Choosing Supplemental Coverage

Again, even though you may be eligible for free public health care, it won’t kick in immediately, and even when you get it, you might want a backup plan.

Bottom line, you have four options: an international policy, a local policy, a travel policy, or no policy at all.

This fourth option can be more reasonable than it may seem, depending on where you decide to relocate and spend your time. In some countries, medical care is so affordable that it can make sense to pay for it as you need it, rather than to insure against it. Most people, though, most places in the world, feel more comfortable knowing that they’re covered in case of medical emergency or, certainly, calamity.

Not everyone is comfortable going naked, as it were.

This means you’ve got to decide whether you want an international policy, a travel policy, or a local, in-country one.

One of the main advantages of an international health insurance policy is that it can cover you under all circumstances anywhere in the world, making it a good option if you intend to travel regularly beyond your chosen overseas haven; if your overseas plan is to move around among two or three countries; or if you intend never to settle anywhere but to roam the world perpetually, discovering and exploring as your wanderlust dictates.

An international policy also can be a good option if you’re an American and intend to divide your time between your chosen overseas haven and the United States, because it can be possible to purchase an international health policy that will also cover you when you return or pass through Stateside.

This is the kind of coverage Lief and I have opted for. Our international policy covers us anywhere in the world, including in the United States when we visit. We’re paying extra for this, as the United States is the most expensive place in the world to obtain medical care. Given our lifestyles and travel schedules, though, we decided recently to make this additional investment.

All that said, an international health insurance policy has an important downside: It’s more expensive than a local one, perhaps substantially more expensive. Local medical insurance can cost less than US$100 a month. In some countries, depending on your age, less than US$50 a month.

It’s important, though, that you understand what you’re buying. Policy options, details of coverage, deductibles, and premium costs vary dramatically both country to country and agency to agency within a country.

In addition, local insurance providers accept new policyholders only through a certain age that is typically younger than the cut-off age for an international policy. In other words, depending on the country where you’re intending to relocate and your age, a local policy may not be an option. You may have no choice but to invest in a (more expensive) international policy if you want formal health coverage.

Note, too, that some in-country insurance companies allow you to renew your policy only until a certain age. Others offer lifetime coverage.

Here, then, is the thinking you should entertain as you consider your options for health insurance overseas:

First, do you want a local policy or an international one from a big company? There are pluses and minuses either way.

Second, if you intend to be only part-time in another country, spending only a limited time abroad each year, perhaps what you want is not health insurance but travel insurance.

Finally, depending on where you’re thinking about taking up residence as an expat, you could consider the option of going without insurance, period.

This is a very personal choice. The most important thing is that you can sleep at night. If the thought of going naked, as it were, sounds horrifying, don’t consider it.

However, we know a number of expats who do just that. Since these folks spend most of their time in places where the cost of medical care is extraordinarily low, they don’t worry about insuring against it.

What’s more, in some countries, once you become a permanent legal resident, you’re eligible for free health care. During our years living full-time in Ireland, for example, we enjoyed medical care at no cost, including coverage for the delivery of our son, Jack. This would be the case in France, too, if you qualify for full-time legal residency.

Which option is right for you? In short:

Local insurance is cheap but limited in its coverage. International insurance is more expensive (though less expensive than comparable coverage in the United States, for example) and should cover you anywhere you travel. What you decide to do depends on your age, your current health status, and your retirement plan.

Lief and I carry an international insurance policy with a high deductible. We’re still relatively young and healthy, and we move around a lot, typically in countries where health costs are low, so the high annual deductible isn’t a concern for us. We’ve decided that we don’t mind paying as we go for ordinary medical care (our son’s sore throats, for example, and Lief’s two dislocated shoulders). However, we want to be covered in the event of a medical catastrophe anywhere in the world. That’s what our high-deductible international policy allows for.

Most countries have both public and private health care facilities. Public health care systems (also called social security systems in many countries), especially in developing nations, typically offer a lesser standard of care than you are probably accustomed to. If you are traveling to (or living in) a country that does offer private health care, we recommend that as your number-one option for medical and emergency treatment.