Tuesday, August 1st 2017

Should an expat get international or national health insurance?

Written by

Rafael Bracho

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What is the best option for expats?

Have you wondered the difference between national health insurance andinternational health insurance? Are you an American expat who is interested in health coverage from the highest quality international insurance providers? This article covers:


  • When choosing a policy, if you do not have any major preexisting conditions, the local country has an unfavorable policy towards expats or a poor healthcare system, and you can afford private insurance. We recommend choosing an international provider.

  • International providers offer coverage and a familiarity that an expat comes to expect from insurance policies.

  • They offer worldwide coverage backed by some of the largest insurance institutions.

Deciding to purchase international health insurance from international insurance providers, it can be a trying process. Decisions need to be made as to the company, the program, the options, and the deductibles. One major decision is to decide from what type of company to purchase the policy from. In general, there are two types of companies that you may obtain coverage from in your country:

  • Domestic In-Country National Providers

  • International Insurance Providers

Deciding what type to work with should be your first step.

Over the years, we have met and helped many expats obtain coverage, and spent many hours explaining the coverage and options. It is no surprise that most of our clients are American or Canadian Expats. Things that we take for granted in insurance might not be the case from your national insurance providers. Just for reference, we refer to an expat as someone who is residing in a foreign country other than their passport country, for more than 6 months out of the year. Generally international healthcare plans are only available to “expats.”

WeExpats Recommends International Insurance Providers:

For most expats we recommend international insurance providers as they provide a much more robust policy that has better coverage, as well as backed-by international insurance trusts that are regulated by agencies which support some of the biggest providers in the world.

Instances when we do recommend getting a local or national plan is:

  • When the client has preexisting conditions that private policies will not cover

  • If they do not have the budget to afford the $100-$400USD a month the private insurance companies charge

  • If the host country has a great free healthcare system.

Over the years, we have seen many of the same issues and talking points come up when discussing options with our clients. Here is a list of some of the main topics brought up that you should consider when making your decision:

        1. Challenges with the Language:

Can you understand everything the agent is discussing? Are they answering your questions in a reasonable fashion? Can they answer questions specific to your medicare or home country’s laws? Can you read the fine details of the policy? Are materials available in English? Can you call the support line in an emergency or with a claim dispute with a fluent English-speaker there to assist you and translate into the local language? Will your explanation of benefits for a claim be in English? This may not seem as big of a deal to some, but it is a major deciding factor for many of our clients. Being in an emergency is already stressful enough without having to deal with language barriers.

        1. -Deductibles-

Many national carriers treat deductibles as a per-event deduction, not a cumulative of your medical expenses. This means that if you break your leg and have a heart attack in the same year, they will have separate deductibles for each individual claim. For larger claims, this can really eat into the savings you would have had. International insurance providers offer plans that have a single annual deductible that can be met with all of your eligible medical expenses.

        1. -Guaranteed Renewable-

Will the carrier guarantee coverage for life, and not cancel you if you have substantial claims? Or will your carrier single you out for an individual policy increase due to “excessive claims”? Is it in writing in the contract? Will they cancel your policy after a certain age? Last thing you want to find out is that a national plan will drop you just as you need the coverage the most. We only work with international plans that guarantee renewal from the best international insurance providers that will not single you out for a premium increase due to claims.

        1. -Hidden Exclusions in Policies-

We have worked with many clients that sign up with national plans, not sure exactly what they purchased and then discover that cancer or heart issues will only be covered after a 12-or-24-month waiting period. Many national plans do not ask loads of health questions in advance, and therefore they will deny claims due to preexisting conditions. International plans will ask the questions, review your medical records, and specifically address any preexisting conditions so that you will know what to expect at the time of signing. Underwriters are very thorough and will be upfront with you so that there are no surprises down the road when a claim is filed.

        1. -What will they pay?-

If you need the top cancer specialist in that country, who charges more than his peers, will you be able to use him? Will he or she be part of your plan? Will the plan only pay pennies on the dollar for what he or she bills? Will you have access to the specialty hospital or the surgeon everyone recommends with your insurance policy? Private insurance companies are used to paying claims worldwide determining liability using UCR a cost basis (Usual, Customary, Reasonable). If you want to go to Singapore for a surgery that cost 5 times more than your home country, they will pay that cost. They know that in certain countries, the UCR cost basis is much higher than other countries. In the 5 years we have been helping Expats worldwide, we have never had a claim get denied for the cost, and only once was it denied for not being a usual procedure—being that the person was trying to get an experimental surgery.

        1. -Options for Care-

International plans usually allow you to have coverage anywhere in the world and allow you to use any doctor, and any facility on a reimbursement basis. Many plans have arranged for a direct payment with major private hospitals in your country in the event of major hospitalization. This means that typically you have to pay up to your deductible, submit a claim, and then they will reimburse you. In instances when your bill is very large, the insurance company will assure payment to the hospital, often wiring a deposit on your treatment.

Furthermore if a treatment is not available in your country, you may utilize your plan elsewhere. We have found that most doctors and specialists who work with the expat community do not participate in national insurance networks as they find them to be a hassle, limit their reimbursements, and not worth their effort to manage the paperwork process.

        1. -Third Party Arbitration-

Can you imagine trying to work with the foreign country’s legal system as an outsider? Most international plans have a process in place to appeal to an outside party in the event of a denied claim. In the unlikely event legal action is required, then a suit is handled in American legal system by a third-party arbitration to assure a neutral decision.

        1. -Finally who is behind your insurance carrier?-

Is there a reinsurer such as Lloyd’s of London behind them in the event of catastrophic, unplanned claims that would financially cripple smaller carriers? Several unexpected organ transplants, or complicated cancer situations can cause financial ruin for even the most stable insurance company. All our international carriers are reinsured with large international trusts for such events. By being backed by such large institutions also means that they are required to adhere to stringent regulations that assures longevity and client protection.

Lots of questions to ask, and lots of decisions to make. Our firm has worked exclusively with expats and understand their unique needs. Let us review what your options are, and work with a plan that suits your unique needs and budget.

Interested in getting health insurance while living abroad? Get a free quote today by clicking below.

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