In some places in the world it is possible to get valid and comprehensive health insurance for less than $100 a month. In some countries, the cost of medical care can be so low that it may make more sense to pay for it when you need it, rather than insure yourself against it. And, under certain circumstances, healthcare can even be free.

These are all potential benefits of one of the most important, complicated and personal aspects of retiring abroad. With a few exceptions (particularly military policies), your US health insurance probably won’t cover you outside the US, and Medicare generally won’t work overseas.

Therefore, when planning how to pay for your medical care as a retiree in another country, choose from three options.

Healthcare Options Abroad

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You can purchase a local insurance policy, invest in an international insurance policy, or opt out of insurance altogether.

The latter option may sound scary and risky, maybe even insane, but I know a number of full-time retirees abroad who have chosen to go the uninsured route.

They’ve done the math and realized that it’s better to keep an emergency medical fund (an amount of money that would be enough to cover even catastrophic care in the country where they live), than to pay monthly insurance premiums.

When you talk about a place where a doctor’s visit costs only a few dollars, as it can be in Thailand or Vietnam, you begin to understand how this math works.

However, most retirees are uncomfortable with not having medical insurance. In this case you choose between a local health insurance policy and an international one.

A Local Health Policy

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A local policy is one purchased in the country where you intend to retire. The big advantage of this type of health insurance is that it can be super cheap.

Depending on your age (which is the main determining factor), you can purchase comprehensive care coverage at standard international facilities in some countries for as little as $80 a month.

In other words, you could get health insurance in some of Latin America’s most attractive retirement locations, including Panama, Uruguay, Ecuador and Colombia, for less than $1,000 a year. The disadvantage of this type of policy is that coverage is geographically limited.

A local health insurance policy will cover you only in the country where it was purchased and sometimes only in particular regions or at particular establishments in that country.

Local Policy Limits

Health insurance
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Some local health insurance purchased in Panama, for example, will only cover you in Panama or a particular hospital.

This may be fine if you retire full-time in Panama and don’t plan on traveling outside Panama often.

Even if you plan to live full-time in a particular city, choosing to get your medical care through a particular hospital in that city can be risky. Hospitals can and sometimes fail. So what?

The other downside to country-specific health insurance is that you usually can’t buy it after age 60 or 65, depending on the country and insurer.

Your cover will not stop after you reach the cut-off age (assuming you’re paying premiums), but, beyond that age, you won’t be able to qualify as a new policyholder.

This is one reason why, if you’re considering retiring abroad, it’s important to address health insurance as early as possible.

International Health Insurance

Senior at a doctor's office
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If you plan to travel abroad a bit during your retirement, you will probably want to take out health insurance through an international carrier.

Perhaps you plan to settle in Ireland or France, for example, so that you can travel throughout Europe on a regular basis.

Or perhaps you’re considering retiring abroad part-time, settling in Mexico but frequently returning to the United States so you can keep in touch with your grandchildren.

In situations like these, an international policy makes the most sense, because you can tailor it to your plans.

What to know About International Health Insurers

Money for health care
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The largest international health insurer is Bupa Global. Coverage through Bupa will be more expensive than local coverage (possibly much more), but it will also be more flexible.

And while international coverage is more expensive than local coverage, it’s almost always less expensive than US health insurance (Medicare aside).

Coverage through an international insurer like Bupa may be based in the country where you will spend most of your time, but, depending on your policy, may cover you around the world.

It may even cover you in the US, although the US may not be your base country of coverage.

Including the United States in your coverage will also increase the cost of your premium considerably because the United States is the most expensive place in the world to seek medical care.

The cost of a Bupa policy varies depending on your base country, the geographic scope of your coverage, your age and any pre-existing conditions. A typical premium for a 60-year-old might cost $400 a month.

Free Healthcare Abroad

Doctors discuss a patient's medical record
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In some places abroad, healthcare may even be free. Indeed, this is the case in many countries.

The trick is that you have to be a legal resident and usually have to have paid into the social system at some point to access the free healthcare services available.

The added problem is that the free health services available may not be up to a standard that you will be comfortable with.

Healthcare is free for eligible residents in most of Europe, for example.

Other Factors to Consider

Senior filling out medical paperwork with caregiver

I have lived in Ireland for seven years. We have used the free public health services in that country often and have always been happy with the results. In fact, my son Jackson was born in the public hospital in Waterford, Ireland.

The treatment he and I received was amazing and it was also free. (Although we were paying into the social services system because we ran a business in the country at the time.)

However, our experiences were during Celtic Tiger Ireland, which refers to the nation’s economy in the mid-1990s to late 2000s, a period of rapid real economic growth fueled by foreign direct investment. Today, some 20 years later, Irish public healthcare is nearly at breaking point. Hospitals are closing and patients with serious concerns are also on long waiting lists for treatment.

And in most of Central America, for example, most foreign retirees won’t want to use free healthcare even if they’re entitled to it.

Should you Keep Your Medicare?

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If you retire overseas, should you keep your Medicare? As I mentioned, Medicare generally won’t do you any good outside the US.

However, I recommend that you continue to carry at least Medicare Part A, which is typically free, considering it a backup plan.

The best strategy is often to keep paying for Medicare while investing in a local country policy in the country where you plan to base your retirement.

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