When moving abroad, you will face many new and challenging questions that must be answered to make the transition a good one. Regarding healthcare, there are some basic questions that most expatriates have when choosing to purchase an expatriate insurance plan. Here are some answers to help walk you through the process.
Why Choose a Private Expat Plan instead of a National Plan
National, state-funded or public health Insurance can be very different to what most Expatriates are used to and can be of limited service for internationally mobile citizens. Many public plans offer less in terms of medical services than what is covered under a private plan. For example, it is unlikely you will be covered for medical evacuation benefits under a public health plan. Just like you would compare international health plans to pick the best coverage, review and compare your expatriate insurance plan to the national/public plan offered in the country where you will be located.
Public plans (including Medicare in the USA) generally only cover you in your host country or region. For an expatriate that travels for business or returns home throughout the year, benefits stop at the border. When covered under a national plan you may not have access to the leading private facilities or specialists. Private plans also offer 24/7 medical assistance (to find a doctor or facility), translation services (help with communicating with local healthcare providers), repatriation, etc. Finally, most private providers offer optional riders for dental, vision, add, etc.
Which is More Expensive — National or Private Plans
It depends on where you are living. Health care costs and domestic insurance plans in the US are significantly higher than in other countries. Further, expatriates in the US are not bound by the ACA and can choose a policy the best suits their needs, and wallet, rather than a domestic US health insurance plan, which can often be significantly more expensive.
In other countries where health care, and public health plans, costs are less, the quality of care may vary from city to city or facility to facility. It makes sense to have private insurance to pay for the costs of treatment at high-quality facilities without the long waiting periods. An Expatriate plan provides you the option to choose the facilities from which you receive your care.
Typical Questions When Buying an Expatriate Plan
Is there is an underwriting process when applying for Expatriate Healthcare?
Medical underwriting is required by international healthcare companies when you apply for one of their global medical plans. For US Citizens, familiar with the protections and benefits of the Affordable Care Act (AKA Obamacare), it does not apply here. You can be turned down or denied coverage. The process is generally to obtain and review the medical history of the applicant. It is not overly burdensome (most providers can complete underwriting in 3–5 business days) unless some unusual circumstances arise.
How are pre-existing conditions handled?
A great question without a simple answer. Most applicants come with preexisting conditions and are insurable. In some cases, pre-existing conditions would prohibit coverage from a provider. Other issues in your medical history can be managed with adjustments to the plan (riders, exclusions or cost adjustments) or the cost of the coverage might be adjusted.
GeoBlue’s Xplorer Plan (for US Citizens) has a nice benefit to address pre-ex; from GeoBlue’s website: ”If you were previously covered by a group or individual U.S. health plan that issues you a Certificate of Creditable Coverage, GeoBlue will apply this prior coverage to the pre-existing conditions waiting period, provided you meet GeoBlue’s medical underwriting criteria. GeoBlue will also consider private health insurance issued in other countries as creditable coverage. GeoBlue does not consider surplus lines insurance sold in the U.S. as creditable coverage. The number of months of coverage shown on the Certificate will reduce or eliminate the six-month pre-existing condition waiting period. If you have six or more months of creditable coverage, your waiting period will be eliminated. If you have less than six months creditable coverage, your waiting period will be reduced by the number of months you had creditable coverage. For example, if you have two months of creditable coverage, your waiting period will be reduced from six months to four months.” GeoBlue offers additional benefits if you maintain a health plan in the US while working abroad.
Do I Have to Buy an Expatriate Health Plan?
In some cases, the public health care system is high quality and affordable, sometimes free. In that case, you may not want to purchase a private medical plan. However, we recommend that you check local requirements (review visa and your company’s requirements and policies).
US Requirements: US citizens who are outside of the US for more than 11 months of each year do not have to comply with ACA (AKA PPACA or Obamacare). They can choose any insurance plan that fits their needs. “Foreign nationals who live in the United States for a short enough period that they do not become resident aliens for federal income tax purposes are not subject to the individual shared responsibility payment even though they may have to file a U.S. income tax return. The IRS has more information available on when a foreign national becomes a resident alien for federal income tax purposes. ” Read More at IRS.gov.
Are There Age Restrictions on Expatriate Plans?
There are often limitations and restrictions based on age when applying for international health plans. GeoBlue will not allow anyone over the age of 74 to apply for a new policy. However, if you have a plan in place with them prior to age 75, they will allow you to continue with coverage to age 84. Cigna Global will provide coverage for life regardless of your age at the time of your application.
One example: IMG will allow you to apply up to age 74 and coverage will terminate after you turn 75. If you have had a plan with them prior to your 65th birthday and have maintained coverage through age 75, they provide a Senior Plan option to allow you to continue coverage. This plan has fewer benefits and lower maximum coverage amounts — but it is an option. In general, insurance companies’ risks increase as their client base ages so they have to manage those risks with increases in price, restrictions on benefit and/or limitations on coverage.
What do Expatriate Plans Cost? Are there Certain Countries where Expat Plans Cost More?
For a husband and wife, ages 62 and 60, IMG Global Medical Plan offers 1) Worldwide excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan or 2) Worldwide coverage (including US, etc.). IMG’s plans would cost (ages 60 and 62) as little as $2,260 for a plan Excluding the US, etc with a $10,000 deductible and as much as $41,546 for Worldwide coverage and a $100 deductible (benefits for these plans — Silver, gold and Platinum plans — differ as well, i.e. maximum benefit limits). GeoBlue Xplorer(for US Citizens) offers two options: Worldwide coverage 1) including the US -more expensive — or 2) Excluding the US — less expensive. CignaGlobal Medical Plan will adjust pricing based on where you are going to be living and it varies by country.
Plans will cost more if you want US coverage — medical costs are highest in the US. Age is also a key factor — less expensive for younger applicants and more expensive as you get older. Other factors may change (similar to US health plans); for example, if you use an accredited facility you may not have to pay co-insurance. You might have to pay co-insurance for a facility in the US but not one that is located outside of the US…
Compare, Review Plans and Make an Educated Choice
In general, expatriates and global citizens should do their research, compare international health plans options and ask a lot of questions when making their buying decision. Price is only one factor, benefits and exclusions for particular plans are just as important. Read the fine print!
Author: Joe Cronin
Citizen of the world. Insurance Guru, Expatriate Advisor, Travel Expert. #TravelSafe Owner of InternationalCitizens.com and InternationalInsurance.com