The Expat Health Insurance Guide: How I Pay $120/Month for Better Coverage Than Most Americans
I pay $120/month for private health insurance in Colombia. It covers doctor visits, specialists, hospitalization, and emergency care. The same level of coverage in the US would cost me $450-1,500/month — and that’s before the deductible, copays, and out-of-pocket maximums that make American healthcare the most expensive in the developed world.
This isn’t an anomaly. It’s the norm for expats worldwide. Here’s the complete guide to health insurance abroad — what it costs, what it covers, and why it’s almost certainly better than what you have now.
The US Healthcare Cost Crisis
Let’s start with what you’re escaping:
- Average individual premium: $450-700/month (employer-sponsored) or $500-1,500/month (marketplace)
- Average family premium: $1,400-2,400/month
- Average annual deductible: $1,750 (individual) / $3,500 (family)
- Average out-of-pocket maximum: $8,000-9,000 (individual)
- Americans who delay care due to cost: 38% (Gallup)
The US spends more per capita on healthcare than any nation on Earth — over $13,000/person/year — yet ranks 37th globally in the WHO’s healthcare system efficiency. Colombia ranks 22nd.
Your Options Abroad
Option 1: International Health Insurance
SafetyWing Nomad Insurance — The digital nomad standard:
- Cost: $45-85/month (age-dependent; ~$45 for age 25-29, ~$73 for 40-49)
- Coverage: $250,000 max, $250 deductible
- Covers: Hospitalization, urgent care, emergency dental, some outpatient
- Doesn’t cover: Routine checkups, pre-existing conditions (first 6 months), mental health
- Best for: Digital nomads, short-term expats, visa requirements
Cigna Global:
- Cost: $150-500/month depending on plan and age
- Coverage: Comprehensive including inpatient, outpatient, wellness
- Best for: Long-term expats wanting full coverage with worldwide network
Option 2: Local Insurance (My Recommendation)
Most countries offer excellent private health insurance at a fraction of US costs:
| Country | Private Insurance Cost | Doctor Visit | Dental Cleaning |
|---|---|---|---|
| Colombia | $80-325/month | $20-50 | $15-30 |
| Mexico | $50-200/month | $25-60 | $20-40 |
| Thailand | $40-250/month | $15-40 | $15-35 |
| Portugal | $100-300/month | $30-60 | $30-50 |
| Vietnam | $30-150/month | $10-30 | $10-25 |
| Malaysia | $80-200/month | $15-40 | $15-30 |
| United States | $450-1,500/month | $150-300 | $100-300 |
Option 3: Pay Out of Pocket
When a doctor visit costs $20-50 and a dental cleaning costs $15-30, many expats skip insurance for routine care entirely and only carry catastrophic/hospitalization coverage. This is a viable strategy in low-cost countries.
Medical Procedure Savings
| Procedure | US Cost | Colombia | Thailand | Mexico |
|---|---|---|---|---|
| MRI | $1,000-3,000 | $100-250 | $150-300 | $150-350 |
| Root Canal | $700-1,500 | $100-200 | $80-200 | $100-250 |
| Knee Replacement | $30,000-70,000 | $5,000-10,000 | $8,000-15,000 | $7,000-12,000 |
| LASIK (both eyes) | $4,000-6,000 | $800-1,200 | $1,000-2,000 | $1,000-2,000 |
| Dental Crown | $800-1,500 | $150-300 | $200-400 | $150-350 |
Critical: Medicare Does NOT Work Abroad
If you’re approaching 65 or already retired: Medicare does not cover healthcare outside the United States (with extremely rare exceptions in border areas). This means retirees abroad need either international or local insurance. The good news? It’s still dramatically cheaper than US coverage.
My Setup in Colombia
I use a combination approach:
- Prepagada (local private insurance): $120/month — covers doctor visits, specialists, hospitalization, emergency
- SafetyWing: As a backup for emergency evacuation and coverage when traveling outside Colombia
Total monthly health cost: ~$170/month for comprehensive coverage. That’s less than most Americans pay for dental insurance alone.
For the full breakdown of Colombia’s healthcare system, ColombiaMove’s healthcare guide covers EPS enrollment, prepagada options, and hospital recommendations.
How to Choose
- Short-term nomads (under 1 year): SafetyWing is the simplest option
- Long-term expats (1+ years): Get local private insurance in your country of residence + SafetyWing for travel
- Families: Cigna Global or local insurance (many countries cover dependents cheaply)
- Retirees: Local insurance + comprehensive international policy as backup
The bottom line: You can get better healthcare coverage abroad for $100-200/month than most Americans get for $500-1,500/month. That savings alone — $4,000-16,000/year — can fund a significant portion of your life abroad.
Read my complete expat tax guide for how healthcare costs interact with your tax situation.
Disclaimer: This is informational content, not medical or insurance advice. Coverage details, costs, and availability vary. Always verify current pricing and coverage before purchasing insurance.