U.S. Expats: Know Your Healthcare Responsibilities

No matter where you go, it will be different than in the U.S.

As U.S. expats, Americans move to other countries for many reasons. One of them may be the high cost of healthcare in the U.S., where insurance premiums and deductibles take an average of 11.5% of the US median income, based on averages during 2008-2020. For seniors and retirees, healthcare costs take 12% – 13% of their monthly income. 

Of course, in places where workers make less, the percentage of their income spent on healthcare increases. For example, workers in Mississippi spend an average of 19% of their incomes on medical costs. 

The average annual U.S. healthcare insurance premiums in 2022 are $7,911 for single coverage and $22,463 for family coverage. The average family premium has increased 20% since 2017 and 43% since 2012. 

Your age will affect the size of monthly premium. Forty-year-olds average $477 per month, while 60-year-olds pay about $970. To monthly premiums, add amounts paid for the deductible portion of the bill: annual individual deductibles averaged $1,669 in 2021. Even after reaching their deductible, most insured have other forms of out-of-pocket health costs in the form of co-payments and co-insurance for health services or prescription drugs. 

For those who are looking at becoming U.S. expats and need or want excellent, accessible, affordable healthcare as  U.S. expats, read on. 

First, clarify for yourself the services you need most.  

Are you young and/or healthy? Don’t take many medications and have no chronic illnesses? You may need just accident or emergency coverage. More comprehensive coverage is needed if your health is deteriorating or if a chronic illness runs in the family. If your family will move with you, think about each of their needs as well. 

Know the costs in advance to avoid surprises. 

Keep in mind that a premium refers to a regular payment you make every month, regardless of whether or not you’ve made an insurance claim. 

A deductible, on the other hand, is the money you need to pay for any given medical procedure before your insurance plan kicks in. In general, higher premiums mean lower deductibles. 

Are prescription medications included in the insurance plan? What else might you use that will increase your monthly healthcare spending? 

Public vs Private international health insurance 

Research what is available to you as an expat in the country you’re moving to. Pay special attention to the country’s public, compared to private, insurance, access and coverage. U.S. citizens not on Medicare aren’t used to the public option, and it can be a great choice for saving money, if your situation allows it. National public health insurance may be offered depending on your visa type, residency status, work status, length of stay, etc.

As you read through the different requirements in various countries, you’ll find that as an expat, you may need some type of private, international health insurance. You might use it until you’re eligible for the country’s public plan, or as supplemental insurance in addition to the public plan to pay for non-covered expenses such as prescriptions, eye tests and dentistry, or as a step up from what’s offered through public plans.

There are plans available for individuals and families. Once you have your policy in place, you have the freedom to select a doctor or hospital that best suits your needs. You will also be covered by your policy for medical treatments and receive many extra benefits that can give you added peace of mind.

What you will find in several of the most popular expat destinations 


Mexico has a 3-tiered healthcare system. The first is public insurance through IMSS for all private and public employees, who pay a premium directly from their paycheck. The Seguro Popular covers the unemployed, the homeless, and those with exclusionary or pre-existing medical conditions. The final tier is private insurance. Most expats prefer private hospitals in Mexico as they offer some of the best facilities, English-speaking staff, and healthcare services in the world. 

The top private hospitals in Mexico are accompanied by expensive medical bills. Check on getting expat medical insurance while staying in the country. Mexico’s premiums increased by 28% for individual plans in 2021, making it the highest increase witnessed by any location. It’s worth noting that premiums for family plans only increased by six percent. 

United Kingdom 

The U.K. ranked 10th overall in the 2021 World Index of Health Innovation. The National Health Service is different from the systems in many other countries. Services vary for U.K. citizens and for visitors and citizens of other countries living in the United Kingdom.  

One challenge about the healthcare system in the U.K. is that healthcare differs in different regions of the country. England, Northern Ireland, Scotland and Wales each have their own NHS healthcare system. For example, if you live in London, England for six months and you are on the NHS, you will pay £9.35 per prescription item. If you relocate to Edinburgh, Scotland, you will now be in a different UK health care system. Your prescription items will be free. 

But due to long wait times, more and more U.K. citizens are going private – and U.S. expats can consider this as well. Nearly 11% of the English population owns private health insurance. Private insurance allows for faster access to care, especially for elective hospital procedures. 


There is no one centrally managed Canadian healthcare system. Instead, Canada’s 13 provinces and territories each administer their own separate public healthcare systems. All are required to cover medically necessary treatments, but their definitions of what is “medically necessary” can differ. 

For Canadian citizens, permanent residents, and other eligible persons who have enrolled in their province or territory’s version of Medicare, healthcare is free, with exclusions. 

Your individual situation may or may not make you eligible for the public Canadian Medicare program. Even if you qualify for this healthcare, not all medical services are covered. You may need to add on private insurance to cover dental care, vision care, and prescription drug coverage. 

If you do not have access to the public healthcare system, you will need to pay for your healthcare, either out of pocket or by signing up for a private insurance plan. 


Australia has reciprocal healthcare arrangements with many other countries. Even if citizens of these countries don’t yet have permanent residency, they are eligible for most kinds of basic public healthcare.   

Public healthcare in Australia is provided through Medicare. Expatriates living in Australia, including workers and students, pay for their own health care using cash or private health insurance. People who are not eligible for Medicare can apply for an exemption from paying the Medicare tax or for a reduction in the amount they pay. 

People moving to Australia can carry their own private global health insurance policy to cover their healthcare costs and supplement the services that public Medicare doesn’t cover, as do half of all Australians. 


Spain’s universal healthcare system, Sistema Nacional de Salud (SNS), allows U.S. expats who are permanent residents to be part of the public healthcare system. That includes people who have an employer or who are self-employed and contribute to social security. It also includes those under 26 years old who are students. As well, EU and UK senior citizens are automatically eligible for SNS coverage when they are permanently living in Spain. 

For those in the process of relocating to Spain but aren’t yet eligible for public health insurance coverage, you must have your own private health coverage in the meantime. The Spanish government has a private state insurance program, Convenio Especial, for a modest monthly fee. 

You can also choose to use private international medical insurance, and receive a higher level of service and convenience at hospitals and clinics. Private insurance also grants shorter wait times and greater privacy. 


All German residents must be insured for hospital and outpatient medical treatment, and it is mandatory to show proof of health insurance when applying for a German visa.  

Both EU and non-EU nationals working in Germany are subject to compulsory state health insurance (known as statutory sickness insurance, or gesetzliche Krankenversicherung, GKV). All U.S.expats who are employed are automatically insured by the public health system. You’ll notice a small portion of your salary is deducted for tax purposes which goes towards your social contributions. Your employer also pays for half of your contributions. 

Higher earners must sign up for private health insurance, which can offer shorter wait-times and better hospital conditions. PKV is private insurance that a small portion of people choose for a greater level of service. Participants are required to have an income which is greater than €57.600 per year, or €4.800 per month. 


The French healthcare system is the world’s best, according to the World Health Organization.  If you are a legal resident, you are eligible for public healthcare coverage, regardless of your employment status. Senior citizens and those with chronic illnesses are covered for 100% of their medical costs. 

The ‘Protection Universelle Maladie’ or PUMA law allows anyone residing in the country access to public healthcare. In order for U.S. expats to qualify as a resident, you need to have lived in the country for at least three consecutive months and be a permanent resident. 

The French system covers about 77% of healthcare costs, including general practitioners, hospitals, dentists, and pharmaceutical costs. Most of the rest is covered by supplemental health insurance, 

But some things are not covered, which is one reason that 95% of the French population also carries private insurance and many expatriates have expat medical insurance. Private health insurance can also pay for services that require substantial out-of-pocket payments from patients, such as dentistry and vision. It can also cover the remaining 30% of basic care costs that patients are expected to pay out of their pocket as a co-pay when they use the public system. 

The views expressed in this article are not to be construed as personal advice. You should contact a qualified and ideally regulated adviser in order to obtain up-to-date personal advice with regard to your own personal circumstances. If you do not then you are acting under your own authority and deemed “execution only”. The author does not accept any liability for people acting without personalised advice, who base a decision on views expressed in this generic article. Where this article is dated then it is based on legislation as of the date. Legislation changes but articles are rarely updated, although sometimes a new article is written; so, please check for later articles or changes in legislation on official government websites, as this article should not be relied on in isolation. 



Susan Austin

Susan Austin is a freelance writer living in Prague, Czech Republic. Originally from the U.S., she has written and worked in many industries, including healthcare, transportation, travel and leisure, museums, education, and archaeology.

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