Public healthcare systems
Costa Rica's CAJA: ~$80-100/month for full coverage. Excellent for routine, longer waits for elective.
Spain's SNS: free or low-cost for residents. World-class quality.
Portugal's SNS: similar to Spain. NHR residents access at minimal cost.
France's Sécurité Sociale: comprehensive, ~5% of income.
Italy's SSN: free for residents after 1 year of residency, comprehensive.
Most public systems are excellent for routine care. Wait times for elective procedures can be longer than US norms — many expats supplement with private insurance for faster access.
Private health insurance for expats
Cigna Global, GeoBlue Xplorer, IMG Global Medical: $100-$300/month for comprehensive expat health insurance.
Cigna Global is the premium option — global hospital network, US-based customer service, transparent claims.
GeoBlue Xplorer: backed by BlueCross. Strong network in Europe and Latin America.
IMG: more budget-friendly. Good for digital nomads as well as retirees.
What they cover: hospitalization, surgery, doctor visits, prescription drugs, emergency evacuation. Some cover dental, vision, mental health.
What to ask: pre-existing condition coverage (many exclude or charge extra), age limits (some won't cover new applicants over 75), lifetime maximum.
Cash-pay medical tourism
Many expensive procedures are 60-80% cheaper at top private hospitals in expat destinations:
Hip replacement: $40K (US) → $9-15K (Costa Rica/Mexico/Thailand)
Knee replacement: $35K (US) → $8-13K (popular destinations)
Heart bypass: $100K (US) → $20-35K (top private hospitals)
Dental implant: $4-6K (US) → $1-2K (Mexico, Costa Rica, Thailand)
LASIK: $4K (US) → $1-1.5K (popular destinations)
Quality at top private hospitals (Bumrungrad in Thailand, Hospital CIMA in Costa Rica, Hospital ABC in Mexico) matches or exceeds US standards. Many doctors trained in the US.
Mental health and prescriptions
Many expensive specialty drugs are dramatically cheaper abroad. Eliquis (blood thinner): $500/month US, $50-100/month many countries. Levothyroxine, statins, blood pressure meds: pennies on the dollar.
Mental health care: psychiatry and therapy generally available, often more affordable than US. English-speaking providers in major expat hubs.
Picking your healthcare strategy
Most expat retirees end up with a hybrid: enroll in the public system (low cost, excellent for emergencies + routine) + private insurance ($150-$250/month for faster elective access + extras + evacuation).
Total monthly: $200-$400/month for very good coverage. Compare to $500-$2,000/month for US private health pre-65 or Medicare + Medigap + Part D ($400-$600/month).