Health Insurance for Senior Expats
Are You Better Off Leaving the U.S.?
By Kim Brant-Lucich, Co-author of Survival Guide to Caring for Aging Parents
There is a new familiar dinner-party topic. Someone brings up the exorbitant cost of a prescription drug, or may casually mention that their neighbor just sold their home and moved to Portugal. Suddenly, everyone at the table is doing the math on what it would take to start over somewhere else. For years, people have tossed around the idea that it’s cheaper to take endless cruises than to pay for the high cost of senior living. Lately, though, it’s no idle daydreaming. A growing number of Americans — of every age, not just retirees — are seriously exploring life abroad. When they begin researching their options, healthcare and health insurance are often the concerns that keep people from pulling the trigger. These days, though, as U.S. healthcare costs spiral out of control, healthcare may even be the impetus for the move. Since the beginning of 2025, there has been a significant uptick in U.S. citizens exploring other nations because of the changing political climate in the USA. A company called “Expatsi,” which guides people exploring moves abroad, claims that their following and membership at expatsi.com has grown exponentially. Many of the more popular nations for U.S. expats are those with national or public healthcare systems such as Mexico, Portugal, and Canada.
In the past year, Canada has become exceedingly popular. The numbers back this up — and they’re moving fast. Canada’s Bill C-3, passed in December 2025, eliminated the old rule limiting how many generations born abroad could inherit citizenship, instantly creating millions of new potential US-Canadian dual citizens. In just the first seven weeks after the law took effect, Canada received over 12,000 citizenship-by-descent applications, with Americans leading the way. By late May 2026, more than 6,100 people had been granted proof of citizenship under the new rules, and people born in the United States accounted for 51% of those approvals — more than any other country. Another roughly 121,800 applications were still awaiting a decision as of May 2026, bringing total citizenship-by-descent applications filed since the law passed to well over 125,000. In June 2026, Canada actually froze the processing of new citizenship-by-descent approvals for a short time, as they reviewed some of the already-approved applications over verification concerns. In any event, in the case of Canada, most of these applicants aren’t packing boxes tomorrow. They want the passport “just in case.”
The trend for expats has historically been to secure a different pace of life, stretch a fixed income further, or get more affordable healthcare and other services. However, as I mentioned earlier, an increasing number of people are seeking whatever dual citizenship they may be eligible to obtain by ancestry because they have genuine concerns about the direction of the country. This is no longer just a retiree phenomenon, either — people in their thirties and forties are asking the same questions their parents are. When the conversation moves from “wouldn’t it be nice” to “how would we actually do this,” it inevitably lands on the same worry: what happens if I get sick?
Healthcare matters enormously for aging parents, because Medicare, for the most part, does not travel. Step outside the US border for good, and you’re on your own to figure out how healthcare works wherever you land. The good news is that, in many popular destinations, “figuring it out” turns out to be a lot less frightening — and a lot less expensive — than what many families are already paying in the United States, where the average American now accounts for over $15,000 a year in healthcare spending, according to federal data. The actual cost to the individual retiree can range from roughly $203/month in 2026 for Medicare Part B and Medicare Advantage to anywhere from $500 to $1500/month for higher earners or people choosing comprehensive Medicare Supplement plans on top of their Medicare Part B premiums. Note, also, that the cost of Medicare increases annually. Between 1966 and 2026 (sixty years), there have only been four occasions when the cost decreased slightly from one year to the next. When people talk about being medically poor, this is what they mean.
Source: https://pennycalc.com/medicare-premiums/history/
Costa Rica has built its reputation among American retirees for a reason. The country runs a dual public-private system, and legal residents can enroll in the public Caja system for a modest, income-based monthly premium. A private specialist visit typically runs $50 to $100 out of pocket, and even a procedure like a colonoscopy can come in under $400. Discount medical membership plans, running around $14 a month, are popular for trimming those costs down even further. It isn’t the US system minus the price tag — wait times and access vary by region — but for a lot of families, the math works. Other Central and South American countries that are hoping to attract Expats, like Ecuador, offer similar models for healthcare. Ecuador’s public system is open to foreign residents and runs roughly $80/month. Be advised, however, that much of the nation is rural and healthcare facilities are not found on every street corner, as they are in the U.S.
Mexico offers something similar through IMSS, its public social security health system, which is open to foreign residents voluntarily. Annual premiums range from roughly $500 to $1,200 depending on age — a fraction of what the same coverage would cost at home. The tradeoff is real: long waits for a general practitioner, equipment and staffing shortages in some areas, and not every doctor speaks English. Many expats use IMSS as their base coverage and pay out of pocket at private clinics when speed or English-language care matters most. In addition, with private insurance, numerous physicians make house calls, and there are networks of physicians who treat patients at their homes.
Portugal consistently ranks among the top destinations for Americans, and its healthcare system is a major reason why. Legal residents gain access to the national health service, and even private supplemental insurance through Portuguese banks runs around 130 euros a month, with modest copays. One American expat described a prescription that would have cost $250 at home coming to about 60 euros with national coverage. It isn’t unusual to hear people describe the care itself, not just the price, as a genuine upgrade from what they left behind.
Ireland is the trickiest of the five to unpack, largely because of its two-tier system. Public hospital stays are free, but a GP visit without a Medical Card runs 50 to 75 euros, and waiting lists for a specialist can stretch nine to eighteen months. Most American arrivals end up buying private insurance right away — typically $1,300 to $2,700 (1,200 to 2,500 euros) a year for a single adult — and there’s a real incentive to sign up within nine months of establishing residency, since insurers can otherwise add age-based loading fees for waiting. These costs are still a fraction of what the same care costs in the United States.
Canada is having its own moment, given the citizenship surge. Its publicly funded system covers residents, but almost every province except Ontario imposes a waiting period — often the rest of the current month plus two more — before a new resident’s coverage kicks in. Families typically bridge that gap with private travel-style insurance, running roughly $80 to $200 a month per adult. Once coverage begins, it’s comprehensive for hospital and physician care, though dental, vision and prescriptions are usually still out of pocket or covered through a separate private plan — not so different from Medicare here at home. Canada also has urgent care facilities, and costs vary depending on residency and services provided. I was recently in Vancouver when a rear crown fell out. It was a crown that sits on top of an implant, so it wasn’t a simple problem, and I was worried about waiting until I returned home to the U.S. to see my regular dentist. After a few phone calls, I was able to get an appointment with a dentist whose office consulted with my periodontist back home, did the work needed, and reseated the crown. It was done so well and with so much care and compassion (I’m a terrible patient), that I have been contemplating returning to Vancouver for all my dental work. The cost was far less than I would have paid in the U.S.
Now, despite all of the apparent good news about healthcare overseas, this is where I want you to slow down and pay attention. The moment you start Googling “health insurance for expats,” you’ll find no shortage of companies eager to help — and eager to sell. There are dozens of international insurance brokers out there, and many of them are legitimate, well-established names. But this is also an industry built around fear and unfamiliarity, two things that make people easy to upsell. Plans that include coverage back in the US, for instance, can run $10,000 to $28,000 a year or more — often many times what a comparable local plan would cost, and sometimes more than people were already paying for insurance at home. Sales representatives aren’t always forthcoming about what’s excluded, what your real out-of-pocket exposure looks like, or whether a far cheaper local public option would serve just as well. Before you sign anything, get quotes from at least three providers, read the exclusions — not just the coverage highlights — and ask directly whether the plan covers pre-existing conditions, which is where many older applicants get an unpleasant surprise.
A few places worth starting your research: International Living (internationalliving.com) publishes country-by-country healthcare guides written by actual expats living there. The U.S. State Department’s country information pages (travel.state.gov) include health and insurance guidance for nearly every destination. American Citizens Abroad (aca.org) is a nonprofit advocacy group — not a seller — that publishes unbiased guidance for Americans living overseas. And if you do want to compare brokers directly, well-known names like Cigna Global, Allianz Care, and IMG are worth a look — but treat their quotes as a starting point for comparison, not a final answer. There is a website called expatsi.com which is geared toward people exploring moves abroad. They have a variety of useful tools, including an online test to determine the best country for you, organized scouting trips, webinars, and immigration and healthcare expert consultants. The company was started by two U.S. expats currently living in Mexico. Some of their webinars, services, and consultations are offered for a price, but they’re not a big business trying to gauge you. I took one of their scouting trips to Mexico, and it was invaluable. You can also find out more about health (and other) insurance from current expats in their respective countries of residence.
Whether any of this leads your family to an actual move, or just gives you a more informed answer the next time someone at dinner brings up Portugal, the lesson is the same one I keep coming back to: know before you go. Health insurance overseas can be dramatically better, and dramatically cheaper, than what many of us are paying today — but only if you do your homework instead of trusting the first glossy brochure that lands in your inbox. Beware of anyone who wants you to sign quickly. Take your time, compare your options, and make your decision with real numbers instead of promises.