International Health Insurance for Expats: Costs and How to Choose

Health insurance is the expat expense people most often get wrong in both directions. Some pay thousands a year for an international policy they don't need because the local public system already covers them. Others assume they are covered and find out otherwise in a hospital billing office.

This guide explains when you actually need international health insurance, how it differs from local cover and travel insurance, roughly what it costs at different ages, and how deductibles, pre-existing conditions and evacuation cover work. It also covers countries where insurance is a visa condition, including the Schengen area, Germany, the UAE and Australia.

The short answer: if you are moving to a country with a public system you can join, such as the UK or Canada, you may only need a short bridging policy. If you are moving somewhere without one, moving frequently, or want treatment outside your country of residence, an international plan is usually worth it.

When the public system covers you

Before buying anything, check what you get through your visa or residence.

• UK: Most visa holders pay the Immigration Health Surcharge (£1,035 a year for workers, £776 for students) and can then use the NHS on broadly the same terms as residents. Health and Care Worker visa holders are exempt from the surcharge but still get NHS care. See GOV.UK's healthcare surcharge page.
• Canada: Permanent residents and many work permit holders join their provincial plan. Ontario no longer applies its old three-month waiting period, but several provinces, including British Columbia, still make newcomers wait up to about three months. Private bridging cover for that gap is cheap and sensible.
• Australia: Medicare is for citizens, permanent residents and visitors from countries with a reciprocal health care agreement, such as the UK, Ireland, New Zealand and several European countries. Temporary skilled visa holders without such an agreement usually need Overseas Visitor Health Cover, and international students need Overseas Student Health Cover.
• Germany: Everyone living in Germany must have health insurance. Employees usually join the statutory system, which costs 14.6% of salary plus a fund-specific additional rate (projected to average about 2.9% in 2026), shared with the employer.
• UAE: No free public system for most expats; insurance is mandatory and provided through your employer.

If you are joining a public system, your main needs are cover for any waiting period, cover for trips abroad, and possibly private cover for faster treatment or dental care.

Local plans vs international plans

A local plan is sold in your country of residence and covers treatment there, sometimes with emergency cover abroad. It is usually cheaper, and in some countries it is the only kind that satisfies residence rules.

An international private medical insurance (IPMI) plan covers you across a region or worldwide, follows you if you move, and lets you choose where to be treated. It costs more, but suits people who:

• move between countries every few years
• live somewhere with limited healthcare and want treatment elsewhere
• want continuity of cover regardless of employer
• are in a country with no accessible public system

Many employers in the Gulf and Asia offer group international plans. Group cover often accepts pre-existing conditions that an individual policy would exclude, which is a real benefit if you have a medical history.

What it costs: approximate premiums by age

Premiums depend on age, coverage area, deductible, the level of outpatient cover and where you live. These are approximate annual ranges for an individual comprehensive plan (inpatient and outpatient) with a moderate deductible, drawn from published insurer price tables and broker estimates. Treat them as illustrative only.

Two things move the price most. The first is US coverage: excluding the United States can cut the premium by half or more. The second is age: premiums rise with each age band, and many insurers won't accept new applicants over 65 or 75. Adding a partner and children roughly doubles or triples the cost.

Say you are 38, living in Dubai, and your employer's plan covers only the UAE. A regional plan excluding the US might cost a few thousand dollars a year to top up; a worldwide plan including the US could cost three times as much. Unless you plan treatment in the US, the extra rarely makes sense.

Deductibles, co-pays and limits

A deductible (or excess) is what you pay before the insurer pays. Choosing a $1,000 or $2,500 deductible instead of zero can reduce the premium noticeably, and makes sense if you have savings and rarely see a doctor.

A co-payment is a percentage you pay on each claim, often 10% to 20% for outpatient care, usually with an annual cap. An annual limit is the most the policy pays in a year. For international plans, look for at least $1 million, or unlimited cover, for inpatient care.

Check the sub-limits too. A plan with a $2 million annual limit may still cap physiotherapy at a few sessions, mental health at a small sum, or maternity at a fixed amount after a waiting period of 10 to 12 months.

Pre-existing conditions

This is where policies differ most, and where people are most often caught out. Insurers handle your medical history in three main ways:

1. Full medical underwriting: you declare your history upfront and the insurer lists exactly what it excludes. Clear, but declared conditions may be excluded permanently.
2. Moratorium: no forms upfront, but anything you had symptoms of or treatment for in the past five years (or a similar period) is excluded until you go a set time, often two years, without symptoms or treatment.
3. Medical history disregarded: usually only on larger group schemes; pre-existing conditions are covered.

Always answer health questions fully. A missed diagnosis, even a minor one, gives the insurer grounds to refuse a large claim later. If you have diabetes, a heart condition or a history of cancer, get written confirmation of what is covered before you resign from a job that provides group cover.

Evacuation and repatriation cover

Medical evacuation pays to move you to the nearest suitable hospital when local facilities can't treat you. Repatriation brings you home for treatment or, in the worst case, returns your remains. Air ambulance flights can cost tens of thousands of dollars.

If you live somewhere with limited specialist care, such as rural parts of Africa, South Asia or small island states, treat evacuation cover as essential. Check whether the plan lets you choose to be evacuated to your home country or only to the "nearest appropriate facility", which might be in a neighbouring country you have never visited.

Insurance as a visa condition

Some countries make insurance a condition of entry or residence.

For short visits, see our guide to travel insurance for visa applications and our Schengen visa application guide. The UAE's Ministry of Human Resources and Emiratisation explains the national scheme on its health insurance page. For Dubai-specific costs and employment, read our guide to living and working in Dubai.

Travel insurance is not health insurance

Travel insurance covers emergencies on trips, usually for up to 90 days or a year, and assumes you have a home country to return to. It typically excludes routine care, chronic conditions and long-term residence. Once you move abroad, a travel policy may stop paying the moment the insurer realises you live there. Use it for the first few weeks while longer-term cover starts, not as your main plan.

How to compare insurers

Use the same checklist for every quote:

• Coverage area: worldwide, worldwide excluding USA, or regional.
• Inpatient limit: at least $1 million, ideally unlimited.
• Outpatient cover: included or optional, with or without co-pay.
• Deductible and co-pay: per claim or per year.
• Pre-existing conditions: underwriting method and what is excluded.
• Waiting periods: for maternity, dental and some treatments.
• Direct billing: whether the insurer pays hospitals directly in your city.
• Evacuation: included, and to where.
• Renewal terms: whether the insurer can exclude new conditions or refuse renewal after a claim. Look for guaranteed renewal.
• Regulation and claims record: check the insurer is licensed in its home jurisdiction and read independent reviews about claims, not sales.

Get quotes directly from several insurers and from at least one independent broker, who is usually paid by the insurer. Ignore marketing about "average" premiums; ask for a written quote with your age, location and deductible.

Frequently Asked Questions

Do I need international health insurance if I live in the UK?

Usually not, if you paid the Immigration Health Surcharge or are otherwise entitled to NHS care. Some people add private UK insurance for faster elective treatment, and frequent travellers may want separate travel cover.

How much does international health insurance cost per month?

As a rough guide, a healthy person in their thirties might pay around $120 to $450 a month for comprehensive cover excluding the US. Including the US can cost several times more. Your exact price depends on age, location, deductible and medical history.

Does international health insurance cover pre-existing conditions?

Often only partly. Individual plans may exclude them permanently or for a waiting period, typically two years without symptoms. Group plans through an employer are more likely to cover them.

Is travel insurance enough for living abroad?

No. Travel insurance is designed for short trips and usually stops covering you once you become resident elsewhere. For a move longer than a few months you need local health insurance, an international plan or access to a public system.

Is health insurance mandatory in Dubai?

Yes. Employers must provide health insurance for employees, and sponsors must insure dependants they sponsor. Since January 2025, mandatory employer-provided cover applies across all emirates.

Final Thoughts

Start with what you are already entitled to. A surcharge-paying UK visa holder or a Canadian permanent resident needs far less private cover than someone moving to a country without accessible public healthcare.

When you do buy, prioritise the inpatient limit, evacuation and honest underwriting over extras like wellness benefits. Excluding US cover and choosing a sensible deductible are the two quickest ways to cut the premium without losing protection that matters.

Get quotes in writing, keep copies of your health declarations, and review your policy every year, especially before you change jobs or countries.