The problem no one tells you
Medicare stops at the US border. Here's what happens next.
Original Medicare (Parts A and B) provides almost no coverage outside the United States. Most employer-sponsored plans also terminate when you establish foreign residency. This is the single most underestimated challenge of retiring abroad — and the most dangerous to ignore.
⚠️ The Medicare trap: Many Americans keep paying for Medicare Part B ($185.50/month in 2026) while living abroad — effectively paying for nothing. Others drop it to save money, then face a permanent late enrollment penalty if they return. This is a significant financial decision. Plan it before you leave, not after.
The good news: international health insurance for retirees is widely available, generally excellent quality, and — outside the US — significantly cheaper than American premiums. A 60-year-old can get comprehensive coverage for $300–$500/month. At 65, expect $400–$700/month depending on coverage level and destination.
Find your fit in 30 seconds
Which plan fits your retirement profile?
Retiring fully abroad (settled in one country)
Cigna Global — Silver or Gold
Comprehensive global coverage, strong chronic condition support, direct billing at most international hospitals. The gold standard for long-term retirees.
Splitting time US / abroad (regular US visits)
GeoBlue Xplorer or Aetna International
US network coverage included. GeoBlue uses BCBS PPO network — 96% of US hospitals in-network. Aetna strong in Americas.
Scouting trip (first 3–12 months exploring)
SafetyWing Nomad Insurance
Month-to-month billing, no long-term commitment. Budget option while you decide where to settle. Not suitable as permanent retirement coverage.
Age 70+ or hard to insure
BUPA Global
Accepts applicants up to age 85. Lifetime renewal guarantee — they cannot cancel you for getting sick. Premium pricing but unmatched acceptance policy.
Provider comparison — 2026
The six plans worth considering
We reviewed the major providers available to Americans retiring abroad. Rankings are based on coverage quality, hospital networks, age acceptance, and suitability for retirees — not commission rates.
Best Overall
Cigna Global
The gold standard for long-term expat retirees. 2M+ provider network, three plan tiers, comprehensive chronic condition coverage.
Monthly cost (age 60)
$250–$600
Monthly cost (age 65)
$350–$800
Network
2M+ providers, 200+ countries
US coverage
Optional add-on (doubles premium)
Plan tiers
Silver / Gold / Platinum
Lifetime limit
Unlimited
Why retirees choose it
Best chronic condition and pre-existing condition coverage in the market
Direct billing at major hospitals — rarely pay upfront
Unlimited lifetime benefits — no cap if you face serious illness
Modular plan — pay only for what you need
24/7 multilingual support
Watch out for
Adding US coverage roughly doubles the premium
Complex plan structure — worth spending time comparing tiers
GeoBlue Xplorer
Best for Americans splitting time between the US and abroad. BCBS network — seamless US coverage at no extra cost.
Monthly cost (age 60)
$350–$700
US network
Blue Cross Blue Shield PPO — 96% of US hospitals
Coverage areas
Worldwide including US
Best for
Part-time expats, frequent US visitors
Strengths
No extra cost for US coverage — unlike Cigna, which charges to add it
Familiar BCBS network and claims process for Americans
Strong for Americans who'll visit grandchildren or family regularly
Watch out for
Higher premiums than excluding-US options
If you won't use US care often, you're paying for coverage you won't use
SafetyWing Nomad Insurance
Best budget option for scouting trips and first-year exploration. Month-to-month — no annual commitment required.
Monthly cost (age 55–65)
$56–$148
Commitment
Month-to-month
Coverage limit
$250,000 per incident
Best for
Testing destinations, nomadic first year
Strengths
Lowest premiums of any provider — significantly cheaper than comprehensive plans
No annual commitment — cancel or pause anytime
Covers emergency medical, evacuation, and basic hospitalisation
Important limitations
Does not cover pre-existing conditions
Lower coverage limits — not suitable as permanent retirement coverage
Not designed for settled retirees — best as a bridge while you decide
BUPA Global
Best for older retirees (70+) or those who can't find coverage elsewhere. Accepts applicants up to age 85 with lifetime renewal guarantee.
Age limit
Accepts up to age 85
Monthly cost (age 65)
$500–$900+
Renewal guarantee
Lifetime — cannot cancel for health
No-claims discount
Up to 30%
Strengths
Accepts applicants when most other insurers say no
Cannot be cancelled because you get sick — lifetime renewal guaranteed
Moratorium underwriting: pre-existing conditions covered after 2 symptom-free years
Personal relationship manager included
Watch out for
Premium pricing — most expensive option on this list
UK-based insurer — may feel less familiar to Americans
US coverage costs extra
Aetna International
Strong US brand recognition, solid Americas coverage. Good mental health parity — a notable advantage over competitors.
Monthly cost (age 60)
$200–$700
Network
Strong in Americas and Asia
Mental health
Full parity — rare in expat plans
Best for
Americas-based retirees, families
Strengths
Mental health coverage on par with physical health — uncommon in expat plans
Familiar American brand — customer service in English
Strong for Latin America and Asia destinations
Watch out for
Claims processing has been reported as slower than Cigna
Some reimbursements require significant follow-up
IMG Global (Patriot America)
Budget-conscious retirees who are generally healthy. High-deductible options keep premiums manageable — use local healthcare for routine care.
Monthly cost (age 60)
$150–$400
Strategy
High deductible + local care
Best for
Healthy retirees, countries with strong public healthcare
Coverage
Catastrophic / major medical
Strengths
Lowest premiums for healthy retirees willing to use local public healthcare for routine care
Works well in countries like Portugal and Spain where public SNS/SNS system is accessible to residents
Watch out for
Not suitable if you have chronic conditions or need regular specialist care
High out-of-pocket costs if a serious event occurs
Side-by-side
Quick comparison table
| Provider | Best for | Age 60 est. cost | US coverage | Pre-existing | Max age |
|---|---|---|---|---|---|
| Cigna Global | Settled retirees, chronic conditions | $250–$600/mo | Add-on (expensive) | May be covered | No limit stated |
| GeoBlue | Part-time expats, US/abroad split | $350–$700/mo | Included | Case by case | 84 |
| SafetyWing | Scouting trips, first year | $56–$148/mo | Limited (30 days) | Not covered | 69 |
| BUPA Global | Older retirees (70+) | $500–$900+/mo | Add-on | Moratorium basis | 85 |
| Aetna International | Americas-based, mental health focus | $200–$700/mo | Available | Case by case | No limit stated |
| IMG Global | Budget-conscious, healthy retirees | $150–$400/mo | Available | Limited/excluded | 79 |
Cost estimates for a healthy non-smoker. Actual premiums vary by destination, health history, coverage level, and deductible. Always get a personalised quote before deciding.
Before you buy
5 decisions to make before choosing a plan
1. Will you include US coverage?
Adding the US to your coverage area roughly doubles the premium with most providers. If you'll visit the US infrequently, consider buying short-term travel insurance for those trips instead of paying for year-round US coverage. For regular visitors, GeoBlue's all-in approach may be more cost-effective.
Adding the US to your coverage area roughly doubles the premium with most providers. If you'll visit the US infrequently, consider buying short-term travel insurance for those trips instead of paying for year-round US coverage. For regular visitors, GeoBlue's all-in approach may be more cost-effective.
2. What will you do about Medicare?
Medicare Part A (hospitalisation) is premium-free if you have 40+ work quarters — keep it. Part B ($185.50/month in 2026) is optional but carries a permanent late-enrollment penalty if you drop it and return to the US later. Run the numbers: if you plan to return, keeping Part B may be worth the cost. Consult a fee-only financial advisor who specialises in expat planning.
Medicare Part A (hospitalisation) is premium-free if you have 40+ work quarters — keep it. Part B ($185.50/month in 2026) is optional but carries a permanent late-enrollment penalty if you drop it and return to the US later. Run the numbers: if you plan to return, keeping Part B may be worth the cost. Consult a fee-only financial advisor who specialises in expat planning.
3. Do you have pre-existing conditions?
Unlike ACA plans in the US, international health insurance is NOT required to cover pre-existing conditions. Many plans exclude them entirely or require waiting periods. Cigna Global is generally the strongest option for retirees with pre-existing conditions. Disclose everything honestly — non-disclosure can void your policy entirely.
Unlike ACA plans in the US, international health insurance is NOT required to cover pre-existing conditions. Many plans exclude them entirely or require waiting periods. Cigna Global is generally the strongest option for retirees with pre-existing conditions. Disclose everything honestly — non-disclosure can void your policy entirely.
4. When should you get coverage?
Before you leave — not after you arrive. Many plans have waiting periods for certain conditions. You do not want to discover a coverage gap when you need it most. Get coverage in place at least 30 days before your departure date.
Before you leave — not after you arrive. Many plans have waiting periods for certain conditions. You do not want to discover a coverage gap when you need it most. Get coverage in place at least 30 days before your departure date.
5. Will you use local healthcare?
In countries like Portugal, Spain, and Costa Rica, legal residents access the public healthcare system. Many retirees use a hybrid approach: international insurance for major events and evacuation, public or private local care for routine visits. This can reduce premiums significantly.
In countries like Portugal, Spain, and Costa Rica, legal residents access the public healthcare system. Many retirees use a hybrid approach: international insurance for major events and evacuation, public or private local care for routine visits. This can reduce premiums significantly.
Find your best retirement destination — with healthcare built in
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Cost data reflects publicly available premium estimates for a healthy non-smoker as of April 2026. Actual premiums vary by age, health history, destination, coverage level, and deductible chosen. Nothing on this page constitutes insurance, financial, legal, or medical advice. ExpatAce is not a licensed insurance broker. Always get a personalised quote and read policy documents carefully before purchasing. Some links on this page are affiliate links — we may earn a commission at no extra cost to you. This does not affect our recommendations. Our methodology →