Here's the thing nobody tells you until you're already abroad: that $50/month travel insurance you bought? It's not health insurance. It covers emergencies and evacuations. It doesn't cover the doctor visit for the cough that won't go away, the dental filling you need, or the ongoing medication you take.
Real health coverage as an expat is critical — and the options vary wildly by country. Some countries let you join excellent public systems for almost nothing. Others require expensive private insurance. A few have both.
This is the guide I wish existed when I moved abroad.
Key Takeaways:
- Travel insurance ≠ health insurance. You need long-term coverage if you're living abroad
- Many countries require proof of health insurance for visa applications
- Public healthcare enrollment is possible in most EU countries after getting residency
- Private international insurance costs $100-400/month depending on age and country
- Top providers: Cigna Global, Allianz, AXA, SafetyWing (budget), IMG
Last updated: March 11, 2026
The Three Types of Expat Health Coverage
Before diving into countries, understand your options:
1. Local Public Healthcare
Free or nearly free. Available after legal residency. Quality varies by country.
Many countries allow legal residents to enroll in the national healthcare system. This is usually the cheapest and most comprehensive option — but it requires legal residency (not just a tourist visa) and can have waiting times for specialists.
2. Local Private Insurance
$80-300/month. Faster access, choice of doctors. Available to anyone.
Private insurance in your country of residence. Faster than public, lets you choose your doctor and hospital, covers dental and vision in many cases. Often required for visa applications.
3. International Health Insurance
$100-400/month. Works globally. Best for nomads and multi-country expats.
Global policies from companies like Cigna, Allianz, AXA, or Bupa. Cover you in multiple countries, ideal if you move frequently. More expensive but maximum flexibility.
Budget option: SafetyWing Nomad Insurance starts at ~$45/month but has coverage limits and a $250 deductible. Good as a bridge, not as primary coverage.
Country-by-Country Guide
Portugal 🇵🇹
Public system (SNS): Excellent. Available to legal residents. Register at your local Centro de Saúde with your número de utente (health number). Costs: €0-5 per GP visit, €0-20 for specialist referrals.
Private insurance: ~€80-120/month. Allianz, Medis, and Multicare are popular local options. Required for D7/D8 visa applications.
Wait times: Public GP: 1-2 weeks. Specialist: 2-6 months. Emergency: immediate.
Verdict: Get private insurance for your visa application, then enroll in SNS once you have residency. Use private for fast specialist access, public for everything else.
Spain 🇪🇸
Public system (SNS): Universal through social security contributions (~€100/month for self-employed). One of Europe's best — fast specialist access, excellent hospitals.
Private insurance: ~€100-200/month. Sanitas, Adeslas, and DKV are major providers. Required for Non-Lucrative and Digital Nomad visas.
Wait times: Public GP: same week. Specialist: 2-8 weeks. Emergency: immediate.
Verdict: Spain's public system is excellent and faster than Portugal's. Enroll through social security if you're working/self-employed. Private insurance as supplement.
Germany 🇩🇪
Public system (GKV): Mandatory for employees earning under €69,300/year. Comprehensive coverage including dental. Costs: 14.6% of income, split with employer.
Private system (PKV): Available for self-employed and high earners. Starts at ~€250/month for young, healthy applicants. Better coverage but premiums increase with age.
Verdict: If employed in Germany, you'll be automatically enrolled. Self-employed expats choose between public and private — get professional advice, as switching from private to public later is very difficult.
Thailand 🇹🇭
Public system: Available but primarily Thai-language and often crowded. Quality varies.
Private hospitals: World-class (Bumrungrad, Bangkok Hospital, Chiang Mai Ram). A GP visit costs $20-40. Full health checkup: $100-200.
Private insurance: Required for retirement and LTR visas. Plans from AXA, Pacific Cross, or Thai-based insurers start at $100-200/month. Bumrungrad offers its own insurance plans.
Verdict: Skip the public system — go private. It's so affordable that private coverage + out-of-pocket costs are still dramatically cheaper than US healthcare.
Mexico 🇲🇽
Public system (IMSS): Open to legal residents for ~$600/year. Covers most needs but wait times can be long and facilities basic.
Private insurance: $80-200/month. GNP Seguros, AXA Mexico, MetLife Mexico.
Verdict: Many retirees enroll in IMSS as a safety net ($50/month) and use private doctors for routine care (GP visit: $30-50). Dental care is exceptional and cheap — a cleaning costs $30-50.
Italy 🇮🇹
Public system (SSN): Excellent and affordable. Legal residents can enroll by paying ~€2,000/year in voluntary contributions. Covers GP, specialists, hospital, prescriptions.
Private insurance: €100-200/month. Required for digital nomad visa. Generali, UniSalute, and Allianz are popular.
Wait times: GP: 1-3 days. Specialist: 2-8 weeks (public) or days (private). Emergency: immediate.
Verdict: Private insurance for your visa, then SSN enrollment once you have residency. The €2,000/year public enrollment is exceptional value.
Malaysia 🇲🇾
Public system: Available to citizens and permanent residents. Very affordable but crowded.
Private hospitals: Excellent and affordable. A GP visit costs $15-25. Major surgery: 50-80% less than the US.
Private insurance: Required for MM2H visa. $100-200/month from AIA, Prudential, or international providers.
Verdict: Private all the way. Malaysian private healthcare is world-class and still affordable.
Colombia 🇨🇴
Public system (EPS): Available to legal residents. Contributions based on income (12.5%). Covers comprehensive care.
Private insurance (Prepaid Medicine): $80-150/month. Faster access, better facilities. Colsanitas and Coomeva are major providers.
Verdict: Enroll in EPS for comprehensive base coverage, add prepaid medicine for faster access to better facilities.
How to Choose Your Plan
Step 1: Check Visa Requirements
Many countries require health insurance for visa applications. Check the minimum coverage amount — it's often €30,000 in EU countries.
Step 2: Bridge with International Insurance
Use international insurance (Cigna Global, Allianz, SafetyWing) for your first 3-6 months while you sort out residency.
Step 3: Enroll in Local Systems
Once you have legal residency, enroll in the public healthcare system if available. This is almost always the best value long-term.
Step 4: Keep Private as Supplement
Many expats maintain cheap private insurance alongside public enrollment — for faster specialist access and dental/vision coverage.
Common Mistakes to Avoid
- Using travel insurance as health insurance — it doesn't cover routine care, pre-existing conditions, or ongoing treatment
- Not enrolling in public systems — many expats pay for expensive private insurance when they could join excellent public systems for nearly free
- Ignoring dental — many basic plans exclude dental. Budget separately or get a plan with dental coverage
- Forgetting prescriptions — if you take regular medication, verify it's available (and what it costs) in your destination country before moving
- US Medicare doesn't work abroad — if you're a US retiree, you need separate coverage
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