason is legal. For many residence visas, insurance for expats is the only way to demonstrate you can pay for medical care without relying on the host country's system.

Several countries require proof of health insurance for specific long-stay visas, including:

• Spain Non-Lucrative Visa – minimum €30,000 coverage with no copays, no deductibles, no waiting periods, issued by an insurer authorized to operate in Spain
• Germany national long-stay visas – proof of adequate health insurance is generally required, but the exact requirement depends on the visa type. Check the German Federal Foreign Office guidance for your specific visa category.
• Portugal D7 Visa – proof of health insurance is generally required; verify the current official consular guidance for the exact requirement before applying. Check AIMA or your nearest Portuguese consulate for up-to-date requirements.
• Thailand Retirement Visa (O-A) – Thailand's O-A long-stay visa currently requires health insurance covering the full stay with at least US$100,000 or THB 3,000,000 in overall medical coverage.
• Mexico Temporary and Permanent Residency – health insurance requirements vary; verify the current official requirement with INM (Instituto Nacional de Migración) or your nearest Mexican consulate before applying.

Beyond visa rules, three further reasons matter:

• Higher quality / specific care. Local public systems may not readily provide complex surgeries, specialist mental health support, or advanced dental and vision services.
• Cost protection. Going uninsured in a country with expensive private care can mean bills in the thousands or tens of thousands of dollars.
• Portability. Health insurance for expats typically follows you across countries – useful if your base is in one country, but you travel often, or if you're a digital nomad.

For the tax side of moving abroad, see our US expat tax filing guide 2026 and our moving abroad checklist. For visa options, see our guide to European Golden Visa programs 2026.

Types of expat health insurance

There are three main types: travel, local, and international.

Travel health insurance

A short-term type of medical insurance, usually for trips up to several months. It's cost-effective and gives you access to emergency healthcare if you need it on vacation or a short business trip.

What it doesn't do:

• Preventive care or treatment for chronic conditions
• Planned surgeries
• Dental work
• Mental health care

Travel insurance is usually short-term and often limited to emergency cover; check the visa rules and the policy wording for your specific destination and situation.

Local health insurance

Pretty much "In Rome, do as Rome does." Local insurance plugs you into the same system locals use. It's more comprehensive than travel coverage – but it comes with trade-offs:

• Language barrier – local doctors often work only in their native tongue
• Gaps in the system – specific treatments may not be available; waiting times can be long
• Limited private access – many local plans cover only public clinics and hospitals
• No coverage abroad – your insurance won't follow you out of the country

International health insurance

International plans (often called expat medical insurance) are the most comprehensive option and usually the most expensive.

They work well for digital nomads or anyone who moves around during the year. Whichever country you live in, you get access to quality care through your insurer, and coverage can extend back to your country of origin. Most international plans cover the full range – emergency, preventive, ongoing care, and specialist treatment.

The trade-off is the price tag. The upside is a reliable fallback wherever you are.

What does expat medical insurance cover?

Coverage depends on the plan you choose. The categories below drive cost and matter most when you compare quotes.

Inpatient and outpatient care

• Outpatient care: visits where you come and go the same day – consultations, prescriptions, bloodwork, X-rays, mammograms.
• Inpatient care: hospital admissions of at least one night, including planned surgeries, childbirth, and emergency hospitalizations.

Most plans include both, but limits and copays often differ. Start by assessing your current health state and factor in ongoing and potential needs.

Emergency medical treatment

What happens if you get in a car accident, your appendicitis flares up, or you black out from a panic attack? Check that emergency cover – including ambulance transport, evacuation, and repatriation – is included, especially if you're moving to a country with limited specialist care.

Specialist consultations and diagnostics

You'll need these when a problem isn't an emergency but can worsen untreated – a persistent cough, a mild allergic reaction. Check whether your plan covers specialist consultations without a long referral chain that delays care.

Prescription medication

If you take prescription meds, confirm two things before you move:

• Your plan covers the medication
• The medication is available in your destination country

Maternity and family coverage

If you or your partner plans to have a child, factor in regular check-ups, tests, and childbirth itself. Maternity benefits often have waiting periods; the exact length varies by insurer and plan.

For family coverage, confirm:

• Which family members are included
• Whether their pre-existing conditions are covered
• What is the family annual limit

Dental and vision options

Dental and vision are usually add-ons, not core coverage. Plans that include them generally cover:

• Routine cleanings, basic dental work, crowns, fillings, bridgework (full or partial)
• Eye tests, prescriptions for new glasses, allowance toward lenses or contacts

Cost of expat health insurance

According to William Russell's 2026 pricing data, the average premium for an individual purchasing a policy runs around US$3,020 before discounts and about US$2,517 in a discounted sample scenario.

Including US treatment usually increases the premium substantially; compare live quotes for the same age, area of cover, deductible, and add-ons.

Several factors affect your expat health insurance cost:

• Your age
• Your medical history
• Optional extras (dental, vision, mental health, maternity)
• And – the largest factor – the country/region of coverage

The following figures are drawn from the Pacific Prime International Health Insurance Cost Report (2025/2026), a third-party estimate. They are not verified by official insurer or government sources, and actual premiums are quote-based and will vary by insurer, age, deductible, and area of cover. Selected figures (USD, rounded):

 

The figures below are indicative estimates based on market data. Actual premium changes depend on the insurer, plan tier, age, and area of cover; get a live quote to compare costs for your specific profile.

Best international health insurance providers

The following five providers are among the top health insurance providers for US expats and cover Americans living abroad worldwide in 2026. Including US treatment in the area of coverage usually raises premiums substantially.

Always check the area of cover and annual limit for each provider before choosing a plan; Cigna Global, Allianz Care, AXA, and Bupa all offer high-limit options, but availability depends on the plan tier and area of cover selected.

Cigna Global

One of the oldest players on the scene, Cigna Global offers international health insurance with 24/7 multilingual support and a global network of 2.4 million providers in 200+ countries.

Key features:

• Round-the-clock multilingual help centers
• 2.4 million providers across 200+ countries
• Annual limits range from $1,000,000 (Silver) to $2,000,000 (Gold) and unlimited (Platinum), per Cigna's published plan pages.
• Pricing is quote-based; use Cigna's online tool to get a live quote for your age, destination, and area of cover.

Cigna lets you build a plan in modules – inpatient, outpatient, maternity, vision/dental – so the price varies widely by what you select. All plans include inpatient treatment as standard.

Allianz Care

Allianz was founded in 1890 and today provides international health coverage through brands such as Allianz Care.

Standard coverage includes:

• Doctor visits
• Hospitalization
• Vaccinations
• Surgeries
• Diagnostic tests
• Prescription drugs
• Cancer treatment

Bundled services (availability varies by plan and location):

• Telehealth (online consultations)
• Mind coaching / mental health support
• Fitness coaching
• Nutrition hub

Allianz Care offers three plan tiers with the following maximum annual limits:

AXA

AXA Global Healthcare is part of the AXA Group, whose roots date to 1890 and the AXA brand to 1985. AXA Global Healthcare's official pages support a provider network in 192 countries.

Standard features:

• Emergency cover for overnight hospital stays and ambulance transport
• Evacuation and repatriation if the needed care isn't available in your region
• Cancer care, including chemo- and radiotherapy
• Virtual doctor service: online consultations with specialists
• Mind health service: help from a qualified psychologist
• Second medical opinion service

AXA Global Healthcare's personal Care plans currently go up to US$5,000,000 on Care Signature, with worldwide or worldwide excluding USA area-of-cover options.

Bupa

Bupa was founded in 1947 in the UK. Bupa Global's public plan pages show Major Medical at £2,000,000 and Select at £1,000,000, with worldwide or worldwide excluding US area-of-cover options available. Pricing is quote-based.

Standard services:

• In-hospital private rooms
• 24/7 access to a doctor online
• Global evacuation and repatriation

Coverage areas:

• Preventive care
• Pre-existing conditions (subject to underwriting)
• Mental health care
• Cancer care

For US expats searching specifically for Bupa expat insurance USA, note that US treatment coverage is a separate plan area and significantly raises the premium.

SafetyWing

SafetyWing Nomad Essential covers emergency medical care in 180+ countries. SafetyWing publishes age-based pricing on its website; the current sample price is $62.72 per four weeks for ages 18–39. Prices rise with age; check SafetyWing's pricing page for your age group.

SafetyWing Nomad Essential does not cover:

• Routine or preventive care
• Pre-existing conditions
• US treatment, except for limited incidental home-country coverage for US home-country members; check the current certificate of coverage for the exact terms and limits.

SafetyWing's Essential plan is travel medical insurance and is not designed for long-term residency abroad. For longer-term living abroad, compare SafetyWing's other products alongside dedicated expat health insurance plans.

Now Health International

Now Health International is a specialist international health insurer offering coverage in over 200 territories worldwide. The company offers two plan families – WorldCare and SimpleCare – designed to suit different healthcare needs and budgets.

The entry-level WorldCare Essential plan starts from approximately USD 26 per month and covers inpatient and day-patient treatment. Higher-tier plans – WorldCare Advance, WorldCare Excel, and WorldCare Apex – add outpatient care, dental treatment, and routine maternity benefits.

Annual benefit limits by plan tier:

 

USA elective treatment is available as an optional add-on on selected WorldCare plans. Eligible inpatient and day-patient treatment received within the provider network is covered in full, while eligible inpatient and day-patient treatment received outside the network is subject to a 50% co-insurance. Terms, conditions, and benefit limits apply.

Premiums are quote-based and vary depending on factors such as age, area of cover, and selected benefits.

What to consider when choosing expat health insurance

Several factors decide both fit and price when choosing one provider or policy over another.

Your own profile and needs

Three things drive your premium:

• Age – the older you are, the higher the premium.
• Medical history – providers don't cover pre-existing conditions by default; you'll need a rider, and pricing depends on the condition.
• Optional extras – US coverage, dental, vision, mental health, and maternity all stack additional costs to the base premium.

What your health insurance provider offers

• Coverage area. The more countries you include, the higher the premium. Adding the US is the single largest cost line on most plans.
• Coverage limits and exclusions. Match the annual limit to expected medical costs. Read exclusions carefully – a $5M limit isn't useful if the plan excludes the conditions most likely to send you to the hospital.
• Network strength. A plan with a strong direct-billing network in your city means you don't pay upfront and chase reimbursement.
• Cost-sharing. Three components: the premium (fixed monthly amount), the deductible (what you pay before the plan kicks in), and copays (your share of each visit or treatment). Higher deductibles usually mean lower premiums.
• Extras. Dental, vision, mental health, and maternity services – know which are included and which cost extra.

US tax implications of expat health insurance

How the IRS treats your premiums depends on how you earn your income. There are three tracks:

If you're self-employed

• Deduct 100% of premiums for yourself, your spouse, and your dependents on Schedule 1 (Form 1040), Line 17.
• The deduction is calculated on Form 7206.
• The plan must be established under your trade or business.
• You must report a net self-employment profit for the year; the deduction can't exceed that profit.
• The deduction reduces your AGI and applies whether or not you claim the Foreign Earned Income Exclusion (FEIE).

If you're an employee

• If your employer pays your premiums, the coverage is generally excluded from wages for income tax purposes, but many employers still report the cost in Box 12, Code DD of Form W-2 for information only. The amount reported is not taxable, and you do not get a separate deduction for that employer-paid coverage.
• If you pay your own premiums and itemize on Schedule A, you may deduct qualifying medical expenses that exceed 7.5% of AGI under IRC Section 213.

ACA / Minimum Essential Coverage

The federal ACA shared-responsibility payment has been $0 since tax year 2019, so no federal penalty applies for TY2025. Some states still have their own coverage mandates; check the state instructions for the return you file.

For the broader filing picture, see Do US citizens living abroad pay taxes?

Is expat health insurance tax-deductible?

US expat health insurance tax-deductible treatment falls into three scenarios:

• Self-employed health insurance deduction on Schedule 1 (Form 1040), Line 17
• Itemized medical expense exceeding 7.5% of AGI on Schedule A
• Employer-excluded benefit under IRC Section 106 for employees with employer-sponsored international plans

The self-employed deduction is now calculated on Form 7206, which replaced the worksheet previously published in Publication 535. Under the IRS individual shared responsibility provision, the federal payment is $0 for TY2025, so no federal penalty applies regardless of coverage status.

For the full picture of which forms you'll likely need, see our complete guide to US tax forms for expats in 2026 and our overview of US expat tax obligations.

Self-employed expats

A self-employed US expat deducts 100% of health insurance premiums for themselves, a spouse, and dependents on Schedule 1 (Form 1040), Line 17. The deduction is calculated on Form 7206.

Three conditions apply:

• The plan must be established under your trade or business (the policy can be in your name or the business's name for Schedule C filers).
• You must report a net self-employment profit for the year – the deduction can't exceed that profit.
• Neither you nor your spouse can be eligible for subsidized health coverage through an employer plan during the months you're claiming the deduction.

TFX client scenario

A US freelance consultant in Portugal with $85,000 in self-employment income paid $4,200 in 2025 for a Cigna Global expat plan covering himself and his spouse. The full $4,200 deducted on Schedule 1, Line 17 reduced his AGI by $4,200. At the 22% marginal bracket for TY2025 (single filers, taxable income over $48,475 up to $103,350, or $48,476–$103,350), the deduction saved him approximately $924 in federal income tax.

Self-employed expats abroad should also check our coverage of the Foreign Earned Income Exclusion and self-employment tax for expats – both interact with how you plan around the self-employed expat health insurance deduction.

Employees and salaried expats

Two rules apply, depending on who pays the premium:

• Employer-paid premiums: generally excluded from wages for income tax purposes under IRC Section 106. Many employers still report the cost in Box 12, Code DD of Form W-2 for information only – the amount is not taxable, and you don't claim a separate deduction.
• Self-paid premiums (itemizer): if you itemize on Schedule A, deduct qualifying medical expenses, including premiums, that exceed 7.5% of AGI under IRC Section 213. The 7.5% threshold applies to total qualifying medical expenses for the year – not to insurance premiums alone.

ACA and foreign residents

The federal shared-responsibility payment is $0 for TY2025, so there is no federal penalty regardless of your coverage status. The MEC framing still matters for:

• How foreign coverage interacts with state-level mandates
• Employer Form 1095 reporting

Some states have their own coverage mandates; check the state instructions for the return you file.

Taxes for Expats – your filing partner abroad

Choosing the right health insurance is one part of moving abroad; staying compliant with the IRS is another. TFX can help you review whether your premiums qualify for the self-employed deduction, how that deduction interacts with the FEIE, and whether employer-paid cover is correctly excluded under IRC Section 106.

We can help you confirm:

• Whether your premiums qualify for the Schedule 1 (Form 1040), Line 17 self-employed deduction
• How that deduction interacts with the FEIE
• Whether your employer-paid international cover is correctly excluded under IRC Section 106

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