If you plan to live abroad for six months, a year or longer, travel insurance stops being the right tool and expat health insurance takes over. This guide explains how true international private medical insurance differs from nomad travel cover, what the main insurers publish about their plans, and how to pick one that works for your visa and your health.
Last checked against official sources in October 2026.
Still deciding where to base yourself before you buy expat health insurance? Take the free WhereToNomad quiz to match your passport and income to a visa, then come back to choose the insurance. If you only need short-term cover, read our best travel insurance for digital nomads guide instead.
Expat Health Insurance vs Travel Insurance
Travel insurance is built for trips. It covers emergencies, usually has an end date, and often pays for little beyond urgent care. Expat health insurance, also called international private medical insurance (IPMI), is built for people who live somewhere. It can include routine doctor visits, specialist care, prescriptions, mental health, maternity and chronic condition management, depending on the plan you choose.
The practical differences:
- Length: Expat health insurance is written for 12-month policy terms that renew. Travel plans are usually short or capped.
- Routine care: Many IPMI plans offer outpatient cover as a module. Travel insurance generally does not.
- Underwriting: IPMI insurers assess your medical history when you apply. Travel policies mostly do not ask in the same detail.
- Cost: Expect to pay more per month for broad expat health insurance than for a basic nomad plan.
Two products in our expat health insurance list sit in the middle. SafetyWing’s Nomad Insurance Complete and Genki Native are monthly health plans aimed at people abroad, which is why we include them next to the traditional insurers. For a direct comparison of the travel-style products, see SafetyWing vs World Nomads and our Genki insurance review.
Expat Health Insurance Providers Compared
This expat health insurance table uses information the insurers and neutral sources publish. Prices for the traditional insurers are quote-based, so no figures are listed unless an official page shows one.
| Provider | Style | Area options published | US cover | Pre-existing conditions |
|---|---|---|---|---|
| Cigna Global | Annual IPMI, Silver, Gold, Platinum, Close Care | ”Worldwide including USA” is a separate option | Optional, raises price | Underwriting applies; check your policy schedule |
| Allianz Care | Annual IPMI, Care Base, Enhanced, Signature | Worldwide, Worldwide excluding USA, Africa, Europe | Choose Worldwide to include it | Depends on underwriting option |
| Aetna International | Annual IPMI | Areas 1 to 7 | Area 1 only | Confirm at quote stage |
| Bupa Global | Annual IPMI | Worldwide or Worldwide excluding USA, depending on plan | Depends on plan | Subject to underwriting |
| April International | Annual IPMI, four tiers | Worldwide or Worldwide excluding USA | Emergency only without US option | Covered only if declared and accepted |
| SafetyWing Nomad Complete | Monthly health plan, 12-month commitment | 175 countries | Add-on for stays over 30 days | Not covered |
| Genki Native | Monthly health plan | Worldwide | Limited | Check the plan wording |
Cigna Global Expat Health Insurance
Cigna’s international page lists four plan levels: Silver ($1,000,000 annual limit), Gold ($2,000,000), Platinum (paid in full) and Close Care ($500,000). Deductible options on each plan run from $0 to $10,000, with cost share of 0%, 10%, 20% or 30% and an out-of-pocket maximum of $2,000 or $5,000. Cigna says it serves people in more than 200 countries and territories. The page refers to “Worldwide including USA” as a distinct option, so the base area excludes US treatment.
Neutral reviews of this expat health insurance range report that Cigna cannot cover residents of some countries, including Cuba, Iran, Syria and Sudan, and that its individual policies are generally fully underwritten with no moratorium. Confirm both points against the Customer Guide before applying. Visit Cigna Global →
Allianz Care Expat Health Insurance
Allianz Care’s current individual range has three core plans: Care Base (entry level), Care Enhanced and Care Signature, with optional outpatient and dental add-ons and a choice of deductible. Allianz says you can choose Worldwide, Worldwide excluding USA, Africa or Europe, and suggests picking the area where you live or travel more than six months of the year. A November 2025 announcement says the new plans target people spending 12 months or more abroad, including digital nomads. Visit Allianz Care →
Aetna International Expat Health Insurance
Aetna publishes an areas of cover guide for its international plans. Area 1 is the largest and is the only area that includes the United States. Areas 2 to 7 get progressively smaller, down to Area 7, which covers African countries only. Aetna states that the area you pick must include your country of residence, and it suggests including your home country if you may return there for treatment. Aetna also lists sanctioned countries and regions it cannot cover, including Cuba, Iran, North Korea, Syria and Crimea. Visit Aetna International →
Bupa Global
Bupa Global is a premium insurer with a network that one broker review puts at over 1.6 million providers. Its published plan ladder varies by market: a Hong Kong market brochure, for example, shows plans that are either worldwide or worldwide excluding the US, with excesses (deductibles) from USD 1,500 up to USD 10,000 on some tiers. Plan names and options differ by where you buy, so request a quote for your country of residence. Visit Bupa Global →
April International
April International lists long-term (12+ months), short-term, digital nomad, student and travel plans, with 180+ countries covered. A neutral review of its MyHealth International range describes four tiers, optional deductibles from 500 to 5,000 on the top plans, and a choice of worldwide cover or worldwide excluding the US. The same review says that without the US option you still get accident and emergency cover on US trips of up to 60 days. Visit April International →
SafetyWing Nomad Insurance Complete
SafetyWing’s official page shows Nomad Insurance Complete at $177.50 per month for ages 18 to 39, with 10% off for annual payment. Care is covered at any licensed provider in 175 countries. Pre-existing conditions are not covered, and the page defines them broadly: anything you were treated or diagnosed for at any point, or had symptoms of in the last two years. Maternity has a 10-month waiting period. The plan is a 12-month commitment, and you can cancel within 15 days or at renewal. For US stays over 30 days, you need the Hong Kong, Singapore and US add-on. Visit SafetyWing →
Genki Native
Genki’s Native page says it covers you worldwide, at any licensed doctor or hospital, public or private, and that it is open to people from every country, including nomads without legal residence. It states that cover in the USA is limited and that Native is not a replacement for statutory health insurance that some countries require. You can join up to age 55, and there is no maximum age once covered. Cover is up to EUR 1,000,000 on Basic or EUR 3,500,000 on Premium, and Genki names Squarelife as the insurer. Pricing is shown only in Genki’s quote tool. Visit Genki →
US vs Worldwide Excluding US Expat Health Insurance Pricing
The single biggest price lever in expat health insurance pricing is whether the US is in your area of cover. American healthcare costs are far above the rest of the world, and insurers price accordingly. One broker guide says adding the US can raise premiums by roughly 50% to 100%. Another review of Cigna calls it a significant increase.
If you are an American living abroad and expect to return home for treatment, the choice is real. Many people buy worldwide excluding US expat health insurance for daily life and rely on emergency cover for short US visits. Cigna’s ExpatDen review, for instance, reports emergency cover on US trips of up to three weeks each time under its excluding-US area, and April’s review reports 60 days. Treat these as example terms and confirm them in your own policy.
Also check where a plan stops. One Cigna review says US territories such as Puerto Rico and Guam are not covered, and Aetna’s guide shows the US appears only in Area 1. Ask any expat health insurance broker to confirm this in writing.
Expat Health Insurance Underwriting: Moratorium vs Full
How an insurer treats your health history decides whether a claim is paid, so understand the underwriting options in expat health insurance before you compare prices.
- Full medical underwriting (FMU): You declare your history. The insurer can accept a condition, accept it at a higher price, or exclude it. Allianz says that under full underwriting, pre-existing conditions are generally covered unless the policy says otherwise.
- Moratorium: No medical questionnaire. Allianz says pre-existing conditions become eligible only after 24 continuous months with no symptoms, treatment, medication or advice for them. A broker guide describes Bupa’s moratorium as excluding conditions with symptoms or treatment in the previous five years, with eligibility after two clean continuous years.
- No underwriting or exclusion model: SafetyWing and Genki-style nomad plans typically exclude pre-existing conditions altogether. Read the definition, because SafetyWing’s covers a lifetime of diagnosis.
If you manage a chronic condition, FMU is usually the safest route in expat health insurance because you find out about exclusions before you need care. Never hide a condition on a health form. April’s published guidance warns that concealment can lead to refused claims or a cancelled policy.
Direct Billing in Expat Health Insurance
Direct billing means the insurer pays the hospital, not you. It matters most for large bills. Reported terms:
- Bupa: For planned inpatient and day-patient treatment at network hospitals, it pays the hospital directly after pre-authorization. Smaller outpatient costs may need to be paid first and reclaimed.
- April: A neutral review says approval is required before a stay or treatment over 2,000 and should be requested at least 5 days ahead. Without approval, it reports that April pays only half. Emergencies do not need approval.
- Cigna: Expatica describes claims as usually direct billing, sometimes reimbursement.
- SafetyWing and Genki: Our existing reviews describe both as reimbursement-based, so you pay first and claim after.
Before you buy expat health insurance, ask whether your destination’s best hospitals sit in the insurer’s network. Cash flow matters if you could face an overnight admission.
What Visa Officers Want From Expat Health Insurance
Every visa is different, and consulates can change their checklists. A few examples:
- Spain: The Spanish consulate page for the digital nomad visa asks for a certificate from an insurer authorized in Spain, and the policy must cover all the risks covered by Spain’s public health system. See our Spain digital nomad visa guide for the full document list.
- Portugal: One Portugal visa guide reports that the visa application commonly needs travel-style medical, emergency and repatriation cover valid in Portugal, and that AIMA agents may later prefer a Portuguese health policy running at least 12 months. Our Portugal D8 guide covers the rest.
- Common asks: Recognized insurer, minimum medical limit, repatriation, a zero deductible, the destination named on the certificate and a start date matching your arrival.
The lesson is simple: for a visa, read the consulate checklist first, then buy. A global expat health insurance plan may be perfect for you and still fail a country-specific wording test. Our how to apply for a digital nomad visa guide explains the full sequence.
How to Choose Expat Health Insurance
Use this checklist when comparing any expat health insurance quote.
- Define your area. Decide whether the US needs to be in your area of cover.
- Check your residence. Confirm the insurer accepts residents of your country, and your passport nationality.
- Choose your underwriting. Pick full medical underwriting if you have any history to protect.
- Set the deductible. A higher deductible lowers the premium but raises what you pay on a claim. Cigna’s published options run from $0 to $10,000.
- Add outpatient only if you need it. It raises price, but if you see doctors regularly it often pays for itself.
- Test the visa wording. Match limits, repatriation and deductible with the consulate checklist.
- Compare expat health insurance quotes in the same currency, same area, same deductible.
Expat health insurance is also not a replacement for statutory cover where you are legally required to join the local system. If your situation is complex, speak to a licensed broker.
Frequently Asked Questions
What is expat health insurance?
Expat health insurance, also called international private medical insurance, is a policy for people who live outside their home country. It usually renews every 12 months and can include routine and specialist care, not only emergencies.
Is expat health insurance different from travel insurance?
Yes. Travel insurance covers trips and emergencies, while expat health insurance is built for long stays and can cover ongoing care. Underwriting, price and visa acceptance also differ.
Does expat health insurance cover the United States?
Only if you choose an area of cover that includes it. Cigna lists Worldwide including USA as a separate option, Allianz offers Worldwide and Worldwide excluding USA, and Aetna includes the US only in Area 1.
Are pre-existing conditions covered by expat health insurance?
It depends on the insurer and underwriting option. Full medical underwriting can cover a declared condition, a moratorium usually excludes it for the first one to two years, and nomad plans like SafetyWing exclude it entirely.
Will my expat health insurance be accepted for a digital nomad visa?
Not automatically. Spain asks for an insurer authorized in Spain with cover equal to the public system, so check the consulate checklist for your country before you buy.
Also read: Best Travel Insurance for Digital Nomads | Genki Insurance Review | SafetyWing vs World Nomads | How to Apply for a Digital Nomad Visa
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