Health Insurance for Retirees Abroad: What Medicare Won’t Cover

Disclaimer: This guide is for general education, not individualized financial, legal, or medical advice. Insurance availability, premiums, and public system eligibility change frequently. Always confirm details with official sources and a licensed advisor in your state or country of residence.

This is the single most important healthcare fact for Americans retiring overseas: Medicare coverage outside the U.S. (official CMS guidance) — Medicare does not pay for healthcare received outside the United States, with very limited exceptions (some emergency coverage in Canada and Mexico near the US border, and on board ships within 6 hours of a US port). Original Medicare Parts A and B, Medicare Advantage, and Medicare Part D prescription plans all stop at the US border.

You can keep your Medicare enrollment while living abroad, and many expat retirees do — paying the Part B premium ($185/month in 2026) to maintain coverage for trips back to the US. But for day-to-day healthcare in your retirement country, you need a separate plan. The three main options are international private insurance, local private insurance, and public healthcare enrollment (where available).

TRICARE and FEHB (Federal Employee Health Benefits) are exceptions: both provide limited international coverage. TRICARE For Life works with Medicare and covers some overseas care. FEHB plans vary by carrier but some include foreign coverage. If you have either, check your specific plan before purchasing additional insurance. Note: Medicare rules and premiums are set annually by CMS and can change; verify the current year’s policy at medicare.gov before making enrollment decisions.

International Private Health Insurance

Global plans from insurers like Cigna Global, Aetna International, Allianz Care, and IMG Global cover you in multiple countries with access to private hospitals worldwide. These plans offer the broadest coverage and the most flexibility — you can see any doctor, in any country, without referrals. Premiums are the highest of the three options, but coverage is the most comprehensive.

Best for: Retirees who travel frequently, want English-speaking providers guaranteed, or live in countries with lower-quality public healthcare.

Local Private Health Insurance

Many countries have domestic insurers that offer plans specifically designed for foreign residents. Thailand’s Thai Health Insurance, Malaysia’s AIA and Great Eastern, and Mexico’s GNP Seguros are examples. Premiums are significantly lower than international plans because coverage is limited to one country. Networks are restricted to in-country hospitals and clinics.

Best for: Retirees who plan to stay in one country long-term and are comfortable with the local healthcare system.

Public Healthcare Enrollment

Several countries allow foreign retirees to join the national public healthcare system. Costa Rica’s CAJA ($80–$150/month, covers most medically necessary care including pre-existing conditions), Portugal’s SNS (free after registering as a resident with a tax ID), and Spain’s Convenio Especial (€60/month for residents) are the most notable. Public systems often have longer wait times for elective procedures but provide comprehensive coverage at minimal cost.

Important: eligibility for public healthcare varies by country and typically depends on your visa type, formal residence registration, and in some cases contribution history — not simply time spent in-country. Confirm your specific visa’s eligibility with the local health authority before relying on public coverage.

Best for: Retirees on a tight budget who are willing to accept wait times and language barriers in exchange for low cost.

Insurance premiums for retirees increase significantly with age. The table below shows approximate monthly premiums for international private health insurance (mid-tier plan, $250 deductible, inpatient + outpatient coverage).

Estimated as of Q2 2026 based on published rate sheets from major international insurers; actual quotes vary by individual health history, residency status, chosen deductible, and insurer. All amounts in USD.

Deductibles and co-pays: The premiums above assume a $250 annual deductible. Raising the deductible to $1,000–$2,500 can reduce premiums by 20–35%. Most plans charge 0–20% co-insurance for outpatient visits after the deductible is met. Inpatient stays at network hospitals typically have no additional co-pay with direct billing. Prescription co-pays range from $5–$30 per medication depending on the plan tier.

Critical note: Most international health insurance plans have a maximum enrollment age of 74–80. If you move abroad at 70 and enroll then, you can typically continue renewing past 80. But if you wait until 80 to first apply, very few insurers will accept you. Enroll as early as possible.

Private insurance estimates are for a 65-year-old enrollee on a mid-tier plan. All amounts in USD unless otherwise noted. Public system eligibility depends on visa type and residence registration — see footnotes.

Footnotes:

1. Malaysia — Partial: Foreigners can use subsidized public hospitals at $5–15/visit, but coverage is pay-per-visit, not enrolled. Quality and wait times at public facilities are significantly below private options.
2. Vietnam — Limited: Public social insurance is accessed primarily through employment-linked contributions, which is not typical for retirees. Most retired expats rely on private insurance.
3. Portugal SNS: Free after registering as a resident (NIF tax ID + proof of address). Requires a D7 or equivalent long-stay visa — tourist visa does not qualify.
4. Spain Convenio Especial: Available to registered residents who are not employed and not covered by another EU system. Requires empadronamiento (town hall registration) and a valid residence permit.
5. France PUMA: Eligible after 3 months of stable, legal residence. Requires a valid long-stay visa or residence permit — not available on tourist stays.

The right combination depends on your budget, health status, and where you plan to retire. Here are four common scenarios:

Scenario 1: Healthy, age 60–70, moderate budget

Best setup: International private plan (mid-tier, $250–$500 deductible). Cost: $300–$600/month depending on region. Gives you maximum flexibility across countries and access to private hospitals everywhere. Drop US coverage to "worldwide excluding US" if you don’t plan frequent return trips.

Scenario 2: Pre-existing conditions, any age, budget-conscious

Best setup: Retire to a country with public healthcare access (Portugal, Spain, Italy, France, Costa Rica). Enroll in the public system for chronic condition coverage at $0–$150/month. Optionally add a local private plan for faster specialist access and private hospital rooms. This dual approach is the most cost-effective way to cover pre-existing conditions.

Scenario 3: Healthy, age 55–65, tight budget

Best setup: Local private plan in a low-cost SE Asian country (Thailand, Vietnam, Philippines). Cost: $80–$300/month. Covers in-country care at private hospitals. Supplement with a separate travel insurance policy for trips outside your retirement country. Trade-off: no cross-border coverage.

Scenario 4: Age 75+, limited insurance options

Best setup: If you already hold an international plan, keep renewing it — most insurers allow indefinite renewal for existing policyholders. If you need new coverage, IMG Global accepts applicants up to age 80. Beyond that, rely on public healthcare (if available) plus self-insurance (a dedicated healthcare savings fund of $50,000–$100,000). Consider countries with low out-of-pocket hospital costs: Thailand ($20–$50/night at private hospitals) or Malaysia ($15–$40/night).

Worked Example: 67-Year-Old Retiree in Portugal

A 67-year-old US retiree in Lisbon on a D7 visa enrolls in Portugal’s SNS (free after residence registration + NIF tax ID) for primary care, chronic condition management, and hospital coverage. They add a local Portuguese private plan (€180–€350/month) for faster specialist access and private hospital rooms. They keep Medicare Part B ($185/month) for US visits. Total monthly healthcare cost: $365–$535. Without the private supplement, SNS alone covers all medically necessary care at $185/month (Part B only).

Pre-existing conditions are the biggest challenge for retirees seeking international health insurance. Here is how different plan types handle them:

• International private plans — Most apply a moratorium or exclusion period of 12–24 months. After this period, pre-existing conditions are covered only if you have had no treatment, symptoms, or consultations during the moratorium — a moratorium does not guarantee future coverage if the condition remains active or requires ongoing management. Some plans (Cigna Global, Aetna International) offer full medical underwriting where you pay a higher premium to cover pre-existing conditions from day one. Diabetes, hypertension, and heart conditions are the most commonly affected.
• Local private plans — Similar moratorium approach, but with less flexibility. Thai insurers typically exclude pre-existing conditions permanently or require a 12-month waiting period. Malaysian plans may decline applications entirely based on medical history.
• Public systems — No pre-existing condition exclusions. Costa Rica’s CAJA, Portugal’s SNS, Spain’s Convénio Especial, and Italy’s SSN all cover pre-existing conditions from enrollment. This is the single strongest argument for choosing a country with public healthcare access if you have chronic health conditions.

Strategy for retirees with pre-existing conditions: Choose a country with public healthcare access (Portugal, Spain, Italy, France, Costa Rica) for comprehensive coverage of chronic conditions, and optionally add a private plan for faster access and private hospital rooms.

The providers listed below are among the most commonly used by US expat retirees. This is not an exhaustive list, and inclusion does not constitute an endorsement or recommendation. Plan availability, premiums, and network coverage vary by country, age, and health status. Always compare multiple quotes and verify coverage in your specific retirement country before enrolling.

• Cigna Global — Largest international network. Three plan tiers (Silver, Gold, Platinum). Accepts new enrollees up to age 75. Strong in SE Asia and Europe. Claims process is efficient with direct billing at major hospitals. Premiums are mid-to-high range.
• Aetna International — Good coverage across all 14 countries. Offers medical underwriting for pre-existing conditions (higher premium but immediate coverage). Maximum entry age: 74. Popular with US expat retirees due to brand familiarity.
• Allianz Care — Strong in Europe and the Americas. Competitive premiums for the 55–65 age bracket. Offers a "worldwide excluding US" plan that significantly reduces premiums if you don’t need US coverage.
• IMG Global — Best value for SE Asia coverage. Offers both comprehensive and hospital-only plans. Maximum entry age: 80 (one of the few accepting older applicants). Lower premiums than Cigna or Aetna but smaller hospital network.
• Now Health International — Asia-focused insurer based in Hong Kong. Competitive premiums for Thailand, Malaysia, Philippines, Vietnam, and Indonesia. Direct billing at 2,000+ hospitals across Asia. Less suitable for Europe or Americas.