One of the biggest benefits of moving abroad is the possibility of gaining access to good, inexpensive health care. In so many of the countries we cover regularly—like Mexico, Ecuador and Panama, for instance—you’ll find you can get care as good (and perhaps better) than what you’re used to. And it will cost you half or even less what you pay up north.
While you could go without health insurance entirely, most expats do arrange for coverage of one sort or another. Here’s what you need to know about your options:
What non-U.S. health insurance options are available to you?
International policies: International executives and others who travel a lot to many different countries often get worldwide policies that cover them everyplace they go. Cut your finger in Calcutta or break a bone in Beijing, you’re covered. These plans are genuinely international.
The companies offering these plans are used to dealing with a far-flung group of clients. They’re likely to have a customer service department and at least some English-speaking staff. That can be a big plus if you need to call or e-mail about processing claims or getting reimbursements.
But these policies sometimes only cover major medical, so if you need more comprehensive coverage, be sure to check that it’s included. Also, ask how the company handles reimbursement claims and how long processing takes. If the claims office is half a world away, for instance, see if it accepts faxed or digitally-scanned receipts for faster processing.
International health insurance companies include BUPA and Health Care International, among many others.
True international plans offer some conveniences but can cost more than other options, so evaluate whether you need one. Unless you plan to divide your time among several countries abroad, they may offer more than you need.
Country-specific policies: If you plan to spend most of your time in a single country abroad, consider a country-specific policy. It’s practical, focused on your needs—and probably costs less—than a full international plan.
Some large international health insurers also offer country-specific policies. BUPA is one of these; it has a Latin American division with offices in Mexico, Ecuador and the Dominican Republic. Blue Cross Blue Shield operates in Panama. If you’re retired U.S. military, note that TRICARE is also widely accepted in Panama.
In most countries you’ll also find large national insurance companies that offer health insurance in their suite of products. In Mexico, Grupo Nacional Provincial is one of the largest national insurers. In Ecuador there’s Salud, S.A. Panama has ASSA—which has recently expanded into Costa Rica.
With a country-specific policy, ask about the breadth and depth of an insurer’s provider network—especially for the region where you plan to live. As with international policies, ask how reimbursement is handled; you may need to open a local bank account where reimbursements can be wired.
Most importantly, since this policy only covers you in one country, consider what you’ll do for coverage when you travel elsewhere—such as vacations back to the U.S. Some plans offer short-term international coverage for just these situations. If a plan doesn’t, see if you can add a rider for this. Note that you’ll be limited in how many days or months you can be “abroad”—that is, outside your plan’s base country. But some limits are really generous.
Do you qualify for a new private health insurance policy?
Insurance companies worldwide have a lot of things in common. Among these are the limits they put on coverage. Generally speaking, companies won’t issue you a new health insurance policy if you’re age 65 or older—though they’ll continue an existing policy past this age. (A few companies, such as Health Care International, will issue new policies up to age 75.) And they won’t cover pre-existing conditions in a new policy no matter what your age.
If you’re over the age limit for a private policy, check whether the country you’re considering has a nationalized health plan; you may still qualify to enroll in this. Ecuador, Costa Rica, France and Mexico are among the countries with nationalized plans.
And, of course, you can always pay out of pocket.
How easily can your pre-existing conditions be managed, and what do they cost?
A health-care insurer certainly will exclude any pre-existing conditions you have when it issues you a new health insurance policy.
Some health plans make an exception for an illness after a waiting period of three to five years, provided that you are symptom-free and require no treatment during the waiting period. (Pregnancy—no kidding—falls into this category. Some cancers may also qualify.) But chronic illnesses don’t meet this requirement, including common ailments like asthma, allergies, heart and lung disease, high cholesterol, high blood pressure and diabetes.
To be conservative, assume that you’ll need to pay out-of-pocket for pre-existing conditions. Fortunately, the lower costs for health care abroad makes this much more affordable.
Can you get the prescription medicines you need?
Medicines for common health conditions like asthma, diabetes, high blood pressure, or any of the other usual suspects are easy to find. Your existing medicine may well be available in your new country. It may even be sold without a prescription.
Ask for drugs by their brand name. If a drug is still on patent and available in the local market, it probably will be known by its brand name. Brand-name drugs usually cost less than they would in the U.S. (as little as half). But they still cost much more than generics.
Once you’re settled into a country and have a local doctor, you may be able to switch to lower-priced generic medications. But if you use a brand-name drug now, factor that cost into your budget—just in case generics aren’t available or they don’t work for you.
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