Do You Need Health Insurance as an American Living Abroad?

Written by Mike Wallace

MBA

Reviewed by Allen Pfeister

MBA, CPA

Mike Wallace

MBA

Mike Wallace, CEO at Greenback Expat Tax Services, has extensive experience in finance, operations, and strategic leadership. Mike has worked in numerous C-Level roles, including at large financial institutions. Mike holds a Master's in Business Administration (MBA) from the University of Chicago's Booth School of Business.

Allen Pfeister

MBA, CPA

Allen Pfeister is a Partner at Tax Uncomplicated, collaborating with Greenback Expat Tax Services and Klemsen Consulting. Allen holds an MBA from the University of New Orleans and a BS in Accounting and Finance from Louisiana State University.

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Updated on February 18, 2026

11 minute read

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Wallace, M. (2026, February 18). Do You Need Health Insurance as an American Living Abroad?. GreenbackTaxServices.com. Retrieved , from https://www.greenbacktaxservices.com/blog/expat-health-insurance/

Yes, and in many countries it is legally required. Most U.S. domestic health plans, including employer-sponsored coverage and Medicare, provide little to no coverage outside the United States. According to Medicare.gov, Medicare generally does not cover healthcare outside the U.S., except in rare emergency situations near the border. That means Americans living abroad need a separate health insurance solution.

Your three main options are:

• Local health insurance in your host country (often required for visa or residency)
• International health insurance with worldwide coverage across multiple countries
• Short-term travel insurance for temporary stays under six months

The right choice depends on how long you plan to live abroad, how often you travel between countries, and whether you want coverage that includes the U.S. during visits home.

Here’s what you need to know about each option, how much they cost, and the U.S. tax implications most expat insurance guides overlook.

Why Spring Is the Time to Lock In Expat Health Insurance

If you are researching expat health insurance right now, you are not too early. You are right on time. Several factors converge in spring, making this the critical window for securing coverage.

• Corporate plan renewals: Many international companies operate on a fiscal year that begins in April, particularly in the UK, India, and Japan. As corporate plans renew or change on April 1, employees who are unhappy with their employer-provided coverage, or whose premiums just increased, start looking for private alternatives in March. If your employer’s plan is changing and you want to compare options, now is the time to research before your renewal window closes.
• Summer move planning: A significant number of international corporate assignments and teaching contracts follow a summer move cycle. Families planning to relocate in June or July (when the school year ends) need to start the visa and residency application process months in advance. Since countries like Spain, Portugal, Thailand, and Germany require proof of private health insurance as part of the visa application, that means March is when the paperwork needs to come together.
• Tax year coordination: If you are moving abroad in 2026, your health insurance choice affects your U.S. tax return for this year. Decisions about whether to keep Medicare Part B, whether to set up an HSA-qualifying plan before you leave, and whether your new international policy qualifies for the self-employed health insurance deduction all benefit from early planning. Starting in spring gives you and your accountant time to coordinate your coverage with your tax strategy.

What Types of Expat Health Insurance Are Available?

Local Health Insurance

Local health insurance covers you within a single country. In many popular expat destinations, enrollment in the national health system is mandatory for residents, and contributions are deducted from your salary or required as part of your visa.

• Best for: Long-term residents staying in one country who want the most affordable option and can access the local healthcare system.
• Limitations: Coverage ends when you leave the country. It may not include English-speaking providers. Some national systems have long wait times for specialists or elective procedures.
• Countries that require it: Germany, France, Spain, the Netherlands, Switzerland, the UAE, Singapore, and Thailand (for certain visa types) all require proof of health insurance for residency.

International Health Insurance

International health insurance is designed for people who live, work, or travel across multiple countries. These plans offer worldwide coverage and typically include benefits that local plans do not: emergency medical evacuation, repatriation, access to English-speaking providers, and the ability to choose any doctor or hospital.

• Best for: Digital nomads, frequent travelers, corporate expats, and anyone who moves between countries regularly or wants the flexibility to seek treatment in their preferred location. Also worth considering is whether your employer’s corporate plan is being renewed with reduced benefits or higher premiums, and whether you want to compare private alternatives.
• Limitations: More expensive than local plans. Some plans exclude the U.S. from coverage (or charge significantly higher premiums to include it). Pre-existing conditions may be excluded or subject to waiting periods.

Short-Term Travel Insurance

Short-term travel insurance covers emergency and acute medical needs during temporary stays abroad, typically ranging from 30 days to six months. These plans do not cover routine care, preventive visits, prescriptions, or chronic conditions.

• Best for: Short-term assignments, extended vacations, or temporary coverage while establishing residency and enrolling in a local or international plan.
• Limitations: Not appropriate for anyone living abroad long-term. Will not satisfy visa or residency health insurance requirements in most countries.

How Do They Compare?

How Much Does Expat Health Insurance Cost?

Expat health insurance costs vary significantly based on your age, location, coverage level, and whether the plan includes the U.S. According to Pacific Prime’s 2024 Cost of International Health Insurance Report, average annual premiums for individual plans ranged from $3,900 in Poland to $15,296 in the United States.

Here is a snapshot of average annual costs in popular expat destinations:

Source: Pacific Prime 2024 Cost of International Health Insurance Report. Figures reflect average IPMI premiums for a 36-year-old with inpatient and outpatient coverage and no deductible.

How to Lower Your Premiums

Several choices can reduce your costs significantly:

• Exclude U.S. coverage. Removing the U.S. from your plan can lower premiums by 20% to 40%. Only include U.S. coverage if you visit frequently or plan to seek treatment there.
• Increase your deductible. Moving from a $0 deductible to $1,000 or $2,500 can cut premiums substantially. This works well in countries where routine care is affordable out of pocket.
• Choose regional coverage. If you live and travel within a single region (e.g., Southeast Asia or Europe), a regional plan costs less than worldwide coverage.
• Skip optional add-ons. Dental, vision, and maternity riders increase premiums. In countries with affordable dental and vision care, these may not be worth the added cost.
• Pay annually. Most insurers offer a 5% to 10% discount for annual payment compared to monthly billing.

What Should You Look for When Choosing a Plan?

When evaluating expat health insurance plans, consider these factors in order of importance:

• Coverage area and exclusions: Confirm whether the plan covers your host country, countries you travel to frequently, and the U.S. (if needed). Review what is excluded, especially pre-existing conditions, mental health, maternity, and dental.
• Provider network and direct billing: Plans with direct billing arrangements mean the hospital bills the insurer directly, so you avoid paying large amounts out of pocket and filing reimbursement claims later. Check whether hospitals in your area are part of the plan’s network.
• Coverage limits: Annual maximums range from $500,000 to unlimited. If you live in a country with expensive healthcare (Singapore, Hong Kong, the U.S.), higher limits matter. A cardiac bypass in Singapore can cost $180,000 or more, and cancer treatment in Europe can exceed $300,000 annually.
• Emergency evacuation and repatriation: These benefits cover air ambulance and medical transport to the nearest appropriate facility or back to your home country. For expats in remote areas or countries with limited medical infrastructure, this can be lifesaving.
• Guaranteed renewability: Some plans guarantee renewal regardless of health changes. Without this, you could lose coverage after a major diagnosis just when you need it most.
• Policy flexibility: Look for plans that allow you to adjust coverage, deductibles, and optional benefits at renewal. Your needs may change as your expat situation evolves.

What Are the U.S. Tax Implications of Expat Health Insurance?

This is where Greenback’s expertise becomes especially relevant. Most expat health insurance guides focus entirely on choosing a plan and skip the tax implications, but your insurance decisions directly affect your U.S. tax return in several ways.

Health Insurance Premiums May Be Tax-Deductible

Health insurance premiums you pay out of pocket, including international and foreign health insurance premiums, are deductible as a medical expense on Schedule A if you itemize deductions and your total medical expenses exceed 7.5% of your adjusted gross income (AGI).

If you are self-employed, health insurance premiums are even more valuable. Self-employed individuals can deduct 100% of their health insurance premiums as an above-the-line deduction (using Form 7206), which reduces AGI directly. This includes premiums for international health insurance covering you, your spouse, and your dependents. You do not need to itemize to take this deduction.

The ACA Individual Mandate No Longer Applies Federally

Since 2019, the federal individual mandate penalty has been $0. You will not face a federal tax penalty for not having U.S. health insurance while living abroad. However, some states (California, Massachusetts, New Jersey, Rhode Island, and the District of Columbia) still impose their own individual mandate penalties. If you maintain state tax residency in one of these states, check whether your foreign health plan satisfies the state requirement or whether you are exempt. For more details, see our guide on the Affordable Care Act for expats.

Medicare Decisions Affect You While Abroad

Medicare does not cover care outside the U.S. However, the decision to enroll or delay enrollment has long-term financial consequences.

• Medicare Part A (hospital insurance) is premium-free for most people who have paid Medicare taxes for 10+ years. There is no penalty for enrolling late, and it costs nothing to keep. Most expats should enroll at 65 even if they live abroad.
• Medicare Part B (medical insurance) charges a monthly premium ($185/month in 2025) and penalizes late enrollment with a permanent 10% surcharge for each 12-month period you could have enrolled but did not. If you plan to return to the U.S. eventually, maintaining Part B coverage may be worth the cost to avoid penalties. If you are certain you will not return, delaying enrollment saves money now but carries risk later.

HSA Contributions Require a Qualifying U.S. Plan

If you want to contribute to a Health Savings Account (HSA), you must be enrolled in a qualifying High Deductible Health Plan (HDHP) that meets IRS standards. Foreign health insurance plans do not qualify, even if they have high deductibles. You can still use existing HSA funds for qualified medical expenses worldwide, but you cannot make new contributions unless you have a qualifying U.S. plan.

Medical Expenses Abroad Are Deductible

Beyond insurance premiums, out-of-pocket medical expenses incurred abroad are deductible on the same terms as domestic expenses. According to IRS Publication 502, you can deduct the cost of medical procedures performed in another country, transportation to receive medical care, prescription drugs (if legal in both countries), and medical equipment. All amounts must be converted to U.S. dollars.

Do You Need Expat Health Insurance for a Visa?

Many countries require proof of health insurance before granting a visa or residency permit. Requirements vary:

If you are planning a move abroad, research your destination’s requirements well before your visa application. Some countries require minimum coverage amounts, specific policy durations, or coverage from approved providers. If you are targeting a summer move, most visa applications take 30 to 90 days to process, which means you should have your insurance policy secured by March or April to meet application deadlines for a June or July arrival.

How Does Greenback Help with the Tax Side of Health Insurance?

Choosing the right expat health insurance plan is one decision. Making sure it works with your U.S. tax strategy is another. Greenback’s CPAs and Enrolled Agents help expat families with the tax side of health insurance, including:

• Determining whether your premiums qualify for the self-employed health insurance deduction or the itemized medical expense deduction
• Calculating whether itemizing deductions saves you more than the standard deduction
• Advising on Medicare enrollment timing and Part B penalty avoidance
• Evaluating HSA eligibility and contribution strategies
• Coordinating your insurance tax benefits with the Foreign Earned Income Exclusion and Foreign Tax Credit

No matter how complex your expat situation may be, you’ll have peace of mind, knowing your taxes were done right. Have questions? Contact us, and one of our Customer Champions will be happy to help. If you’re ready to be matched with a Greenback accountant, click the get started button below.

This article is for informational purposes only and does not constitute insurance, legal, or tax advice. Health insurance requirements and costs vary by country and individual circumstances. For guidance on how your health insurance choices affect your U.S. tax return, contact Greenback to speak with an expat tax specialist.

Related Resources

• HSA for Expats: New IRS Rules Expand Health Savings Eligibility
• Everything Expats Need to Know About the Affordable Care Act
• U.S. Expat Tax Deductions and Credits: Maximize Your Savings
• Self-Employment Tax for Expats: Step-by-Step Guide
• Digital Nomad Taxes: What U.S. Citizens Working Remotely Abroad Need to Know
• Moving Abroad from the U.S.: Pre-Departure Tax and Planning Checklist
• How Do U.S. Taxes Work When You Retire Abroad?
• Foreign Earned Income Exclusion: Your Complete Guide
• Foreign Tax Credit Guide
• State Taxes for Expats: Do You Still Owe?