Living abroad as a U.S. citizen offers incredible opportunities for personal growth, career advancement, and lifestyle enhancement. However, one of the most critical aspects of expat life is ensuring you have proper health insurance coverage.  

Unlike domestic U.S. health plans, international insurance must account for varying healthcare systems, language barriers, emergency medical evacuations, and potential gaps in coverage when returning to the States. 

This comprehensive guide will explore: 

1. The 7 Best Health Insurance Plans for U.S. Expats – Detailed breakdowns of coverage, costs, pros, and cons 
2. Comparison Table – Side-by-side analysis of all providers 
3. Top Destinations for American Expats – Where U.S. citizens are moving most 
4. Citizenship by Investment Programs – Countries where Americans can obtain residency or citizenship through real estate or investment 
5. Key Factors in Choosing Expat Insurance – What to consider before buying 

Why U.S. Expats Need Specialized Health Insurance 

Medicare Doesn’t Work Abroad 

• Medicare does not cover medical expenses outside the U.S. (except in rare border emergencies). 
• Some Medicare Advantage plans offer limited foreign travel coverage, but it’s usually insufficient for expats or long-term immigrants or foreign residents in other countries. 

Employer-Based Plans Often Lack Global Coverage 

• Most U.S. employer health plans do not extend overseas beyond short-term travel. 
• Even if they do, they may not include emergency medical evacuation or local direct billing. 

Healthcare Quality Varies Dramatically 

• Some countries (like Germany or Singapore) have excellent public healthcare, while others (like Thailand or Mexico) rely on private hospitals for expats and foreigners. I personally had to use hospitals in Thailand and I was lucky my travel insurance at the time covered it since I was just traveling for tourism.  
• Without insurance, a single medical emergency could cost tens of thousands. 

Emergency Evacuation is Crucial 

• If you’re in a remote area or a country with limited healthcare, medical evacuation to a better facility can cost $100,000+. 
• Many standard travel insurance plans do not cover long-term expats. 

How I Evaluated the Best Insurance Plans 

We compared insurers based on: 

✅ Global Coverage – Does it work in multiple countries? 
✅ Plan Flexibility – Can you customize deductibles and add-ons? 
✅ Pre-Existing Condition Coverage – Are chronic illnesses covered? 
✅ Emergency Services – Does it include evacuation and repatriation? 
✅ Cost vs. Benefits – Is the premium worth the coverage? 
✅ Customer Support – 24/7 assistance and multilingual help? 

The 7 Best International Health Insurance Plans for U.S. Expats 

Note: I always recommend that you quote with all the companies mentioned below. This way you can have a precise cost based on your age, gender, coverage length and destination. These 15 minutes you are going to “wast” quoting different plans might save you a lot of money! 

1. Cigna Global

Overview: 
Cigna is a top choice for expats who need reliable, high-quality global coverage. 

Pros: 
✔ 1.65M+ hospitals & doctors worldwide 
✔ Customizable plans (Silver, Gold, Platinum) 
✔ Optional dental & vision 
✔ 24/7 customer support 

Cons: 
✖ Could be Expensive compared to regional insurers 
✖ Pre-existing conditions may require extra underwriting 

Best For: Expats who want full global coverage with flexibility. 
Price: $$$$ (~$200–$800/month) 

I used Cigna myself when studying is Sweden. It was compulsory for me to have international health insurance coverage.  

2. IMG (International Medical Group) – Best Budget Global Plan 

Overview: 
A cost-effective option for expats who need basic but reliable coverage. 

Pros: 
✔ Lower premiums than Cigna/Allianz 
✔ Emergency evacuation included 
✔ Covers acute pre-existing conditions 

✔ They also have travel insurance that I use often 

Cons: 
✖ Smaller network in some regions 
✖ Some plans exclude routine care 

Best For: Expats who want affordable emergency coverage. 
Price: $$-$$$ (~$100–$400/month) 

3. Now Health International – Best Mid-Range Expat Insurance 

Overview: 
A well-balanced option for expat families and individuals. 

Pros: 
✔ Competitive pricing 
✔ Direct billing with hospitals 
✔ Preventive care included 

Cons: 
✖ Not as well-known as Cigna/Allianz 
✖ Pre-existing conditions may be excluded 

Best For: Expats who want good coverage without premium costs. 
Price: $$$ (~$150–$500/month) 

4. Allianz Worldwide Care – Best for High-End Expat Coverage 

Overview: 
A top-tier insurer for expats who want the best global protection. 

Pros: 
✔ Extensive hospital network 
✔ Multi-lingual support 
✔ Strong financial stability 

Cons: 
✖ Higher premiums 
✖ Complex claims process 

Best For: Expats who prioritize brand reliability. 
Price: $$$$ (~$300–$800/month) 

5. Safety Wing – Best for Digital Nomads 

Overview: 
A flexible, subscription-based plan for remote workers. 

Pros: 
✔ Affordable (~$40–$120/month) 
✔ Includes limited coverage for U.S. visits 
✔ Cancel anytime 

Cons: 
✖ Not as comprehensive as traditional expat insurance 

Best For: Digital nomads & frequent travelers. 
Price: $ (~$40–$120/month) 

6. Foyer Global Health – Best for Europe & Middle East 

Overview: 
A strong regional option for expats in Europe/GCC. 

Pros: 
✔ Great coverage in Europe & Middle East 
✔ Emergency evacuation included 

Cons: 
✖ Less known in the U.S. market 

Best For: Expats in Europe or the Gulf. 
Price: $$$ (~$200–$600/month) 

7. Global Underwriters – Best for Short-Term Coverage 

Overview: 
A temporary solution for expats needing emergency protection. 

Pros: 
✔ Affordable short-term plans 
✔ Quick application 

Cons: 
✖ Not ideal for long-term expats 

Best For: Short-term expats & travelers. 
Price: $-$$ (~$50–$300/month) 

Comparison Table: Best Expat Health Insurance 

Provider	Best For	Coverage Area	Pre-Existing Conditions	Emergency Evacuation	Price Range
Cigna Global	Comprehensive global care	Worldwide	Limited coverage	✅ Yes	$$$$
IMG	Budget global coverage	Worldwide	Acute onset covered	✅ Yes	$$-$$$
Now Health	Mid-range expat plans	Worldwide	Limited coverage	✅ Yes	$$$
Allianz Worldwide	High-end expat coverage	Worldwide	Case-by-case	✅ Yes	$$$$
Safety Wing	Digital nomads	Worldwide (some U.S.)	Limited coverage	✅ Yes	$
Foyer Global	Europe & Middle East	Worldwide	Medical underwriting	✅ Yes	$$$
Global Underwriters	Short-term coverage	Worldwide	Limited coverage	✅ Yes	$-$$

Top 10 Countries Where Americans Are Moving 

1. Mexico – Affordable, close to the U.S., strong expat communities. 
2. Portugal – Golden Visa, low cost of living, great healthcare. 
3. Spain – Vibrant culture, excellent healthcare, residency options. 
4. Costa Rica – Stable democracy, “Pura Vida” lifestyle. 
5. Canada – Similar culture, strong economy, easy for remote workers. 
6. Thailand – Low cost of living, great food, digital nomad hubs. 
7. Panama – Pensionado Visa, tax benefits, tropical living. 
8. France – High quality of life, excellent healthcare. 
9. Italy – Affordable countryside homes, “Dolce Vita” lifestyle. 
10. UAE (Dubai) – Tax-free income, luxury living. 

Citizenship by Investment or Property Purchase 

Several countries offer residency or citizenship through investment or real estate: 

1. Portugal (Golden Visa) 

• Investment: €250,000–€500,000 in real estate. 
• Benefits: Visa-free EU travel, path to citizenship. 

2. Spain (Golden Visa) 

• Investment: €500,000 in property. 
• Benefits: EU residency, eventual citizenship. 

3. Greece (Golden Visa) 

• Investment: €250,000 in real estate. 
• Benefits: Schengen Zone access. 

4. Malta (Citizenship by Investment) 

• Investment: €690,000+ (donation + real estate). 
• Benefits: EU passport, visa-free global travel. 

5. Caribbean (St. Kitts, Antigua, Grenada) 

• Investment: $100,000–$200,000 (donation or real estate). 
• Benefits: Visa-free travel to Europe/UK, tax advantages. 

6. Turkey (Citizenship by Investment) 

• Investment: $400,000 in property. 
• Benefits: Fast passport (6 months), visa-free travel. 

7. UAE (Dubai Golden Visa) 

• Investment: ~$270,000 in property. 
• Benefits: 10-year residency, tax-free living. 

Final Verdict: Choosing the Best Expat Health Insurance 

• Best Overall: Cigna Global (most comprehensive) 
• Best Budget Option: IMG or Safety Wing 
• Best for Europe/Middle East: Foyer Global Health 
• Best for Digital Nomads: Safety Wing 
• Best for Short-Term Coverage: Global Underwriters 

Before choosing, compare quotes and read reviews. The right plan ensures peace of mind while living abroad! I had the opportunity to live in 12 different countries and I can attest, it’s a fantastic experience. But don’t let your dream become a nightmare because of unpaid medical bills! 

Safe travels!!