Health Insurance for Expats 2026: 3 Options Compared

Short answer: When you move abroad for good, your home coverage does not follow you. US marketplace plans only work inside the US, and free NHS care is tied to UK residency. From there you have three routes: the public system of your new country (Spain’s Convenio Especial runs about 60 euros a month), an international private expat policy (roughly 120 to 500 dollars monthly depending on age), or a nomad insurance subscription from around 50 dollars. Retirees and families usually do best with the local system or a full expat policy. Nomads without a base take the subscription. Pick based on how fixed your address is.

Travel insurance for a two-week trip is a solved problem. Moving abroad is a different animal. The day you give up your home residency, the safety net you grew up with quietly switches off. Many expats find out via a hospital invoice with four digits and nobody behind it.

This guide sorts the options for 2026. You get the three realistic routes, real numbers from Spain, Austria, Costa Rica and Mexico, and a decision grid by profile. If you only need cover for short trips, read our travel health insurance guide instead.

What happens to your US or UK coverage when you move abroad?

If you are American: ACA marketplace plans cover care inside the United States, so keeping one while living in Lisbon buys you almost nothing. COBRA continuation has the same problem, you pay full price for a network you can no longer reach. Medicare does not cover routine care outside the US either. Most Americans abroad drop US coverage entirely and rebuild locally or internationally.

If you are British: the NHS is residency-based, not citizenship-based. Move abroad and your entitlement to free NHS care ends with your UK residency. Inside Europe there are coordination rules that can help in specific cases, for example UK state pensioners using the S1 route. The EU explains how responsibility is assigned on its official page about health insurance cover when living abroad: what counts is your economic status and where you live, not your passport.

Why is travel insurance not enough for a life abroad?

Travel policies are built for emergencies on a timer. They pay for the broken leg in Bangkok and the evacuation flight, but they are not health insurance. Three gaps hurt once you actually live somewhere. Preventive care and chronic conditions are usually excluded, so no checkups, no ongoing prescriptions, no maternity. Duration is capped, often at 365 days from departure. And many policies are only valid while you keep a residence back home.

There is a legal angle too. Many visas require proof of real health coverage. Spain rejects travel policies with deductibles for residency visas, and Costa Rica ties residency directly to its public insurance system. A holiday policy will not open those doors.

Option 1: The public system of your new country

The route most people underrate. Many countries let legal residents join the public system, voluntarily or by mandate. Four examples from our expat cluster, 2026 numbers:

Spain: The Convenio Especial gives residents without other entitlement full access to public healthcare for about 60 euros a month under 65 and around 157 euros from 65. You typically need 12 months of registered residence first, so plan private cover for year one. The full picture is in our guide to moving to Spain.
Costa Rica: Every resident must join the Caja (CCSS) and pay roughly 7 to 12 percent of declared income. In return your spouse and kids are covered at no extra cost and nobody asks about pre-existing conditions. See our guide to moving to Costa Rica.
Mexico: Residents can enroll voluntarily with IMSS. The annual fee is age-banded and modest, but IMSS excludes a long list of pre-existing conditions, so many expats pair it with a private policy.
Austria: Employees are covered automatically through the ÖGK. Without a job you can self-insure for 565.25 euros a month in 2026, reducible on application if your income is low. Details in our guide to moving to Austria.

Strengths: predictable costs, no age limits, family coverage, full access to the local system. Weaknesses: waiting lists for specialists, consultations in the local language, and sometimes a long runway before you qualify at all.

Option 2: International private expat health insurance

This is the full-service route: real health insurance without country borders, free choice of doctors and private hospitals. Providers like Cigna Global and Allianz price by age, region and modules. Realistic 2026 ranges: in your early thirties you start around 120 to 200 dollars a month depending on deductible, the average customer pays about 400 to 500 dollars, and adding US coverage roughly doubles the bill. Past 60, premiums climb fast.

For transition phases and flexible setups there is also a cheaper tier of international travel and expat policies, for example through EKTA, where you configure duration and coverage online. That works well as a bridge between leaving home and joining a local system, but it is not a substitute for lifelong cover.

One thing matters more than the brand: your entry point. Conditions you bring to the contract get excluded or surcharged. Someone who signs at 35 and stays insured does far better than the latecomer at 58.

Option 3: Nomad insurance by monthly subscription

SafetyWing and Genki built a model of their own: worldwide cover as a subscription, cancel monthly. In 2026 SafetyWing’s Essential plan starts around 63 dollars per 4 weeks for under-40s, while the Complete tier with full health coverage runs about 160 dollars a month. Genki starts near 53 euros monthly without US coverage and roughly doubles by your fifties.

Know the limits. The cheap tiers are emergency cover, not full healthcare. Preventive care, dental and chronic conditions are excluded or reserved for the expensive tiers. Some immigration offices refuse subscription policies as visa proof. And there are age caps: past 60 the options get thin and pricey. For the first years of nomad life, though, the model is hard to beat.

Which route fits which profile?

Find your row:

Retiree with a fixed destination: Local public system as soon as you qualify (Convenio Especial, Caja), plus a private top-up for short waiting times. Americans: remember that Medicare stays home. Brits: check the S1 route inside Europe before you go.
Digital nomad without a base: Nomad subscription (SafetyWing, Genki) as the foundation, reviewed yearly. Once one country becomes home base, migrate to the local system or a full expat policy.
Family with kids: Favor countries with family coverage baked in, Costa Rica is strong here. Otherwise price an international family plan, often cheaper than four individual contracts.
Employee with a job abroad: The easiest case, you join the work country’s system automatically (in Austria that is the ÖGK). Just check what is missing, typically dental and private hospital access.
Still choosing a country: Our comparison of the best countries for expats scores healthcare systems too, so read it before you run the numbers.

Rule of thumb: the more fixed your address, the more local your insurance. The more mobile your life, the more you lean on subscriptions or international cover.

Once your coverage is sorted, the fun part starts: planning the scouting trip, comparing flights, locking in a first place to stay. With Zercy you check options at live prices and save the best ones in your Zercy Logbook, so everything for the move sits in one place.

Frequently Asked Questions

How much does expat health insurance cost per month?

In 2026 the realistic range runs from about 50 to well over 500 dollars. Nomad subscriptions start around 50 to 65 dollars, Spain’s Convenio Especial costs 60 to 157 euros, and international expat policies land between 120 and several hundred dollars monthly depending on age, region and deductible.

What coverage do immigration offices accept for a visa?

Most consulates want a policy with no deductible, minimum coverage in the destination country, and sometimes a locally licensed insurer. Spain does not accept the Convenio Especial for visa applications, so you need private cover first. Always check your consulate’s current list before buying.

When does the local public system beat a private policy?

As soon as you are staying long term and can qualify. Public systems have no age limits and no exclusions for pre-existing conditions, which grows more valuable every year. Private policies win on short waits and hospital choice but get expensive or unavailable in old age.

Why should Americans drop their US plan when moving abroad?

Because ACA marketplace plans and most employer plans only pay for care inside the US network. You would pay full premiums for coverage you cannot use, while still needing insurance where you actually live. The standard play is to end the US plan at departure and rebuild with local or international cover.

Read more:

Health Insurance for Expats and Long-Term Travelers 2026: What You Actually Need