RelocateCompassInternational Health Insurance for Expats: What You Need to Know
Types of expat health insurance, what to look for in a plan, and country-by-country visa requirements and costs for Spain, Portugal, Germany, Australia, the USA, Malaysia, Thailand, the UAE, and the UK.
Health insurance is non-negotiable when living abroad. It’s required for most long-stay visas, and getting the wrong policy can cost you thousands in uncovered medical bills — or even a visa rejection. This guide explains the types of expat health insurance, what to look for, and country-by-country requirements for nine destinations.
Types of health insurance for expats
1. International Private Medical Insurance (IPMI) — the gold standard for expats. Covers you globally, including in your home country. Ideal for digital nomads, expats on non-lucrative or passive income visas, and families needing comprehensive coverage. Top providers: Cigna Global, Aetna International, AXA PPP International, Allianz Care. Pros: global coverage, English-speaking support, direct billing. Cons: more expensive (€150–500/month).
2. Local health insurance — a policy from an insurer based in your destination country, required by law for many visa types (Spain NLV, Portugal D7, Germany). Cheaper and meets visa requirements, but only covers you in that country.
3. Public healthcare access — in many countries, once you have legal residency and contribute to social security, you gain access to public healthcare.
| Country | Public healthcare? | Quality | Wait times |
|---|---|---|---|
| Spain | Yes (after empadronamiento) | Good | Moderate (2–6 weeks for specialists) |
| Portugal | Yes (after registering at health centre) | Good | Moderate to long |
| Germany | Yes (mandatory GKV, ~€400/mo) | Excellent | Short |
| UK | Yes (NHS, free for residents) | Good | Long (3–6 months non-urgent) |
| Australia | Yes (Medicare, if reciprocal) | Excellent | Short |
| USA | No universal public system | Excellent (private) | Short (if insured) |
| UAE | No (employer must provide) | Excellent | Short |
| Thailand | Yes (UCS for residents) | Variable | Long in public hospitals |
| Malaysia | Yes (public, but expats rarely use) | Variable | Long in public |
What to look for in an expat health plan
- ✅ No co-payment / no deductible — required for Spain’s NLV
- ✅ Minimum coverage amount matching your specific visa
- ✅ Emergency medical evacuation — essential in Thailand and Malaysia
- ✅ Pre-existing conditions coverage — many plans exclude these
- ✅ Mental health coverage
- ✅ Maternity coverage, often with a 10–12 month waiting period
- ✅ Direct billing — the insurer pays the hospital directly
- ✅ Repatriation coverage — transport home for serious treatment
Country by country
🇪🇸 Spain
Visa requirements: Non-Lucrative Visa and Digital Nomad Visa both need full coverage with no co-payments and no deductibles, from a Spanish-registered insurer. International plans like Cigna Global are not accepted — you need the Spanish subsidiary.
| Insurer | Plan | Monthly cost (30–40) | Co-payment? |
|---|---|---|---|
| Sanitas | Mas Total | €60–120 | No |
| AXA España | Optima Selecta | €80–150 | No |
| Adeslas | Médico Total | €55–100 | No |
| Asisa | Asisa Salud | €50–90 | No |
| Cigna España | Cigna Vital | €70–130 | No |
Your insurer must be registered with the Spanish DGS (Dirección General de Seguros). Once you have your TIE and are empadronado, you can access the public SNS system, though specialist wait times run 2–6 weeks. Buy insurance before your visa appointment — even a €5 co-pay gets a policy rejected. See the Spain Non-Lucrative Visa guide for full visa details.
🇵🇹 Portugal
Visa requirements: D7 and D8 visas both require private health insurance with minimum coverage of €30,000+.
| Insurer | Plan | Monthly cost (30–40) |
|---|---|---|
| Médis | Coração/Mental | €40–80 |
| Multicare | Saúde Prime | €35–70 |
| Fidelidade | Saúde | €45–90 |
| Cigna Portugal | Cigna Saúde | €50–100 |
Portugal’s SNS is available to legal residents after registering at a local centro de saúde — quality is good, but specialist wait times can run 1–3 months. Portuguese consulates are generally less strict than Spanish ones about co-payments, but a no-co-pay plan is still safest.
🇩🇪 Germany
Health insurance is mandatory for all residents — no opt-out — and you need it before registering your address (Anmeldung).
| Feature | Public (GKV) | Private (PKV) |
|---|---|---|
| Cost | ~€220–400/mo (employer splits 50% if employed) | €300–800/mo (varies by age, health) |
| Coverage | Standardised by law | Customisable, often more comprehensive |
| Pre-existing conditions | Covered | May be excluded or surcharged |
| Family coverage | Free for spouse/children (if not employed) | Each person needs own policy |
| Best for | Employees, families, freelancers under €69,300/yr | High earners, self-employed, young & healthy |
Top public insurers (Krankenkassen): TK, AOK, Barmer, DAK-Gesundheit. Top private insurers: Allianz, AXA Konzern, HanseMerkur, Debeka. Freelancers can choose between public and private, but switching from private back to public is very difficult — private is cheaper when young but becomes expensive at 50+.
🇦🇺 Australia
Medicare is Australia’s universal public system, funded by a 2% tax levy, covering free public hospital treatment, bulk-billed doctor visits, and subsidised medicines (PBS). Access is limited to citizens, permanent residents, New Zealand citizens, and some temporary visa holders from countries with a Reciprocal Health Care Agreement (RHCA — UK, Ireland, Italy, Malta, and others), usually for emergency and essential treatment only.
Private insurance is encouraged but not mandatory; a Medicare Levy Surcharge of 1–1.5% applies to high earners without private hospital cover.
| Type | Monthly cost | Covers |
|---|---|---|
| Hospital cover | A$100–250 | Private hospital, choice of doctor, shorter waits |
| Extras (ancillary) | A$50–150 | Dental, optical, physio, mental health |
| Combined | A$150–400 | Both |
Top providers: Bupa Australia, Medibank, HCF, NIB. If you’re on a 482 or 491 visa, check whether your country has an RHCA — some visa conditions (8501) require proof of insurance.
🇺🇸 United States
The USA has no universal public healthcare — without insurance, a hospital visit can cost tens of thousands of dollars.
| Type | Monthly cost (30–40) | Best for |
|---|---|---|
| Employer-sponsored | $50–200 (employee share) | Most employees — employer pays 70–80% |
| ACA Marketplace | $300–600 (before subsidies) | Self-employed, freelancers |
| Short-term plans | $100–300 | Temporary coverage (limited benefits) |
| International IPMI | $200–500 | Digital nomads, short-term residents |
Key concepts: premium (monthly payment), deductible (amount paid before insurance kicks in, $500–$5,000+), copay (fixed per-visit fee), out-of-pocket maximum (legally capped around $9,450 in 2026), and network (staying in-network avoids huge bills). If employed, always take the employer plan — it’s the cheapest option. Pre-existing conditions are covered under the ACA.
🇲🇾 Malaysia
Malaysia has both public and private healthcare, but expats almost always use private — public hospitals have long queues and limited English support, while private hospitals are excellent and affordable by Western standards.
Visa requirements: MM2H needs medical insurance valid in Malaysia (~RM 150,000/year recommended); Employment Pass requires employer-provided insurance; DE Rantau requires medical insurance.
| Service | Private hospital cost |
|---|---|
| GP consultation | RM 80–150 |
| Specialist consultation | RM 150–300 |
| One night in hospital | RM 500–1,500 |
| Emergency appendectomy | RM 8,000–15,000 |
| Childbirth (normal delivery) | RM 4,000–8,000 |
Top insurers: AXA Affin, Great Eastern, AIA Malaysia, Prudential. Even without insurance, costs run 3–5x lower than the USA or Australia.
🇹🇭 Thailand
Thailand has excellent private hospitals, particularly in Bangkok (Bumrungrad, Bangkok Hospital, Samitivej), rivaling Western quality at a fraction of the cost.
Visa requirements: the LTR Visa needs mandatory insurance with minimum $50,000 coverage (or proof of funds to self-insure); the Retirement Visa (O-A) needs minimum $100,000 coverage.
| Service | Private hospital cost |
|---|---|
| GP consultation | ฿500–1,500 |
| Specialist consultation | ฿1,000–2,500 |
| One night in hospital | ฿3,000–8,000 |
| Emergency appendectomy | ฿50,000–120,000 |
| Childbirth (normal delivery) | ฿40,000–80,000 |
Top insurers: Luma Thailand Pass, April International, Pacific Cross, Bupa Global, Cigna Global. Emergency medical evacuation is essential — quality care outside Bangkok is limited. See the Thailand LTR Visa guide for details.
🇦🇪 UAE
The UAE mandates health insurance for all residents, with rules varying by emirate. In Dubai, employers must provide insurance to all employees; dependents must be covered by the sponsor. Health insurance is directly linked to your visa — you cannot get a residence visa without proof of coverage.
| Tier | Monthly cost | Covers |
|---|---|---|
| Basic (Daman Basic, Dubai SAAD) | AED 50–100 (often free via employer) | Essential, limited network |
| Enhanced | AED 200–400 | Better network, lower co-pays |
| Premium / International | AED 500–1,500 | Full coverage, international, top hospitals |
Top providers: Daman, Oman Insurance (Aetna), Bupa Arabia, AXA Gulf, MetLife. Your employer is legally required to provide at least basic insurance — don’t pay for it yourself unless you want better coverage.
🇬🇧 United Kingdom
The NHS is free at the point of use for all legal residents — you don’t need private insurance, though many choose it for faster access. Most visa applicants pay the Immigration Health Surcharge (~£1,035/year) as part of their application, funding NHS access during their stay. Register with a GP after arrival — this is your entry point to all NHS services and gets you an NHS number.
| Service | Average wait (2026) |
|---|---|
| GP routine appointment | 1–2 weeks |
| Specialist referral (non-urgent) | 3–6 months |
| Planned surgery (non-urgent) | 3–9 months |
| Emergency department | 4–8 hours |
Many expats buy private insurance to bypass NHS waiting lists: Bupa UK (£30–80/mo), AXA PPP Healthcare (£30–75/mo), Vitality (£35–80/mo), Aviva (£30–70/mo). The IHS fee is non-refundable even if you never use the NHS.
Cost comparison by country
| Country | Public system? | Local private insurance (monthly) | International IPMI (monthly) |
|---|---|---|---|
| Spain | Yes | €50–150 | €150–400 |
| Portugal | Yes | €35–90 | €150–350 |
| Germany | Yes (mandatory) | €220–400 (public) | €300–800 (private) |
| Australia | Yes (Medicare) | A$100–250 | A$200–500 |
| USA | No | $300–600 | $200–500 |
| Malaysia | Yes (limited) | RM 180–400 | $150–350 |
| Thailand | Yes (UCS) | $60–150 | $150–400 |
| UAE | No (private only) | AED 50–400 | AED 500–1,500 |
| UK | Yes (NHS) | £30–80 (optional) | £150–400 |
Pro tips from experienced expats
- Buy insurance before your visa appointment — most consulates want a certificate of coverage upfront
- Check the consulate’s accepted insurer list, especially for Spain and Portugal
- Ensure “no co-payments, no deductibles” — even a small co-pay can get a Spain NLV application rejected
- Include emergency evacuation coverage — essential in Thailand and Malaysia
- Declare pre-existing conditions honestly — undeclared conditions can void your entire policy
- In the UAE, your employer must provide insurance — don’t pay for basic coverage yourself
- In Germany, private (PKV) is cheaper when young but expensive later — think long-term before switching
- In the USA, always take the employer plan if offered
- Register with a local GP immediately in the UK — it’s your gateway to all NHS services
- Keep digital copies of your policy for hospitals and visa renewals
Choose your health insurance based on visa requirements first, then cost and coverage. A plan that gets your visa rejected is worse than no plan at all.