Healthcare Abroad

What Happens to Your Healthcare When You Move Abroad at 60?

Best International Health Insurance for Over 55s Living Abroad: An Honest Comparison (2026)

By expatover55.com | Last updated: April 2026 | 15 min read

Let’s start with the question nobody wants to sit with — but everyone over 55 planning a move abroad needs to answer honestly.

What happens if you get seriously ill, or injured, 5,000 miles from home?

Without the right health insurance, the answer could be financially catastrophic. We’re not talking about a GP visit or a prescription. We’re talking about hospitalisation, surgery, specialist treatment, or — in a worst-case scenario — emergency medical evacuation back to your home country. The cost of that evacuation alone can exceed $100,000.

This is why healthcare is the number one concern we hear from our community. And rightly so. Getting it wrong is not an option.

This guide gives you an honest, practical breakdown of everything you need to know — what international health insurance actually covers, how much it costs for over-55s, the key things to watch out for (especially around pre-existing conditions), and a comparison of the leading providers available in 2026.

Table of Contents

Do You Actually Need International Health Insurance?

What International Health Insurance Covers (And What It Doesn’t)

The Pre-Existing Conditions Question — Critical Reading for Over-55s

How Much Does It Cost for Over-55s?

The 5 Key Decisions You Need to Make

Top International Health Insurance Providers Compared

How to Get a Quote and What to Watch For

Our Recommendation

1. Do You Actually Need International Health Insurance?

Short answer: almost certainly yes. Here’s why.

Your home country insurance stops at the border. Whether you have private health insurance, Medicare, NHS entitlements, or any other domestic coverage — it almost certainly does not follow you when you move abroad permanently. Many expats discover this the hard way.

Public healthcare in your new country isn’t immediately available. In most popular expat destinations — Portugal, Spain, Thailand, Mexico, Panama — you cannot simply walk into the public healthcare system as a new foreign resident. Access to public care (where it exists) typically requires you to be formally registered, paying into the local social security system, and often waiting a period of time. In the meantime, you’re on your own.

Some countries require it for your visa. Many retirement and residency visas — including Portugal’s D7, Thailand’s O-A, and Costa Rica’s Pensionado — require proof of health insurance as part of the application. This isn’t optional; it’s a legal requirement.

Private healthcare abroad, while cheaper than the US, can still be expensive. A hospital stay in Portugal, Thailand, or Mexico might cost a fraction of US prices — but it can still run into thousands of dollars without insurance. A serious illness or surgery can cost tens of thousands.

The bottom line: international health insurance isn’t a luxury for expats over 55. It’s the foundation everything else sits on.

2. What International Health Insurance Covers (And What It Doesn’t)

Understanding what you’re actually buying is essential — particularly at our age, when the details matter more than they did at 35.

What’s Typically Covered

Inpatient care — hospital stays, surgery, specialist treatment, nursing care. This is the core of all international health plans and is included in every policy, even the most basic.

Day-patient treatment — procedures that don’t require an overnight stay but do require a hospital or clinic setting.

Emergency care — accident and emergency treatment, ambulance services, emergency surgery.

Medical evacuation — transport to an appropriate medical facility, or repatriation to your home country for treatment. This is one of the most valuable benefits for expats in more remote locations and can cost $100,000+ without insurance.

Outpatient care — GP visits, specialist consultations, diagnostic tests, prescription drugs. This is often an optional add-on rather than a core benefit. Strongly recommended for those of us over 55 who see doctors more regularly.

Mental health — increasingly included in comprehensive plans, though limits vary.

Dental and vision — almost always optional add-ons, not included in core plans.

Telehealth — many modern policies now include access to online doctors and consultations, which is genuinely useful for routine queries when living abroad.

What’s Often NOT Covered

Pre-existing conditions — this is the big one (see section 3 below)

Cosmetic procedures

Experimental treatments

Long-term care or nursing home costs

Pregnancy — often excluded or available as a paid add-on with waiting periods

Routine dental and vision — unless specifically added

3. The Pre-Existing Conditions Question — Critical Reading for Over-55s

This is where international health insurance gets complicated — and where people over 55 need to pay the most careful attention.

Most of us have something on our medical record by the time we reach our mid-50s. High blood pressure. High cholesterol. A knee replacement. Diabetes. A history of anxiety. An old back injury. These are pre-existing conditions, and how insurers handle them varies enormously between providers.

The three main approaches:

1. Full medical underwriting

You complete a detailed health questionnaire upfront. The insurer reviews your medical history and makes a decision: cover you in full, cover you with specific exclusions, cover you with a loading (higher premium), or decline to cover you.

Advantage: You know exactly what’s covered from day one. No nasty surprises when you make a claim.

Disadvantage: Takes longer to apply, and if you have significant health issues, you may face exclusions or higher premiums.

2. Moratorium underwriting

No medical questionnaire required. Instead, any pre-existing condition you’ve had in the past 5 years (typically) is automatically excluded for the first 2 years of your policy. If you go 2 years without treatment or symptoms for that condition, it may become covered.

Advantage: Faster and easier to apply. No upfront questions about your health history.

Disadvantage: You don’t know for certain what’s covered until you make a claim. For someone with ongoing conditions, this can be risky.

3. Continuous personal medical exclusions (CPME)

Similar to moratorium, but exclusions for pre-existing conditions are permanent rather than potentially temporary.

Our strong recommendation for over-55s: Opt for full medical underwriting wherever possible. Yes, it involves more paperwork upfront. But clarity about your coverage is worth far more than administrative convenience — particularly for those of us with ongoing health management needs.

Key questions to ask about pre-existing conditions:

Is this condition covered, excluded, or subject to a waiting period?

If excluded, is there any pathway for it to become covered in the future?

Does the exclusion apply to related conditions? (e.g. if heart disease is excluded, does that also exclude cholesterol medication?)

What counts as a “pre-existing condition” under this policy?

4. How Much Does It Cost for Over-55s?

Let’s talk real numbers — because this is what everyone wants to know.

International health insurance is priced based on several factors: your age, the country you’re living in, the level of coverage, whether US treatment is included, your deductible/excess, and your health history.

Age is a significant factor. A healthy person in their 20s might pay around $2,500 per year for coverage, while someone in their 60s could pay $8,000 or more for the same coverage level.

Overall, global policies typically cost $2,000–$15,000 annually depending on coverage level and region.

Real-world cost examples for over-55s (2026 figures):

For a couple — a husband aged 62 and wife aged 60 — retiring in Costa Rica, a Silver-level plan excluding the US costs approximately $7,794 annually with a $1,000 deductible. Worldwide coverage including the US rises to around $10,322 with the same deductible.

Individual coverage can start from around $500 for very basic emergency-only plans, rising to over $10,000 for comprehensive international cover including the United States.

The US inclusion decision is crucial. Adding US coverage can increase premiums by 40–60%, but excluding it means any US medical care comes out of pocket. For most expats who don’t regularly visit the US, excluding it is sensible and saves significant money. Americans who return home for visits regularly should think carefully about this.

Ways to reduce your premium:

Increase your deductible/excess — choosing a higher amount you pay before insurance kicks in ($1,000, $2,500, or $5,000) reduces your premium meaningfully

Exclude the US from your coverage area if you don’t need it

Choose a regional plan rather than worldwide if you’re settled in one area

Take only the cover you need — don’t pay for maternity coverage at 58

Pay annually rather than monthly — most insurers offer a discount

5. The 5 Key Decisions You Need to Make

Before you start comparing providers, get clear on these five things:

Decision 1: Coverage area

Worldwide including US? Worldwide excluding US? Regional (Europe only, Asia only, etc.)? This single choice drives a significant portion of your premium.

Decision 2: Inpatient only, or comprehensive?

Inpatient-only plans cover hospitalisation and surgery. Comprehensive plans add outpatient care (GP visits, specialist consultations, tests, prescriptions). For over-55s, comprehensive outpatient cover is usually worth the additional cost — we see doctors more regularly, and those costs add up.

Decision 3: Your deductible/excess

How much are you prepared to pay out of pocket before insurance kicks in? A higher deductible = lower premium. A $5,000 deductible can significantly reduce annual costs — but only works if you have that amount available as an emergency fund.

Decision 4: Add-ons

Dental? Vision? Mental health? Medical evacuation (usually included, but check)? Decide what you genuinely need rather than buying everything available.

Decision 5: Underwriting method

As discussed above — full medical underwriting is usually the better choice for over-55s with any health history.

6. Top International Health Insurance Providers Compared

The leading international health insurance companies for expats include Cigna Global, AXA Global Healthcare, Allianz Care, IMG Global, Bupa Global, and April International, among others. Here’s how the main options compare for our specific audience — expats over 55.

🏆 Cigna Global

Best for: Comprehensive cover, large provider network, no age limit

Cigna has over 86 million customers in more than 200 countries and is known for its large medical network and excellent service for both individual and corporate clients.

Cigna offers 24/7 customer support in more than 50 languages, and its plans range from budget-friendly options to a comprehensive Platinum plan with unlimited annual benefit limits.

What makes it good for over-55s:

No upper age limit for existing policyholders (important — some insurers stop covering you at 65 or 70)

Strong outpatient coverage options

Excellent cancer care coverage across all plan levels

Established, financially stable company with decades of track record

Plans: Silver, Gold, Platinum

Approximate annual cost (individual, 60, excl. US): $4,000–$8,000 depending on plan level

Pre-existing conditions: Full medical underwriting available

🌍 Allianz Care

Best for: European expats, flexible plan structure

Allianz Care offers a moratorium underwriting option with no medical questionnaires required, making the application process notably faster and more straightforward.

Allianz has been in business since 1890 and offers three levels of care — Essential, Classic, and Premier — with options to add outpatient care, dental, and repatriation coverage.

What makes it good for over-55s:

Strong European hospital network — ideal for Portugal, Spain, France expats

Flexible modular structure — add only what you need

Reputable, well-established European insurer

Telehealth and mental health app included

Plans: Care Base, Care Enhanced, Care Signature

Approximate annual cost (individual, 60, excl. US): $3,500–$7,500

Pre-existing conditions: Moratorium underwriting (full underwriting available on request)

Note: AXA does not provide pre-existing condition coverage for individuals on international health plans — so if pre-existing conditions are a concern, Allianz or Cigna are better options.

🌐 AXA Global Healthcare

Best for: Fast claims processing, strong digital experience

AXA is one of the world’s largest insurance groups and brings significant financial stability to its international health plans.

More than 80% of AXA claims are paid to the client within 48 hours of all documentation being submitted — one of the fastest processing times in the industry. For expats who need to pay upfront and reclaim, this matters enormously.

What makes it good for over-55s:

Excellent digital claims process — straightforward app-based submissions

Fast reimbursement

Five coverage levels from basic emergency to comprehensive Prestige Plus

Strong global hospital network

Plans: Foundation, Standard, Comprehensive, Advanced, Prestige Plus

Approximate annual cost (individual, 60, excl. US): $3,000–$7,000

Pre-existing conditions: Note the exclusion mentioned above — not suitable if pre-existing condition cover is essential

💪 IMG Global (International Medical Group)

Best for: Flexibility, US expats, those with complex health histories

IMG Global is a specialist expat insurer with a strong reputation, particularly among American expats. If you are seriously injured or sick, IMG can arrange evacuation and coordinate your return to your home country to receive medical care at a facility close to your family or at an adequate facility near your current destination.

IMG’s multilingual in-house team of nurses, doctors, and case managers provides 24/7 assistance in case of emergency — not just a call centre, but medical professionals.

What makes it good for over-55s:

Multiple underwriting options, including options for complex health histories

Four plan levels (Bronze, Silver, Gold, Platinum) with good flexibility

Strong evacuation and repatriation coverage

Good prescription drug coverage

Available add-ons for vision, dental, and term life

Plans: Bronze, Silver, Gold, Platinum

Approximate annual cost (individual, 60, excl. US): $3,500–$7,500

Pre-existing conditions: Multiple underwriting methods available — worth discussing your history directly

🌺 April International

Best for: Telehealth, paperless claims, non-US nationals

April International is a strong choice particularly for non-Americans. April International offers unlimited free telehealth to its members, no upfront hospital costs where direct billing is available, and paperless reimbursement for medical claims via its app.

For over-55s who want convenient access to medical advice without always travelling to a clinic, the unlimited telehealth benefit is genuinely valuable.

Plans: Multiple tiers

Approximate annual cost (individual, 60, excl. US): $3,000–$6,500

Pre-existing conditions: Moratorium underwriting standard; full underwriting available

📊 Quick Comparison Summary

Provider

Best For

Pre-Existing Cover

Claims Speed

Age Limit

Cigna Global

Comprehensive cover, large network

Yes (full UW)

Good

None*

Allianz Care

European expats, flexibility

Moratorium

Good

Check policy

AXA Global

Fast claims, digital experience

Limited

Excellent (48hr)

Check policy

IMG Global

US expats, complex histories

Multiple options

Good

Check policy

April International

Telehealth, non-US nationals

Moratorium

Good (app-based)

Check policy

*for existing policyholders

7. How to Get a Quote and What to Watch For

Getting quotes: All the providers above offer online quote tools. However, for over-55s — particularly those with health history to consider — we strongly recommend working with an independent insurance broker who specialises in expat health insurance. A specialist brokerage can leverage industry connections and expertise to connect you with a plan that genuinely aligns with your circumstances, destination, and health needs — with access to over 65+ insurance options rather than being limited to a single carrier.

Red flags to watch for when comparing policies:

🚩 Age cut-offs — some policies stop being renewable after age 65 or 70. This is a serious issue. Always check the maximum entry age and the maximum renewal age before committing.

🚩 Lifetime benefit limits — a policy with a $1 million lifetime limit sounds generous until you need cancer treatment or long-term specialist care. Look for policies with high or unlimited annual limits.

🚩 Vague pre-existing condition language — if the policy isn’t clear about exactly what is and isn’t covered, ask for written clarification before you sign.

🚩 Cheap premiums with high co-payments — a low monthly premium that requires you to pay 30% of every claim can cost more than a slightly higher-premium policy with full coverage. Calculate the total cost of ownership.

🚩 No medical evacuation — this should be standard. If it’s not included, move on.

Questions to ask every provider:

What is your maximum entry age and renewal age?

How do you handle pre-existing conditions — and specifically, [your condition]?

Is medical evacuation and repatriation included as standard?

What is the annual benefit limit and is there a lifetime limit?

Which hospitals in [your destination country] are in your direct billing network?

What is your claims process — pay and reclaim, or direct billing?

How do premiums typically increase with age at renewal?

8. Our Recommendation

For most people in our community — over 55, moving abroad or already living abroad, with some medical history — here is our honest guidance:

If you’re European-based or moving within Europe: Start with Allianz Care or Cigna Global. Both have strong European networks, and Cigna’s no age limit policy is particularly reassuring for long-term planning.

If you’re American or need regular US access: IMG Global or Cigna Global are the strongest choices, with good US network connections and experience handling American expat needs.

If fast, digital claims handling is your priority: AXA Global Healthcare leads on processing speed — but check the pre-existing conditions terms carefully.

If telehealth access matters to you: April International’s unlimited telehealth is a genuine differentiator, especially for managing ongoing conditions with remote consultations.

For everyone: Use an independent broker for your first policy. The market is complex, the details matter enormously at our age, and the right guidance upfront can save you from a very expensive mistake.

The Bottom Line

International health insurance is not the most exciting purchase you’ll make when moving abroad. But it may be the most important.

The expats who thrive abroad are those who move with confidence — and that confidence comes from knowing that if something goes wrong medically, they are covered. The ones who struggle are those who either went without insurance, or bought the cheapest policy without reading the details, and discovered the gaps when they needed them most.

Get this right, and you’ll barely think about it for the next decade. Get it wrong, and it could define your entire expat experience.

👉 [Get a free personalised health insurance quote for expats over 55 here] (affiliate link — I may earn a commission if you purchase through this link, at no extra cost to you)

Take your time. Read the fine print. Ask the questions above. And if you’re unsure, talk to a broker who specialises in expat health insurance for our age group.

You’ve worked too hard and planned too carefully to let this be the detail that catches you out.

This article is for informational purposes only and does not constitute financial or insurance advice. Always seek guidance from a qualified insurance professional before making decisions about your health coverage.

Disclosure: This article contains affiliate links. I may receive a commission if you purchase a policy through links on this page. This does not affect the editorial independence of this review — I only recommend providers I believe serve our community well.

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