Do Expats Need Private Health Insurance?

Whenever you travel abroad you need to consider how you will access good quality healthcare. This is true whether you are travelling on business or on holiday and even more so if you are working or retiring abroad.

Citizens of the EU/EEA and Switzerland can make use of a European Health Insurance Card (EHIC) to access healthcare when traveling within the EU. The EHIC allows you to receive healthcare for free or at a reduced cost from any public doctor or hospital in an EU member country.  There are restrictions to the use of an EHIC.  It is not generally available to cover non-urgent treatments, for instance.

Brexit is bringing a focus on this issue for British expats in Europe.  However, in many countries in Europe you can access the country’s national healthcare service provided you are a resident or pay social security even if you come from a country outside the EU:

• Spain – the state health service establishes that all people, regardless of their nationality, have the right to health care. The National Health Service (NHS) is available for Spanish nationals as well as foreigners, who work in Spain and are registered and contribute to the Spanish social security system. This also applies to foreigners, who have retired from that system, or for those who work or have worked in an EU country or other country with whom Spain has a social security treaty that covers health care.
• France – resident foreigners legally working there and their families are eligible for the French national health insurance system, Sécurité sociale. Supplementary medical insurance is also available from groups called Mutuelles d’Assurances.
• Portugal – access to the health system is based on residence. If you are formally resident in Portugal you are entitled to register with your local health centre and receive state healthcare.
• Italy – the national health service in Italy provides citizens and residents with free or low-cost healthcare that includes access to general practitioners (GPs), treatment at public hospitals, subsidised medicines, lab services, ambulance services and certain specialist care.
• Cyprus – free or low-cost healthcare is available to long term residents and EU citizens with an EHIC card.  Thus people working in Cyprus and paying social security can access free or low cost public healthcare and dental treatment for themselves and their families as can EU Citizens who are receiving a pension from their home country.

The requirements for private health insurance varies throughout the world and should be checked as you investigate the visa requirements.  In Australia every person living on a permanent visa is eligible for public healthcare, but most temporary visa holders need to take out a private health plan. When applying for a working visa, applicants are asked to provide evidence of a private health cover.

New Zealand covers the bulk of the cost of medical treatment but expects most patients to make a contribution. The ‘free’ or subsidised healthcare is available to permanent residents and visitors from countries with a reciprocal agreement with New Zealand (including Australia, Canada, Denmark, Greece, Ireland, Netherlands and the UK).  Those who do not fall under one of these categories, including those working in New Zealand for less than two years are not eligible for publicly funded healthcare and would need to obtain private insurance.

In some countries health insurance is a mandatory condition of entry to the country.  Without proof of the correct insurance coverage entry will be refused.  These include the following:

• Qatar– Medical insurance is compulsory for expats in Qatar and private companies have been legally required to pay the premiums on behalf of their expat employees since 2015.
• United Arab Emirates– Health insurance is required for anyone applying for a visit or tourist visa. Any expats applying for a new visa or renewal of a current visa must be able to demonstrate that they have health insurance.
• Turkey– Expats must have health insurance if they want to get a residence permit in Turkey. Those over the age of 65 have been exempted from the requirement.
• Shengen Zone (26 European countries) – Anyone applying for a Shengen visa, whether for tourism or business purposes, must have international health insurance. There are a number of countries whose citizens do not need a Schengen visa. These include the USA, Canada, Japan, Israel, Australia, New Zealand and the UAE.
  The coverage required is for a minimum of €30,000 and it must cover medical evacuation and repatriation of remains.  It must also cover all of the Shengen countries.
• France– Although part of the Shengen zone, France also has additional requirements for students and non-working expats who may be exempt from the Shengen visa. Students over 28 planning to stay over 90 days must show that they have private health insurance.  Non-working European expats under retirement age have to meet more onerous standards of health insurance cover.
• Cuba– All visitors entering the country must have health insurance. If no insurance is in place on arrival you will be required to purchase coverage from the local Cuban insurance provider available in the immigration area in Arrivals.  The coverage may not match what you can get from an international provider and premiums are likely to be high.
• USA – Although not a formal requirement medical costs in the US are so high that it would be very risky to travel there without medical insurance. There is no such thing as “free” treatment in America and even in urgent care clinics there is a cost. All care, including emergency care, will have to be paid for.  If your health insurance does not pay, you will need to pay and then make a claim.

As an expat moving to America will need to have good quality health insurance cover.  If your employer in the US will not be providing insurance cover you will need to be sure you have identified the cost for you and your dependents.

Whether health insurance is mandatory or not, it is often necessary to consider taking out private cover if the state system is of poor quality or does not cover all potential health issues.  International Private Medical Insurance (IPMI) allows you to access private healthcare around the world.  However, in many cases where you are living in a country and not travelling regularly internationally local private health cover will be the best option and cheaper than IPMI.