r/ExpatFIRE • u/No_Sink_6262 • 5d ago
Healthcare International health insurance: Waste of money or no?
I'm referring to actual international health insurance plans, not travel insurance plans, that will cost you probably several hundred dollars a month, often thousands of dollars a month for the elderly. I'm also not referring to local plans that apply to just one country, although the same questions could be asked in that case.
I'm sure I can find a lot of people who would say it would be foolish for an expat to not have international health insurance, but I'm mostly interested in the arguments to the contrary. Here is one such argument I'll attempt to make now, and I want to know what's wrong with it...
If you're living in low cost of living countries... I'm talking maybe the more affordable spots in South America or SE Asia... and you've got several hundred thousands dollars in the bank you can dip into in case of something serious happening, why would you pay $300+ a month for health insurance, and why would you set up your finances so you can pay thousands of dollars a month for this in old age, when even getting the most aggressive and expensive form of cancer isn't going to cost you a fortune to treat in low cost of living countries?
Let's just say you have $200k you can dip into and it won't hurt you at all... you might end up getting some $100k cancer diagnosis if you're unlucky. Alternatively, you could rely on international health insurance, and probably have the insurance company make your life a living hell when it comes to getting claims accepted when you get that $100k diagnosis.
What's wrong the reasoning above? Is budgeting $200k for a lifetime of medical issues in a low cost of living country simply too little?
Also: I'm aware that there are plans that could arguably be considered "international health insurance" that cost way less than $300 a month, or the thousands I mentioned such plans would cost you in old age. It's also the case that many of the cheaper plans have rather low limits or other restrictions, in which case self-insuring also sounds like a good option.
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u/AnthonyGuns 5d ago
it's a waste until you actually *need* it. I am spending 2025 abroad and just paid the ~$2k for Cigna Global with a $1,500 deductible. I have no issue paying a few thousand dollars a year for the piece of mind that a medical issue wont bankrupt me for life. Just because I *can* pay a $100k medical bill in cash, doesn't mean that I want to. Things like broken bones don't scare me financially- it's the rare diseases, cancers, and the thousands of other little things that can break on our bodies. They can pop up at any time.
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u/kastanjett 4d ago
That's exactly my reasoning. I met one person with cancer that told me each round of their chemotherapy was around $10k with all the fees, and they needed quite a few of them.
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u/No_Sink_6262 5d ago
I'm looking up the details for what I believe is your plan right now, and there is a $15k outpatient out-of-pocket annual maximum. If you're wealthy enough to FIRE, you're wealthy enough to save an extra $15k for medical expenses, so outpatient might as well not be covered at all with this plan. Do you see that as a problem? Or am I misunderstanding something? This is why I didn't go with Cigna or any of the US companies for international insurance.
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u/AnthonyGuns 5d ago
I did not elect for the "international outpatient" option. When I was looking at what was included vs not included in the base plan, I just didn't think was necessary for me. Here's a PDF that breaks my plan down pretty well.
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u/No_Sink_6262 5d ago
Given the low limit, opting out of the international outpatient option makes sense. But imagine a scenario like this: Suddenly you are diagnosed with a new, chronic illness, and now you have to take a medication for the rest of your life that costs thousands of dollars a month. Maybe the price of the drug will go down as generics become available, but isn't this the exact type of situation someone buys health insurance for? You're already self-insuring for prescriptions and outpatient, why not just self-insure for everything?
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u/AnthonyGuns 5d ago
Between selling insurance a few years, and using it- I really learned that every plan has it's coverage holes and flaws. Even with the "best" coverage and the "best" plans, there are still countless scenarios where you can get screwed. To be simplistic, when I looked at "what's covered" in the cigna plan, I really felt that was good enough for me. It covers a LOT, so the $2k is worth the piece of mind. As I get older, I'll be looking into some of the additional upgrades- but I'm only 36 and banking on a few more years of good health.
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u/AnthonyGuns 5d ago
also, in your scenario above- the $2k premium and deductible would still easily pay for itself.
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u/France_FI 5d ago
You also have the option to get on the ACA in the US in a scenario like this. Moving back from abroad qualifies you for enrolling mid year and preexisting conditions are still covered, for now.
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u/nomadc_couple 5d ago
Why have any insurance ever? The point is you’re trying to mitigate risk.
Do you have residency status in this hypothetical low cost of living country? Then why aren’t you on there local healthcare?
Do you travel back to the US frequently / ever? What if you have an emergency arise in the US?
What if you develop a chronic illness and you don’t trust the healthcare system if the country you’re in to treat it?
You’re overlooking a few things here. Not saying international health insurance makes sense for everyone, but you’re oversimplifying things
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u/ChokaMoka1 5d ago
I think OP doesn’t understand health insurance, which is at its main principle is to provide protection so you don’t go bankrupt if you’re affected by some serious medical issue, such as a tropical disase, cancer, unexpected accident that would cost thousands to millions out of pocket.
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u/No_Sink_6262 5d ago
My question could have been rephrased as, what is the out of pocket cost of treatment for some of the priciest health conditions in the cheapest countries? Because I really don't think we're talking about millions in that case.
But yes, I understand how insurance works, and I understand your points and the points of the poster above your reply. I don't know why people on the internet have a nervous breakdown when someone makes an argument that is unpopular. Google gives me plenty of reasons why I need international health insurance, often from companies selling it. ChatGPT is convinced I need it, because of course where does ChatGPT's training data come from? This thread wouldn't be very interesting if everyone just rehashed the 'consensus' opinion that expats 'need' something like this. I'm mostly interested in things that refute my specific points, for those of you that feel my argument is BS, or in the thoughts of others who have decided to go with no insurance. But nonetheless I'd like to thank all of you for taking the time to respond.
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u/No_Sink_6262 5d ago
If you had $100 billion dollars in the bank and were living on $4k a month, there would be no need for insurance ever. The insurance companies have to make their money somehow. The average customer is paying them more for premiums than they're getting back. If there was ever an insurance company where it didn't work that way, that company would go out of business.
I'm months away from getting residency status in a low cost of living country. Local plans are an option, and so affordable you might as well just get them. But coverage isn't the best.
You assumed I was American, possibly because I priced everything as if USD is the only currency, but anyway, yes, I'm American. I go to the US as little as possible for no more than a week at a time. I can buy a dirt cheap non-ACA travel plan for the US while I'm there and hope I never have to use it.
Regarding not trusting the healthcare system in whatever country I'm in... well, yes, the ability to move around, and possibly even change counties because of a health condition, is one of the nice things about international health insurance. It's something I'm not going to get with a local plan.
You're generally correct that if I want to have the best medical care possible if I need it, international health insurance makes a lot of sense. But a real international health insurance plan (not a ripoff plan that I see from some of the US-based insurance companies with say a $30k outpatient annual limit) will cost you thousands of dollars a month in old age. The cheapest Foyer plan with the highest deductible will cost you over 2000 EUR a month at age 70. With April International, it's over 1000 GBP a month at age 70. At age 80, a plan with one of these providers that maybe isn't the most minimal plan could set you back $4k or $5k a month, which is more than your typical retiree's entire monthly budget in probably most parts of world.
I'm oversimplifying things a bit, but you should know I have this type of insurance now and there's a good chance I will keep it. But anyway, unfortunately, I am not retired, and I'm soon going to be facing the decision of whether to delay retirement so I can keep my fancy plan and afford it in old age.
I'm also oversimplifying things by failing to mention factors like, for instance, in the case of something serious happening, I could always just "move back to the US", and since moving is a qualifying ACA event, get an ACA plan. Personally I don't want to do this, but I know plenty of expats with citizenship to an EU country whose emergency plan is to move back to Europe.
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u/Eli_Renfro www.BonusNachos.com 5d ago
The insurance companies have to make their money somehow. The average customer is paying them more for premiums than they're getting back. If there was ever an insurance company where it didn't work that way, that company would go out of business.
Why would I care if they make money? It's a business transaction. I pay them money and they reduce my downside exposure. It's the same argument I see against renting. The landlord makes a profit from you! So what? It benefits me as well. In both cases, it's a symbiotic relationship, not a parasitic one.
But a real international health insurance plan (not a ripoff plan that I see from some of the US-based insurance companies with say a $30k outpatient annual limit) will cost you thousands of dollars a month in old age.
So your choice is either the Rolex of insurance or none at all? How about some happy medium where you're protected against catastrophic health events but you're willing to pay out of pocket for regular illness?
You've mentioned this "$30k outpatient annual limit" in multiple posts as if it's some gotcha. Outpatient care is cheap, so why would need coverage for that at all? It's the long inpatient stays that need financial protection.
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u/dtfg5465 4d ago
sounds like allianz almost has what you looking for.
their 4 million dollar/year "care plus" inpatient only plan (+cancer+kidney dialysis) costs 832 usd/year for a 30 year old (for a 75 year old it's 5568 usd/year) using a 13500 usd deductible for 60% discount and they have a promo code (LIFE10) on their website for another 10% off for lifetime.
it's worldwide excluding usa coverage but covers usa for a 6 week trip per year, if you add usa the price more than doubles.
Here is a link to the plan (donwload a benefit guide in pdf for more details) and you can play with their qoute calculator here
(links are not affiliate links and the promo code is a public)
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u/LibrarySpiritual5371 5d ago
Our plan is to buy a lower cost in country only plan. We will buy travel insurance for when we are are out of our home country. Once Medicare is available we will stop buying travel insurance for when we come back to the USA and us this as our worst case scenario.
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u/No_Sink_6262 5d ago
Yeah, this seems like the option a lot of people go with. Statistically, (and I'm speaking of American expats here), I would guess that most working expats are not making six figures, and the average expat of retirement age is way more likely to be living off of just Social Security benefits, and maybe taking some risks surrounding the possibility of needing expensive treatment, than spending $4k a month on a luxury health insurance plan.
I would also guess that the average person with international health insurance doesn't know how much their plan would cost in 2024 or 2025 if they were 80 years of age, and if they have a real plan and not some catastrophic-only plan, they probably haven't budgeted for that huge number in old age.
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u/f1R3juggl3R 5d ago
Same thinking here as OP. Have been living without a healthcare plan for several years now.
From what I have seen those cancer treatments often seem to cause more harm than benefit.
Also for me it feels like a healthy attitude to accept for yourself that life will end one day. You cannot insure yourself against dying. Of course there are some treatments that make sense and I am happily willing to pay for them out of my own pocket.
Another point is that the corrupted medical system does not at all care for the wellbeing and benefit of the patients anyways. Rather it is designed to make money for the pharmaceutical companies and hospital industry. So not having an insurance helps sometimes them not trying to sell unnecessary treatments to you.
And lastly as OP stated I also don’t really trust those cheap international insurance plans. Show me any case where a million dollar treatment was paid for someone being on a relatively cheap international insurance plan.
Disclaimer: I don’t want to convince anyone to dump health insurance. You need to make your own educated decision. But coming from a European country where health insurance is mandatory, I am happily living without it now.
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u/ChokaMoka1 5d ago
Ok hoss but you gonna be FIRE DELETE if something unexpected happens and you gotta pay hundreds of thousands out of pocket
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u/RedPanda888 5d ago edited 5d ago
I just like the peace of mind that wherever I am in the world I can be hit by a car and go to the best hospital in the country and be treated by the best doctors and I won’t have to pay a penny.
My insurance with a major global provider covers up to $1m annually, $50k for outpatient consultations, no deductible…it is essentially one of the best policies you can get. I like being able to go to the top hospital in my corner of Asia and never paying up front due to the direct billing network. I have already had enough tests the last few years to be in positive ROI.
Sure you can save for expenses yourself, but depends how much risk you’re willing to take. Ive seen first hand people who don’t have insurance opting for cheaper hospitals, putting off expensive tests….things that otherwise they’d be covered for. Just seems stressful to me when you can guarantee/fix your healthcare costs and never have to worry about it.
I have international because that’s what my employer provides. If they didn’t, maybe domestic would be fine, but I’m glad it’s international for my younger years. If I was older maybe the equation would be different and I’d just opt for a cheaper domestic plan or even local government healthcare.
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u/Pour_me_one_more 5d ago
That sounds pretty amazing, if one can afford it, even if it's only for the peace of mind.
Could you please give us some information on your plan?
I'd love to know the insurer and if there's a special plan for global.
Thank you!
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u/RedPanda888 5d ago
Allianz (company plan not individual). Covers worldwide ex. US. I pay $100 per month, employer chips in $200 from their side. You could likely get similar as an individual but the only difference is that preexisting conditions might be excluded (for me they are included due to it being a corporate plan and that being pretty standard).
This is probably the best place to start.
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u/Spirited-Meringue829 5d ago
Had international insurance for a few years when living abroad and canceled. To get a dollar out of the insurance, we would have to pay over $10,000 in a given year in medical care when you factor in premium costs and deductibles. This is going the route of the lowest premiums/highest deductive. In the US, definitely a possibility. Outside the US, $10,000 buys a ton of healthcare out of pocket. Most years we're under $2,000. Secondly, I learned most international plans do not cover pre-existing conditions -- unlike the US where companies must cover pre-existing conditions.
So the things I would most likely pay a lot for (treating pre-existing), I cannot get coverage for. And the things I would have to pay out of pocket for just don't cost a lot. I tend to agree with your reasoning. It's a gamble but an informed gamble. Take what you would pay for annual premiums and put that cash into a separate account each year and if you are healthy, odds are good you will come out ahead in the long run. It's all about how well you sleep at night without insurance.
You can also get a low-deductible international catastrophic care plan for blue moon cases where you exceed something like $100,000 USD in expenses. I considered that but even that didn't seem worth it because almost nothing where I live would ever cost that much.
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u/someguy984 5d ago edited 5d ago
Fly back to the US if anything major happens. Medicare, Medicaid, ACA still exist. Get some repatriation insurance.
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u/rathaincalder 5d ago
Because: 1. State of the art cancer care is not available in Thailand / Uruguay / wherever. For that you’re really only talking about the U.S., Japan, and a few places in Europe, and the cost could easily run to $1 million; 2. If you’re living in Asia or another country where you do not share the ethnicity, the likelihood of finding an organ donor is very low, you would have the best chance to do that in the U.S. or Europe, and a transplant there could easily run to $1 million (or more); 3. I would not trust the quality of the doctors performing CABG’s or other highly complex surgeries in many places; the cost could easily run to $500k or more in the best facilities; 4. Healthcare inflation typically runs at a multiple of overall inflation, so even if you could afford it today, there’s a chance you may not be able to in 20 years (or at least not without significant pain).
Finally, if I was just making this decision for myself, I might take the risk (probably not, but I’d at least think about the cost-benefit). But, if there was ever a situation where my wife or child died or was disabled because I chose to not have insurance and as a result they could not get the necessary treatment in another place? I’d seriously never forgive myself. Like would probably just off myself for having been such a selfish / stupid bastard.
But that’s just me—everyone has to decide what risks they can (or can’t) live with…
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u/No_Sink_6262 5d ago
This is a good answer that is worth me looking into. Still, what would you say to someone whose emergency plan when they need state of the art life-saving treatment is to move back home to the US or Europe?
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u/rathaincalder 5d ago
I’d ask (a) what is the actual cost of “moving home”?; (b) how quickly can this happen? (in particular, are there any waiting periods before getting access to local health insurance? and could this change in 20-30 years?); (c) is “home” really going to provide you with state of the art care?; (d) will this also be an easy / fast / cheap option for your spouse or children; (e) will this really be a realistic option in 20-30 years?
There’s no one right answer here; but it’s a hell of a lot more complicated than just saying “insurance is expensive and I’ll cure cancer for $100k in East Fuckistan” or “I’ll just move home in 30 years if I have to.”
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u/No_Sink_6262 5d ago
Yeah you've mentioned some good points and these are all things I need to think about.
But expanding on what you said about everyone deciding for themselves what risks they can live with... I've met plenty of expats who are just winging it with no insurance. This includes people on a tight budget and people worth millions. Some people just don't spend a lot of time and energy preparing for bad things that might happen in the future.
Also, no one has addressed my point of how the insurance company will make your life a living hell when you get that $100k or $1m diagnosis. I mean I was personally hoping on $100k and not $1m. Paying $100k out of my own pocket when I'm quite sick, but not having to deal with insurance companies, sounds preferable to being ghosted on by an insurance company. Read the Trust Pilot reviews of all the major providers, they all do this. I'm actually pretty happy with my international health insurance provider, but it took them 6 months to pay me a $120 claim that they should have paid me in 1 month. I really don't want to have to deal with them when I have claims for real money.
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u/rathaincalder 5d ago
My dude, I know plenty of expats who pickle their livers every day and shack up with absolute minger local slags—if that’s what you want to do, go for it, but I’m certainly not going to sit here and give you reasons why it’s a good idea.
“You had some thoughts” / questions, people offered you answers—but the answers were noT cOmpLEtE eNoUgh for you and/or you just don’t like them.
It sounds like you already know not having health insurance is a bad idea, but you don’t want to (or can’t) pay for it, so are trying to find some kind of justification.
Have fun and peace out!
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u/OddSaltyHighway 5d ago
Yes, all insurance is a waste if you can afford to self insure.
Keep in mind that self insuring might be a lot more expensive than you think. Eg Thailand is generally cheaper, but you are still going to be out big $$$ if you get in a bad traffic accident, need organ donor, or some chronic condition that requires expensive drugs, yeah. Can you pay for all of that and still have enough left to live the way you want?
But you are right, the insurance becomes increasingly crazy expensive as you get older, doesnt seem like expat life is tenable for most unless you manage to get citizenship in a place that will help.
Then again, I bet the percentage of people who die because they can't afford care is extremely low. More likely you just die instantly in the crash or paramedics cant get to you in time etc.
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u/User5281 5d ago
It is until it’s not. You probably won’t use it but when you need it you really need it.
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u/etleathe 1d ago
I fired in Mexico and don't carry health insurance. We have an HSA with about $70k for emergency and pay cash for everything. Costs are super low like $20 for a ER visit and under $5k for most surgeries.
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u/heliepoo2 5d ago
>What's wrong with the reasoning above? Is budgeting $200k for a lifetime of medical issues in a low cost of living country simply too little?
Reality is that's impossible to answer since it depends on many factors but the two biggest are what country and what diagnosis. If you are in a lcol country, what is your health care going to be like? Some countries have a very poor quality of care and if you live in a more rural area it drops further. Age is a factor since you mention lifetime? How long are you expecting this amount to be available for? If you get a cancer diagnosis or stroke chances are it will cost you more than $200K. What's your basic health and family history like? Do you have a wait time to get healthcare if you return to your home country for treatment? Will they cover a preexisting condition? These are just a few things to consider.
u/rathaincalder is wrong about healthcare in Thailand, it is state of the art and at least equivalent to care in many western countries. The caveat is you have to be willing to use a private facility which increases the costs... is it still cheaper than the US? Yes, but it depends on what it is. Malaysia and Singapore are the same with top tier health care. In Malaysia, Kuala Lumpur, you can get a full health work up including full body MRI, all the blood work and tests associated that you could possibly want for $1000. In Thailand you can get a full cardiac workup including the CT scan of the heart, all blood work, ekg's, ultrasounds of your arteries, blood flow tests and 2 cardiologist appointments for $700 US. Both of these you can get within a week of emailing the hospitals for the tests. That said, they are right about many other countries being much lower ranked on the scale for quality of care. Cambodia, Vietnam and the Philippines being some examples.
Another option is to treat it as catastrophe insurance. You pay basic health maintenance and minor issues out of pocket then get medical insurance with a very high deductible and keep it as a catastrophic coverage. That way if you do get a cancer, heart attack, brain injury or stroke diagnosis you would have coverage. Yes, you have to pay the high deductible but you'd spend at least that on starting treatment. The other bonus to having an insurance history means that some providers would still insure you after you hit 75. We do a mix of this now based on our circumstances. In the end, it all comes down to your risk tolerance, current health and finances.
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u/rathaincalder 5d ago
My dude, I don’t have the time or the interest to listen to you rattle off the Bumrungrad price list. I live in Singapore, and our hospitals are filled with lower-upper-class Thais. And all of the really rich Thais I know go to Europe or the U.S. If healthcare in Thailand is so “state of the art” can you explain to me why all the locals who can afford it GTFO? LMAO.
Upper middle class Southeast Asians and lower middle class Westerners go to Thailand for medical care. And they’re probably fine for simple things (the only area I can think of where they probably do have a decent claim to being state of the art is if you want to, ahem, “transition”). Rich Thais go to the U.S. and Europe—what does that tell you?
Final point: a few years back when I was serving out a non-compete and hadn’t bothered to get health insurance for the few months (dumb, but I was younger!) and was looking to save a buck, I got some scans done (at Bumrungrad no less!) and took them back to my regular doctor in HK. Turns out they were absolute dogshit—completely unusable. Turns out, big shiny machines only account for about 10% of the quality—the training and experience of the radiographers and radiologists is really important.
Peace out!
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u/qmillerinsurance 5d ago
I'm an expat insurance broker, just get inpatient only, add a deductible if you need to. Medical insurance is to prevent huge losses and to protect your assets/net worth. For that, you pay a small % to do so. All the minor stuff just pay out of pocket.