Health Insurance Options for Expats: Types Compared

Local private insurance is purchased from insurers operating in the destination country. In Spain, this includes companies like Sanitas, Adeslas, Asisa, Mapfre, and DKV. These policies cover care within Spain through local provider networks. For how these fit into the broader healthcare system, see public vs private healthcare.

Premiums tend to be lower than international alternatives. The insurer operates in one regulatory environment and contracts with local hospitals and doctors. This efficiency translates to lower costs for comparable coverage.

The limitation is geographic. Coverage applies in Spain but typically not elsewhere, except for emergencies during short trips. Someone who travels frequently or splits time between countries may find local insurance insufficient.

Most local insurers use provider networks. Policyholders choose doctors and hospitals from an approved list. Going outside the network means paying out of pocket or facing reduced reimbursement.

Copay and non-copay models exist. Copay policies have lower premiums but charge small fees for each visit or service. Non-copay policies cost more monthly but have no additional charges when using care.

Coverage varies by policy tier. Basic plans cover essentials. Higher tiers add dental, mental health, maternity, or access to specific hospitals. Reading policy details matters because coverage assumptions often differ from reality.

International health insurance provides coverage across countries. Policies typically cover a region (Europe, worldwide excluding US, worldwide including US) or allow customization. This suits people who move between countries or travel frequently.

Providers in this space include Cigna Global, Allianz Care, Bupa Global, AXA International, and IMG, among others. These are distinct from local subsidiaries of the same brands and operate with different policy structures.

Premiums are higher than local insurance. The insurer takes on risk across multiple healthcare systems and regulatory environments. Worldwide coverage including the US costs significantly more due to American healthcare costs.

International insurance often uses reimbursement models. Policyholders pay for care and submit claims for repayment. Some insurers offer direct billing at partner hospitals, but this is not universal.

Coverage portability is a key feature. If someone relocates from Spain to Portugal, the policy continues. This avoids gaps in coverage and the challenge of obtaining new insurance with pre-existing conditions in a new country.

Home country coverage varies. Some policies include the home country for visits or emergencies. Others exclude it entirely or limit coverage duration. This matters for expats who return frequently.

Travel insurance covers short trips, typically up to 30, 60, or 90 days. It handles emergencies, trip cancellation, and medical evacuation. It is not designed for ongoing healthcare needs. For a detailed comparison, see travel insurance vs private health insurance.

Some expats mistakenly use travel insurance for long-term stays. This creates problems. Policies may void if the insurer determines the person is residing abroad rather than traveling. Claims can be denied.

Travel insurance has a role during transitions. Someone visiting a country before relocating, or traveling while waiting for local insurance to activate, may use travel coverage temporarily. It does not replace proper expatriate health insurance.

Insurance from the home country usually does not cover care abroad, except for emergencies during short trips. US health insurance, for example, typically provides no coverage outside the United States for non-emergency care.

Some countries have reciprocal agreements. EU citizens can use the European Health Insurance Card (EHIC) for temporary necessary care in other EU countries. This is not full coverage but prevents being uninsured during visits.

Maintaining home country insurance while abroad may or may not make sense. If coverage does not apply in the new country, the premium provides little value. Some people maintain it for visits home or eventual return.

Many visas specify health insurance requirements. Spain's non-lucrative visa requires private insurance with no copays and coverage of at least €30,000. Digital nomad visas have similar requirements. The policy must meet specific criteria.

Not all insurance qualifies. Travel insurance typically does not meet visa requirements. Some international policies need documentation proving they meet local standards. Consulates may have lists of accepted insurers.

Local insurance often satisfies requirements more easily. Insurers operating in the country understand visa criteria and offer compliant products. International insurers may require extra documentation or verification letters.

People settling in one country long-term often choose local insurance. Lower costs, easier visa compliance, and integration with local healthcare systems make it practical. The trade-off is losing coverage when traveling.

People who move frequently or maintain ties to multiple countries lean toward international insurance. Higher cost is offset by portability and consistent coverage. Digital nomads and executives on rotation often fall into this category.

Budget constraints influence decisions. Local insurance is more affordable. Someone prioritizing cost over flexibility may accept geographic limitations. Someone prioritizing security across locations pays more for broader coverage. Managing recurring payments across currencies is covered in payment and budgeting tools.

Using multiple insurance types is not uncommon. Someone might have local insurance for routine care in their resident country and travel insurance for trips. Or international insurance as primary with local coverage added for network access.

Layering adds cost but addresses gaps. Local insurance provides networks and visa compliance. International insurance covers travel and potential relocation. The combination handles more scenarios than either alone.

Complexity increases with multiple policies. Understanding what each covers, how claims work, and which policy is primary requires attention. Simplicity has value, but so does comprehensive protection.

These are commonly used insurance options people compare at this stage.