If you’re an American living abroad — whether digital nomad, long-term expat, or remote worker — you need real health insurance, not travel insurance. Here’s the honest comparison of the major providers after 4 years navigating this myself.
The TL;DR
For digital nomads under 40: SafetyWing Nomad Insurance ($45-65/month) — cheap, simple, works while traveling, covers basic medical.
For traditional expats (long-term, settled abroad): Cigna Global or GeoBlue — premium ($150-400/month) but proper international health coverage including chronic conditions, preventive care, and US repatriation.
For senior expats (over 60): Cigna Global or Allianz Care — both designed for older expats with more comprehensive chronic illness coverage.
Travel insurance vs expat health insurance — know the difference
| Travel Insurance | Expat Health Insurance | |
|---|---|---|
| Best for | Trips under 90 days | Living abroad 6+ months |
| Cost | $50-200 per trip | $1,200-5,000/year |
| Pre-existing conditions | Usually excluded | Often covered |
| Preventive care | Not covered | Often covered |
| Routine checkups | Not covered | Covered |
| Mental health | Limited or excluded | Often covered |
| Maternity | Usually excluded | Often covered (with waiting period) |
| Coverage during home country visits | Not applicable | Covers limited US visits |
The 6 providers compared
1. SafetyWing Nomad Insurance — $45-65/month
Best for: Digital nomads under 40 moving frequently
Coverage: $250,000 medical max, $1M emergency evacuation, $5K trip interruption
What’s covered: Doctor visits, emergency room, hospitalization, urgent care
What’s NOT covered: Routine checkups, mental health (limited), dental, pre-existing conditions, maternity
The honest take: SafetyWing is travel insurance dressed up as nomad insurance. It works for basic medical emergencies but is NOT a substitute for proper health insurance if you’re going to be abroad for years. Use for 6-12 month nomad stints. Move to proper insurance for longer-term plans.
2. SafetyWing Remote Health — $130-400/month (depending on age)
Best for: Settled remote workers wanting more comprehensive coverage than basic Nomad Insurance
Coverage: $1,500,000 medical max, preventive care, mental health, chronic conditions
What’s better than Nomad Insurance: Includes routine doctor visits, preventive care, mental health
SafetyWing’s “real” health insurance product. Significantly more expensive than basic Nomad Insurance but actual real coverage. Worth considering if you’re staying somewhere 1+ years.
3. Cigna Global — $200-500/month
Best for: Traditional expats moving abroad for work, family, retirement
Coverage: Multiple tier options up to $2,000,000+ medical max, dental, vision, maternity (1 year waiting period)
What’s great: Most comprehensive coverage of any provider, extensive in-network options globally, US-based customer service, covers chronic conditions
The cost reality: A 35-year-old in Portugal pays ~$250/month. A 55-year-old pays ~$450/month. Customizable deductibles bring premium down.
Best for: Anyone planning to live abroad 2+ years with a more sedentary lifestyle.
4. GeoBlue — $180-400/month
Best for: Americans abroad who still need US coverage when visiting home
Coverage: $1M-$2M medical max, US visit coverage included, access to Blue Cross network in US
What’s unique: The only major expat insurer with proper US in-network access when home for visits
If you’re abroad but visit the US frequently for work or family, GeoBlue’s US coverage during home visits is the deciding factor. Most other expat insurers have limited US coverage (treating it as a “non-home country” with higher costs).
5. IMG Global — $150-350/month
Best for: Adventure travelers, divers, climbers — covers activities other insurers exclude
Coverage: $1M-$5M medical max, includes hazardous activities by default
What’s unique: Covers activities most insurers exclude (skiing past intermediate, diving past 30m, mountaineering)
If you’re an active expat doing serious adventure sports, IMG covers what others don’t. Their administrative experience can be frustrating (slow claim processing) but the coverage is real.
6. Allianz Care — $200-500/month
Best for: Older expats, family coverage, European base
Coverage: Comprehensive tiers, family plans, evacuation included
What’s unique: European insurer with strong relationships with European hospitals; best if your base is in Europe
The “good enough” tiers explained
Tier 1: “I’m healthy, abroad short-term”
Provider: SafetyWing Nomad Insurance ($45-65/month)
Why: Covers actual emergencies + ER visits. Doesn’t cover preventive care but for under-40 healthy people, that’s manageable.
Tier 2: “I’m staying 1-3 years, want real preventive care”
Provider: SafetyWing Remote Health or Cigna Global (basic tier)
Why: Covers annual checkups, mental health, prescriptions, dental, vision.
Tier 3: “I’m long-term abroad, family in tow, peace of mind required”
Provider: Cigna Global (premium tier) or GeoBlue
Why: $2M+ coverage, dental + vision + mental health + maternity, evacuation, US visit coverage.
What about ACA (Obamacare) while abroad?
If you live abroad 330+ days/year, you’re exempt from the ACA’s individual mandate. You don’t need US health insurance.
If you visit the US occasionally, your expat insurance usually covers limited US emergency care. If you spend significant time in the US (4+ months/year), maintain a domestic ACA policy on top of expat insurance.
What about Medicare for US retirees abroad?
Medicare doesn’t cover medical care outside the US (with very limited exceptions). If you’re 65+ living abroad, you have three options:
- Keep Part A (free) for emergencies if you return to the US
- Buy expat insurance (Cigna Global or Allianz Care) for primary coverage abroad
- Get foreign country’s public health system access if you’re a tax resident there (often automatic in EU countries)
FAQs
Do Americans need health insurance abroad?
Yes. US health insurance (including Medicare for retirees) doesn’t cover most care abroad. A single emergency room visit costs $300 in Thailand, $1,500 in Tokyo, $5,000+ in the US. Even short-term travelers need at least travel insurance. Long-term expats need proper expat health insurance.
What’s the best health insurance for digital nomads?
For under-40 nomads moving frequently: SafetyWing Nomad Insurance ($45-65/month) covers basic emergencies and works well. For nomads staying 1+ years in places: SafetyWing Remote Health ($130-400/month) adds preventive care, mental health, and chronic condition coverage.
Does SafetyWing actually pay out claims?
Yes for basic emergency claims. I’ve filed claims with SafetyWing for hospital visits and lost luggage – both paid within 14 days. The claim process is straightforward via their app. The limitation is the coverage scope – it covers what’s listed, not everything you might expect from US-style health insurance.
Is Cigna Global worth $300+/month?
For long-term expats and families, yes. Cigna Global provides actual comprehensive health coverage equivalent to a top-tier US plan, with global network access. For a 1-year stint abroad, it’s overkill. For a permanent expat lifestyle with family, it’s the safer choice.
What about local health insurance in my destination country?
For long-term residents, getting local national health insurance is often best. Many EU countries (Portugal, Spain, Germany) allow you to opt into the national system once you have residency. The catch: enrolling takes time after you move, so you need expat insurance for the first 3-6 months.
Frequently Asked Questions
Do Americans need health insurance abroad?
Yes. US health insurance (including Medicare for retirees) doesn’t cover most care abroad. A single emergency room visit costs $300 in Thailand, $1,500 in Tokyo, $5,000+ in the US. Even short-term travelers need at least travel insurance. Long-term expats need proper expat health insurance.
What’s the best health insurance for digital nomads?
For under-40 nomads moving frequently: SafetyWing Nomad Insurance ($45-65/month) covers basic emergencies and works well. For nomads staying 1+ years in places: SafetyWing Remote Health ($130-400/month) adds preventive care, mental health, and chronic condition coverage.
Does SafetyWing actually pay out claims?
Yes for basic emergency claims. I’ve filed claims with SafetyWing for hospital visits and lost luggage – both paid within 14 days. The claim process is straightforward via their app. The limitation is the coverage scope – it covers what’s listed, not everything you might expect from US-style health insurance.
Is Cigna Global worth $300+/month?
For long-term expats and families, yes. Cigna Global provides actual comprehensive health coverage equivalent to a top-tier US plan, with global network access. For a 1-year stint abroad, it’s overkill. For a permanent expat lifestyle with family, it’s the safer choice.
What about local health insurance in my destination country?
For long-term residents, getting local national health insurance is often best. Many EU countries (Portugal, Spain, Germany) allow you to opt into the national system once you have residency. The catch: enrolling takes time after you move, so you need expat insurance for the first 3-6 months.