Digital Nomad’s Guide to Buying Health Insurance

Laura Lopuch

You’ve been traveling the world — or maybe you’re just about to jet off on your first digital nomad adventure — when your mom says, 

“Did you get health insurance, honey?”

Sigh.

“Yup, mom, I got travel insurance.”

“That’s not what I asked. I want to know if you have medical health insurance in case something happens on your trip.”

“No, mom, I hardly go to the doctor. I’m a healthy beast, why would I need that?”

But that one question wiggles into your brain, and before you know it, you’re on Google, cracking open up a can of worms that you’d never considered.

A can of worms filled with weird acronyms, numbers, and requests to see into the future on how much coverage you can afford, type of care you want, and doctors you want to see in-network vs out-of-network. 

What happens when you’re traveling the world full-time with every doctor out of your network and not right around the corner? Maybe they don’t even speak English. What then?

As a former legal paralegal who worked in the insurance world, I can tell you that it’s a hot mess. Let’s clear up some of the confusion, shall we?

Nomad Travel Insurance vs Health Insurance

Good for you on getting travel insurance. 

No, it’s not the same as medical health insurance.

The health portion of travel insurance only covers you until the insurance company can dump you onto the local healthcare system or back to your normal insurance. Once you’re discharged and released back on the world, you’re on your own.

Travel insurance covers pesky little things like cancellations and lost baggage. They may cover large medical expenses should you break your leg mountain climbing in Switzerland or fall into a shallow canal in Venice (depending on how carefully you read the fine print of their “adventure and sports” coverage). Emergencies will probably be covered. Emergency evacuation is likely included. Maintenance healthcare, pre-existing conditions, pregnancy, optical, dental, vaccinations, anything “routine” probably is not.

That’s why you need to seriously consider health insurance separately, particularly if you are traveling for the long haul.

Digital Nomad Health Insurance

Do I need it?

Americans now are legally required to have health insurance for 12 months out of the year. If you let that coverage lapse, you’re subject to a penalty.

But what if you’re not in the US for a majority of the year?

The IRS says

Are US citizens and U.S. residents living abroad subject to the individual shared responsibility provision?

Yes. However, U.S. citizens who are physically present in a foreign country or countries for at least 330 full days during any period of 12-consecutive months are exempt from the individual shared responsibility payment for any month in the tax year that is included in that 12-month period.

[emphasis added]

Hang on, that doesn’t mean you should skip getting health insurance.

What about that broken leg, my friend? Or you need a root canal while in Thailand, or just to see a doctor because you’ve been puking out both ends for weeks, and you should be getting better now. 

A lot of stuff happens on the road.

When you expose your body to foreign bugs and germs, who knows what could go wrong. Having health insurance is smart. 

Should I get local health insurance?

“You should almost never get health insurance in the country where you will reside, even if you know you’re going to be staying there for a few months or more,” says Anna Wickham

Here’s why: 

Many local insurance companies abroad are scams

Especially in Southeastern Asian countries. Even if the medical issue is covered under your insurance, that company might not take care of you. A company masquerades as an insurance company, gladly accepting your premiums every month, but when you file a claim, Anna says: “you find out that you’ve just been paying some dude every month who has no intention of paying your medical bills.”

Likely, you’ll have no idea what’s going on

Back to Anna: “Some countries, like the Philippines, have a lot of things in English as well as the country’s official language. Vietnam is not one of those countries. I would never get insurance in Vietnam because all the documentation and policyholder support would be in Vietnamese.”

If you choose to get local insurance be sure that you’ve thoroughly vetted the company and can get all of your policy details in your native lanugage.

What to Look for Digital Nomad Health Insurance

You want a plan that offers two areas of coverage:

1. Worldwide, excluding the USA (often adding US coverage is the most expensive portion)

OR

2. Worldwide coverage (note: this is the more comprehensive option)

International Insurance recommends that you make sure you get a health insurance plan that is portable, meaning you’ll be covered in all countries. If you intend to spend time in your native country, look for a medical health plan that gives worldwide coverage.

That way you’ll be covered at home and everywhere else that isn’t home.

What This Health Insurance Plan is Called

Okay, don’t make a newbie mistake and start searching for “health insurance plans for people who travel,” like I did. Trust me — you won’t get the results you’re looking for.

Instead, search for a medical health insurance plan that is called:

  • Expatriate health plan
  • Global health care
  • International health plan
  • International health insurance policy

As Eli_Renfro on Reddit says, “Purchasing an international health insurance policy is generally cheaper and most will cover you in any country except the US and Canada. Obviously read the policy and know for sure what the coverage is prior to purchase.”

Medical Health Insurance Plans by Nationality

Every country is different. (Which is a big reason why you travel: to see the different approaches to life). It only makes sense that each country’s regulations and available options for health insurance are different.

Canadians and Europeans are covered by national healthcare plans. Americans are required to have health insurance, but plans are not subsidized by our government. 

So here are some international health insurance plans broken up by nationality for Americans, Europeans, and Canadians. 

Digital Nomad Health Insurance for Americans

In addition to my research and experience, I took to Reddit’s opinionated, super-helpful members to find you the best international health care policies. 

BUPA

BUPA is an Australian company that also has global coverage. Cost is, “About US$1400 a year with a $10,000 deductible,” says s0nk. “I’m 38. It gets about 15-20% more expensive every year.”

Worldwide Expatriate Association (WEA)

WEA bills themselves as, “far and away a more reliable international healthcare option.” If you’re setting up a business as a digital nomad, you can even get group insurance for your multinational business. How cool is that?

“Great reviews and good price, but (un)fortunately we haven’t needed it yet so haven’t had real experience,” says MostXlent1

“Coverage is good everywhere except US, but still 90% in the US. We would pay a good chunk less if we ditched US coverage completely. Because we are from the States, we also have to pay a fee each year because it’s not ACA-Approved. This was still cheaper than paying for a (way crappier) ACA plan itself though, plus then we would have needed travel insurance to take us back to the States for big issues.”

Cigna Global

As a year-round American digital nomad with no permanent domicile, nomadality uses Cigna: “The option I have allows me to be back in US with coverage for up to 3 months per year.”

Cigna is a huge healthcare insurance provider. That means you’ll get access to their enormous network of doctors, hospitals, physicians and other medical professionals. Cigna has 4.1 out of 5 stars from 1500+ reviews.  

Integra Global

Integra Global describe themselves as, “Smaller, more flexible. Intelligent and personal. We create tailored global health insurance plans for expats, and for others with unique insurance needs.” Digital nomads certainly have unique insurance needs.

Anna Wickham strongly recommends this insurance policy.

“If you’re American and you are quitting your job to travel, you should get international health care through Integra Global and, if at all possible, get the option that excludes American coverage. If you are traveling for a few months and are not required to quit your job, and your employer agrees to still allow you on your company insurance plan while you’re away, let me know where you work because I want to work there.”

AXA

Well-known and reliable, but that strong history comes at a price: it’s expensive.

Felix Oppenheimer on Medium says, “My family have used them for 40 years and never had problems.”

Allianz Worldwide Care

Provides international health insurance plans for individuals, groups, students, and corporate plans.

IMG

A longtime leader in the field of expat insurance, IMG is reliable. The claim process goes smoothly, and they live up to their reputation as an industry leader. They offer a wide range of products, from student and family coverage, holiday coverage to longer term expat style insurance, and even niche coverage for marine captains or crew. 

Whatever you need, IMG will have it covered.

GeoBlue

GeoBlue offers short and long term health plans for people traveling and living abroad, including specialty plans. With no deductible on standard service, maintenance medical care covered, access to the Blue Cross Blue Shield PPO network inside the USA, and reduced costs if you maintain a US form of insurance, it’s a pretty good deal. 

also, for you adventure junkies: There are no extreme sports exclusions with GeoBlue.

ASC Europe

Planning on spending a year or more in Europe as a digital nomad? ASC Europe provides comprehensive coverage for people of all nationalities. That includes maternity, emergency, maintenance healthcare, and optical. With options for life insurance too.

Digital Nomad Health Insurance for Europeans

Travel with your European Health Insurance Card (or EHIC). It allows you to receive free or reduced-cost medical treatment in another member state.

If you’re traveling outside of the EU, boost your insurance policy with World Nomads travel insurance like eleventhor in this Reddit thread does

World Nomads provides basic health insurance (for people of most nationalities, American too) including emergency evacuation and expatiration of remains, which are the two biggies that get expensive without insurance. Their policies are “fire insurance” if something goes wrong during your travels but they don’t cover pre-existing conditions or pregnancy, and they have low caps if something really serious is discovered.

Some companies to consider to augment your EHIC are:

Digital Nomad Health Insurance for Canadians

Since your country has healthcare for its citizens, you’ll leave your provincial or territorial health plan behind when you travel abroad. You will need to get an international healthcare policy. 

Surprisingly, the Canadian government website has super helpful information for you in choosing a new policy:

Ask if the policy:

  • Provides coverage whether or not your provincial/territorial health plan remains in effect;
  • Offers a worldwide 24-hour/seven-day emergency contact number in English and translation services for health-care providers in your host country;
  • Pays immediately for foreign medical costs or requires you to pay up front and seek reimbursement later;
  • Provides a cash deposit in advance if required by a hospital;
  • Covers both health and dental care for the full duration of your stay abroad;
  • Covers pre-existing medical conditions, such as borderline diabetes and heart disease (ask for written confirmation);
  • Includes coverage for injuries resulting from adventure activities, such as mountaineering and scuba-diving;
  • Provides for a medical evacuation to Canada or the nearest location with appropriate medical facilities;
  • Covers premature births and related neonatal care;
  • Pays expenses associated with a death abroad, including the repatriation to Canada of the ashes or remains of the deceased;
  • Provides coverage during visits to Canada or other travel while abroad; and
  • Covers the period before your provincial/territorial plan is renewed upon your return to Canada.

Many of the American companies will cover Canadians too; some other options include:

Viator Expatriate Health Insurance

If you’re a Canadian under 70 years of age who is living, working or studying outside of Canada, you’re eligible for this plan.

It’s only available through an insurance broker, so Google and find a broker that’s right for you. 

Allianz Expatriate Insurance

If you’re looking for a plan providing more than emergency medical coverage, consider picking this plan. Allianz provides 24/7 emergency assistance anywhere in the world with comprehensive protection against sickness or injury costs. 

On Consumer Affairs, Allianz rated 4.3 out of 5 stars based on 932 reviews for their travel insurance program. I couldn’t find any reviews for their international health plan, but if an insurance company is reaping such phenomenal reviews for one product, it’s safe to assume they’re doing right by their customers on a similar product. 

Psst, ladies who are pregnant or want to be soon, this plan has available coverage for maternity and newborn care. 

Cigna

Cigna is a huge healthcare insurance provider. That means you’ll get access to their enormous network of doctors, hospitals, physicians, and other medical professionals. Cigna has 4.1 out of 5 stars from 1500+ reviews.  

Plus, the bigger company means the ability to tailor your insurance policy to your needs. 

Note: When you return to Canada, don’t expect your provincial/territorial health plan to go live immediately, especially if you’ve been abroad for longer than six months.

There could be a requalification period before your coverage is reinstated. When you arrive home in Canada, get a health insurance plan available for temporary visitors to Canada to cover any gap. 

What to Look for in Digital Nomade Health Insurance

When you’re hunting for a suitable international health care plan, consider these five things:

  1. Your marketplace (and where you need to be covered)
  2. Compare health insurance plans (always review several)
  3. Compare health plan networks (where and how will you access healthcare?)
  4. Compare out of pocket costs (look for hidden fees, copays, and things not covered)
  5. Compare benefits (what, exactly, is covered and, more importantly, what is not?)

For Americans, the place to start healthcare policy hunting is at to HealthCare.gov and shopping on your state’s Affordable Care Act marketplace. 

If you want to really educate yourself on the ins and outs of healthcare policies — and I strongly encourage you to do that, so you’ll get the best policy for your lifestyle — check out this article by Nerd Wallet.

It’s superb at breaking down the jargon into actionable, understandable nuggets of info. 

Best Countries for Healthcare

Okay, so you’ve picked a healthcare insurance plan — congrats — and now you’re facing a major medical issue. Maybe that’s a surgery, a dental procedure, or the mind-blowing miracle of having a baby. 

Take advantage of the fact that you’re traveling the world, and handpick the best country to have your medical procedure done. Worldclass hospitals with brilliant doctors and reasonable — gasp — prices are available around the world.

This is called medical tourism

When you consider the world your oyster you’re free to figure out what hospital, what doctor, what country, and the size of medical bill you want for your next major procedure. Then, you travel to the country of your choosing, and get ‘er done. 

It’s amazingly liberating. 

Medical Tourism: What to Look for

Here’s what Christine Gilbert of Almost Fearless recommends:

In general, this is what I look for:

  1. Private hospitals (if you’re in an industrialized country, say Spain, I think you can go public, this isn’t a hard rule, but certainly you want the best medical care possible).
  2. Doctors who speak English
  3. Low costs or an in-country health plan you can buy into as a foreigner
  4. Advice from expats who have used the medical system there
  5. The name of a specific doctor that expats liked
  6. Visa rules that give you at least 90 days in the country or allow you to extend without doing visa runs

Here’s a list of the ten best countries in Europe for healthcare, to get you started.

Best Countries For Specific Medical Procedures

Dental Work

Malaysia

Consider this Asian country for your next dental checkup or procedure. Most of the dentists are trained in the US and the UK, so you get the same education and training as you would at home. 

Dentist studios are state-of-the-art, according to International Living, and their prices aren’t. A check up costs $9. A filling and a cleaning costs about $32.50 compared to approximate $180 in the US. To replace a cap on a tooth costs on average $300, while at home this would cost closer to $1,200.

Mexico

Everything is cheaper south of the border. And with that price discount, it doesn’t come with a next-day hangover of regret. 

Several private US hospital chains own and run hospitals in Mexico, like International Hospital Corporation of Dallas operating in Mexico under the CIMA name. 

Check out Mexico for dental work where an implant costs you $1,750, compared to $3,000 or more in the US

Giving Birth

Mexico and Thailand

Back to Christine from Almost Fearless:

“My birth in the US cost $3,500 for the midwife (not covered by insurance) and $20,500 for c-section (covered by my insurance — at the time my husband had employer provided US health insurance and I was under his plan, even though he worked remotely and we were traveling). For my second, my appointments in Beirut cost something like $75 including the ultrasound and blood work. My appointments in Thailand cost $20 including some tests like the glucose tolerance test for gestational diabetes. My appointments in Mexico cost about $30 each, and I had to pay for blood work out-of-pocket, which was usually $20-$30. The birth itself, an induction plus a c-section including a three-day hospital stay, cost $2,700. If we ignore the midwife costs in the US, that’s about $20,500 vs. $2,700.  I would say that the quality of care in Mexico was on par with what I received in Oregon.”

Justine Marissa had her child in Mexico City at Medica Sur. Her American insurance covered it at the cost of roughly $2600.

She said, “The doctors billing person straight up asked us if we were using American insurance the price would be double, but we fought it and they charged the same as Mexican clients because technically my husband (a Mexican) was going to pay what they didn’t cover. My insurance ended up covering everything!” 

If you’re searching for a country to have your baby in, Christine is the woman to ask. She had her first child in Oregon, and her second in Mexico.

“Some places I would consider: Canada, Mexico, Costa Rica, Argentina, almost anywhere in Europe, Lebanon, Thailand, Australia, or New Zealand.”

Elective Surgery

Malaysia

Elective or cosmetic surgery is huge in Malaysia, and I’m not talking about the price. 

A full-face lift will run you half of the $35,000 it’d cost you in the US

And your accommodations or medical care won’t be skimped on. Penang and Kuala Lumpur were some of Southeast Asia’s first recipients of the United States’ prestigious Joint Commission International certificate. This certificate is the gold standard for healthcare service providers around the world, so you know you’re getting the best care. 

Necessary Surgery

Costa Rica

Jungles, monkeys, and… necessary surgeries held in beautiful facilities conducted by board-certified physicians and surgeons. The World Health Organization ranks Costa Rica’s healthcare system at #36 — just one spot higher than the US’ ranking of 37th.

According to the Medical Tourism Association, here are costs for popular medical procedures

Coronary artery bypass: Costa Rica $31,500, U.S. $88,000

Heart valve replacement: Costa Rica $29,000, U.S. $85,000

Hip replacement: Costa Rica $14,500, U.S. $33,000

Knee replacement: Costa Rica $9,500, U.S. $34,000

Gastric bypass: Costa Rica $11,200, U.S. $18,000

Resources

Searching for the best country to have your medical needs taken care of? Here are the best resources:

TL;DR

Do as your mom said and get an international healthcare insurance policy. It’s hard to see into the future, and even harder to find enormous amounts of money to cover huge hospital bills if your travels turn sour and bloody. 

Do your research to find the best plan and fit for you, your lifestyle, and your budget. 

And, for goodness sake, you’re already traveling the world, so if you have the ability to plan a major medical procedure, do it in a country where the costs are lower. In many countries, you can get the same level of care as you would back home at a fraction of the price. 

 

Want more like this?

Get weekly gear reviews, travel hacks, and packing tips sent straight to your inbox. As an added bonus, we’ll send you a carry on packing list right away.