Health Cover Abroad: What Happens to Your US Insurance

For Americans, healthcare is the emotional core of any move abroad — equal parts hope (“I’ve heard it’s affordable”) and terror (“what if I’m uncovered?”). Both instincts are right: coverage abroad is usually far cheaper than US healthcare, and the transition is where people get caught exposed.

First, the hard facts about your US coverage

• Employer plans and ACA marketplace plans generally provide little to no routine coverage outside the US — and you typically can’t keep ACA coverage without US residency anyway.
• Medicare pays essentially nothing abroad. Whether to keep paying Part B for re-entry protection is its own decision: Medicare and moving abroad.
• Travel insurance is not a substitute — it covers emergencies on trips, not life abroad. The difference matters enough that we wrote it up separately: travel vs expat health insurance.

What replaces it: the three layers of European cover

Layer 1: Private expat/visa insurance (your entry ticket)

Most long-stay visas require proof of private health insurance covering you locally. Comprehensive private cover for a healthy 60-something in Portugal or Spain commonly costs a fraction of an unsubsidised US premium — often a few thousand dollars a year rather than tens of thousands. Insurers range from global names (Cigna Global, Allianz and peers) to strong local carriers. Age limits and pre-existing-condition rules vary, so shop before you’re in a hurry.

Layer 2: The public system (arrives with residency)

Many countries open their public healthcare to legal residents — sometimes immediately, sometimes after a qualifying period or by paying into the system. Public systems handle the serious, expensive things well; the trade-off is waiting times for non-urgent care.

Layer 3: Private top-up (the popular combo)

Many expats settle into public-system membership plus a modest private policy for fast specialist access and private hospitals — often the best value in healthcare anywhere.

The transition trap

The dangerous window is between your last day of US coverage and your first day of solid coverage abroad. Close it deliberately: line up the expat policy to start on arrival (visa applications usually force this anyway), consider short bridge cover for the moving weeks, and never let the gap ride on “we’ll sort it when we land.” Timing this is a standard line on the Financial Relocation Roadmap.

Budgeting honestly

Healthcare abroad isn’t free — it’s priced like a utility instead of a crisis. Budget for premiums, modest out-of-pockets, dental/vision, and the occasional private specialist. For most American households the total still lands dramatically below US costs — run your own numbers with the free calculator and the full picture in retiring in Europe.

This article is general information, not insurance advice. Coverage rules, visa requirements and premiums vary by country and change often — verify current terms with insurers and official sources.