Introduction to Expat Health Insurance
Expat health insurance plans are a necessity in today's globalized world, where so many people are residing outside their native country for an extended period, typically living abroad a year or longer in many cases. Many expatriates living and working overseas are not covered under their employer's insurance or a group health insurance. Expatriate health insurance is an annually renewable major medical insurance that provides a high medical policy maximum, wellness checkups, emergency medical evacuation, repatriation of remains and optional benefits such as maternity, dental, life insurance and more depending on the plan.
Eligibility for Expatriate Health Insurance
Anyone who is residing outside the U.S. for more than 6 months in a given year can purchase expatriate health insurance. Whether you are a U.S. citizen or a non-U.S. citizen, expatriates can purchase such international health insurance. Additionally, non-U.S. residents who permanently stay in their own country can also purchase global medical insurance.
Age Restrictions for Expat Health Insurance
Expatriates under the age of 74 years can apply for expat medical insurance. Some plans allow you to continue the coverage beyond 74 years provided you originally applied for the coverage before your 65th birthday. However, the plan available beyond 74 years of age (senior plan) comes with fewer benefits, a lower policy maximum, and more restrictions.
Different plans offer different coverage areas such as:
- Worldwide excluding US
- Worldwide excluding US, Canada
- Worldwide excluding US, Canada, China, Hong Kong, Japan, Macau, Singapore, Taiwan
If there is a possibility that you will move to a different country, travel to a different country, or are likely to go to another country for a treatment, please make sure that the international insurance you purchase provides coverage in that area. E.g., you plan to retire in Costa Rica, but if you would like to be able to come to the U.S., you should choose 'worldwide' coverage.
Applying for expatriate medical insurance is easy and straightforward. In addition to the demographic information, you will have to answer a series of medical questions. Unlike short term travel medical insurance, expat health insurance plans are not instant issue. Once the application is submitted, it will go through medical underwriting. Underwriting is quick and usually only takes a few days.
Pre-Existing Conditions and ACA
Expatriate health insurance plans are not ACA (Obamacare or PPACA) compliant. That means that they generally don't provide an unlimited policy maximum and there are exclusions or limitations of pre-existing conditions. You will have to disclose your medical conditions and it is possible that you will be declined altogether due to specific conditions that may be excluded. Some conditions could also be covered at a higher price.
Exception: GeoBlue Xplorer insurance plan can apply prior coverage to the pre-existing conditions waiting period, provided you were covered with a creditable coverage (ACA compliant) plan and your insurance company will issue a 'Certificate of Creditable Coverage'.
Formerly, U.S. residents were required to carry ACA compliant health insurance plans, even if they normally reside outside the U.S., but would be in the U.S. for more than 35 days in a given year, or else face a federal tax penalty. However, this requirement ended in January, 2019, and there is no longer a federal penalty for U.S. residents in this situation who do not carry ACA compliant insurance. But it should be noted that although the federal penalty no longer exists, there may be state penalties depending upon where you reside in the U.S. If this is the case for your state, you would need to decide if it is better to have ACA compliant insurance in addition to expat insurance, or simply to pay the state penalty. Of course, if you plan to be outside the U.S. for more than 330 days in a year, this would not apply.
Expat Plans vs Local Plans
Expatriates and even the local residents outside the U.S. often face the choice of whether to purchase an expatriate insurance plan or purchase a local plan. There is no one answer for everyone in every situation. Usually a local plan is limited to a specific country and coverage is not transferrable if you decide to visit or reside in another country, or would like to go to another country for a treatment. In addition, a local insurance plan would not cover emergency medical evacuation and repatriation of remains. Moreover, some local insurance plans may only provide coverage at public hospitals where quality treatment may not be available, or the plan's policy maximum is so low that it would be highly inadequate to receive treatment in a private hospital that provides excellent care. In short, each situation would have to be evaluated on a case by case basis.
Expatriates and global citizens can purchase a long term, annually renewable insurance plan for coverage in the geographic area that they desire and enjoy the peace of mind no matter where they travel in that area.
If you need a shorter term coverage, consider purchasing travel health insurance.