One of the more common questions I get is “What sort of travel insurance do you use?” After being on the road for a certain amount of time, full-time and long-term travelers (including expats living abroad) don’t qualify for standard travel insurance, as most health care plans and programs from our home countries also lapse with a long enough absence. This is where expat health insurance comes in.
Here’s a full explanation of how I insure myself, along with some helpful tips and definitions if you are in a similar position.
Expat Health Insurance
Also known as International Health Insurance or Worldwide Travel Insurance
Expat insurance goes by many names, but the idea is the same; without a country to call your own (at least, as a resident), you don’t have any basic medical care to rely on, and all medical expenses must be paid out-of-pocket. For full-time/long-term travelers and people living abroad, expat insurance is the answer.
But Expat Health Insurance is more than Travel Insurance; think of it as a full-service health and medical plan that provides for you around the world. It will cover you for medical emergencies, but it also has the ability to cover regular doctors’ visits, prescription medication, sometimes dental maintenance and prescription eyeglasses, and even visits to healthcare practitioners like massage therapists and acupuncturists.
In some countries where the cost of living is low or where medical tourism boons, self-insuring can be viable. But if a medical emergency is dire enough or if you are traveling somewhere this isn’t the case (or where medical care is inappropriate and you need to be taken to a place where you can receive the care you need), you could find yourself in a crippling financial bind.
I’ve written about the dirt on travel insurance before, including reasons why you need it and when you don’t, and even what it’s like to endure a serious illness requiring hospitalization on the road. So I won’t create a further case for why you need travel medical insurance here; let’s assume you already know why you need insurance, and want specifics about what to get, and whether expat insurance is your solution.
See also: The Ironies of Expat Life
How to Apply for Expat Insurance
Expat health insurance plans are offered by insurance companies around the world. They tend to be insurers who also offer travel insurance and standard health plans, but you’ll find the occasional dedicated expat insurance company as well.
I like using insurance brokers to help me find the best rates and policies. With one request, I get a summary of various insurance companies and plans, costs, and general policy specifications. I can read up on the policies that best suit my needs and budget, and ask questions of the broker about the quotes, policy administration, applications, and claims. Their answers are usually unbiased, and can be illuminating since they hold experience working with these insurers and can indicate if some are easier or more difficult to manage.
The last company I used to secure my current expat insurance policy (which is called IMG Global Medical Insurance by IMG Global) was Ingle International. I’ve also used Pacific Prime.
(Note: If you think you’ll be interested in an IMG medical insurance policy, feel free to contact me and I’ll refer you to the guy who helped me with mine and knows his stuff when it comes to insurance for long-term travelers).
Considering the insurance world is mired in ambiguity and legalese, and making claims can be hell on wheels, I find that working with an insurance broker who can advocate on your behalf throughout the application and claims process is well worth it.
And it’s free! Buying a policy through a broker doesn’t cost any more than if you go directly to the insurance company, and in fact can sometimes cost less if the broker gets volume discounts.
2021 Update: I recently discovered Safety Wing, which offers both long-term travel insurance as well as remote health plans. While my IMG Global Medical insurance policy had amazing rates for worldwide coverage including the U.S., the reality is all I really wanted was a policy to cover me in the event of a travel medical emergency, so it was like having a Cadillac to do what a wheelbarrow could have handled. Depending on your situation, you might find that Safety Wing will suit your needs well. (Bonus: they cover pandemics like any other illness). Check out this article about Travel Medical Insurance in 2021 and Beyond.
Check out my Travel Lifestyle Guides for more ways to earn money remotely, spend it wisely, and balance the two so you can travel as long as you wish, in a financially sustainable way.
Expat Health Insurance Tips
For a full glossary of insurance terms (which will make some of the lingo below easier to understand), check out the Ultimate Traveler’s Guide to Insurance.
Here are some tips specific to expat health insurance:
Tips for the Application Process
Read the fine print
Read it…before you buy, as well as after. It might be soul-destroying to sift through 30+ pages of policy legalese, but it pays to know your policy inside and out. You don’t want to discover your policy’s limitations in the throes of a medical emergency.
The higher your deductible, the lower your premiums will be.
You can adjust this accordingly in the quotation process to get a policy suited to your needs. If you only plan on using the policy for major medical emergencies and you have a cash buffer to cover the deductible, then setting a high deductible makes sense.
I do exactly this. It means that some of the lower-value benefits of international health insurance (like doctor’s visits and other healthcare practitioner coverage) is lost on me due to the high deductible, but at the same time, it will cover me when I really need it – in the event of an expensive medical emergency/situation.
The higher the co-insurance/co-pay, the lower your premiums will be.
Again you can tweak this during the quotation process to suit your needs and budget.
Excluding USA Coverage reduces premiums.
Many policies have an option for worldwide coverage that excludes cover in the USA, and with the exclusion these policies are considerably cheaper (as much as 50% cheaper) than their worldwide counterparts.
If you get a policy like this and plan to visit (or return to) the U.S., you can simply buy a separate policy for just the dates of travel in the U.S. and it will end up costing you much less than blanket annual coverage.
Pay annually for discounted rates.
This concept applies to most types of insurance policies; the more frequent your payments are, the more money you pay. By paying annually you’ll get the best rates. And if you end up canceling the policy, you’ll get retroactively refunded for the portion of the year you didn’t use, so there’s no loss.
Check for direct pay clauses for hospital stays.
Most insurance companies will directly pay the hospital for your in-patient expenses so you aren’t out-of-pocket and looking for reimbursement. But it’s worthwhile ensuring that this is the case; the last thing you want is to foot an unexpected hospital bill that could be in the tens of thousands of dollars.
Policy Maintenance and Claims
Always call the insurance company before seeking medical care.
Some insurers are so sticky about this that they can actually refuse to cover you if you don’t contact them before seeking medical care. Obviously if you are unconscious or completely unable to pick up the phone, they’ll make an exception, but they expect a call within 72 hours of your being admitted to a hospital, or as soon as is reasonable. You can have somebody call on your behalf if you can’t do it yourself.
Part of the reason for this requirement is because the insurance company might have special arrangements with certain health providers and hospitals (which I’d like to think have been vetted for their standard of care, but alas I may be naively optimistic on this front). Either way, it’s always best to call them first since they hold all the cards when it comes to paying out. They’ll create a file for you, make arrangements to pay the hospital directly, and enhance the chance of your claim going through without complications.
Keep copies of your insurance info everywhere.
You can’t have it in too many places, as far as I’m concerned. I have a card in my wallet, the policy info and documentation on my computer (which gets backed up), a copy on my hidden USB stick, and full policy documentation with a family member back home. (If you travel with a partner, they should have your policy information as well). (See also: Travel Security: How To Keep Your Finances, Data, & Identity Safe On The Road)
As a worst-case scenario, if I’m lying on a hospital bed and have one phone call to make with five minutes of consciousness to enjoy, I can call my Mum (who is my designated representative) and ask her to do the leg-work with the insurance company for me. Otherwise, regardless of the accident or illness that hits me, I’ll have multiple copies of policy information and claims phone number just in case my wallet is stolen or I lose the information in one spot.
Pre-Existing Conditions on Expat Health Insurance Plans
If you have a pre-existing condition, you can still get international health insurance, but it will probably affect which plans you’re eligible for. The key is to keep an eye out for pre-existing condition clauses or exclusions, or try to get special expat insurance that covers pre-existing conditions.
A pre-existing condition is anything that you have experienced symptoms of and/or sought medical advice/treatment for. Most insurance companies look for/exclude pre-existing conditions from the last two years, but if you’re answering a medical questionnaire as part of your application, many questions will delve into your entire medical history. Imagine my surprise when I received an exclusion on a policy for any conditions relating to asthma, due to a temporary and short-lived problem I had experienced 20 years prior.
Long-Term Travel Health Insurance Exclusions
After applying for your travel health insurance policy, you might find yourself at the mercy of certain exclusions. It’s important to declare any pre-existing conditions when you first apply. Otherwise, claims around those conditions could be rejected and won’t be covered. Hello, expensive out-of-pocket costs!
But the crappy part about divulging your pre-existing conditions, is that they could likely lead to an exclusion, which means the insurance company won’t cover you for any illness/injury that is related to that condition.
Some plans will remove exclusions if you’ve been treatment-free for one and a half to two years, so make sure you ask your broker about that.
In the case of pregnancy, some plans will cover maternity care after a waiting period, sometimes 12 months, sometimes less. Other plans just don’t cover it at all.
Aside from pre-existing conditions, most health insurance plans have a list of exclusions that they can’t cover at all. Usually it’s things like injuries resulting from terror attacks or acts of war and nuclear explosions. Some plans also don’t cover recreational activities like skydiving or scuba diving.
If you’re traveling to high-risk areas, you can always apply special extensions for those kinds of coverage to your usual plan.
You can still get international health insurance if you have pre-existing conditions. You’ll either have a higher premium, or an exclusion, and you might have to fill out extra forms or do extra screening tests before being approved.
Expat Travel Insurance for Seniors
For seniors looking for expat health insurance, there are a few important things to look out for in a plan, alongside pre-existing condition coverage.
Coverage for Life
Some expat insurance plans have age restrictions or cut-off ages. It’s important for older expats and long-term travelers to find a plan that doesn’t have these restrictions.
High Overall Limit
As we age, we tend to have more and more medical issues, so it’s important to find a plan that has a higher overall limit on how much it covers.
If you’re traveling in a developing country, it’s important to make sure your insurance covers evacuation, in case you have a serious medical issue that can’t be treated with the resources available and you need to be transported to a more developed place.
Prescription Medications for Expats
If you’re someone who needs to take regular prescriptions, full-time or long-term travel can feel impossible. But it’s still possible to travel and get your medications as necessary.
Taking Prescriptions With You
Wherever possible, it’s advisable to bring as much of your prescription medication with you as the pharmacy will give you in one shot. That way you won’t have to worry about getting the wrong medication by accident in a country with different terminologies for the same medications.
On the other hand, don’t forget that some countries have laws against certain medications, so make sure you check that you’re allowed to bring your meds into the country before you do, especially if it’s a commonly controlled substance.
Getting Your Meds Abroad
Another option is to take a written prescription from your doctor with you, including both brand name and generic name, as well as a list of medicinal ingredients. Then, when you get to your new country (if you’re moving there) or when you know you’re about to need a refill, you can find a local doctor or pharmacy.
Having the notes from your doctor will help them make sure you don’t get the wrong medication, especially since prescription drugs sometimes have different uses in some countries.
Also make sure that you’re getting your medications from a reputable source. Pharmaceutical chains or hospital pharmacies are usually a safe bet. You can also ask your expat insurance provider or local embassy for recommendations.
It’s also worth noting that in some countries you can get the same medication over the counter that would require a prescription in your home country. As I mention in my Guide to Staying Healthy While Traveling, my first line of defence is always a pharmacist, who is not only incredibly qualified, but also free. If you show them your doctor’s notes and prescription forms, they may be able to help you on the spot, perhaps even in a more efficient way than you’ve experienced at home!
When choosing and using your expat insurance, it’s important to make sure it fits your medical needs, and also that you understand how you can use it on the road so that you can get treatment or medications you need. Otherwise, what’s the point in having it, right?
This is just the tip of the insurance iceberg. If you have ANY questions about insurance for travelers, check out this free comprehensive guide.
For regular travel insurance, I have used and endorse World Nomads. Use the widget below for a free quote!
I still love World Nomads…BUT….their language around pandemic coverage is ambiguous at best (and ambiguity in insurance-speak is not good). So my latest travel insurance love (and what I’ll hit the road with again – as long as I’m not visiting the U.S.) is Safety Wing. Here’s a ton of info about their travel insurance and remote health insurance (expat insurance) plans, including Pros & Cons.
Note: If you end up purchasing an insurance policy through some of the links in this post, I will receive a small commission. This in no way affects your price, and helps me to keep The Professional Hobo going as a lifestyle travel resource. Thank you in advance for your support!