Should Americans move abroad for health care?

It may not be the main reason people move abroad, but reduced medical expenses are a big reason expats from the U.S. are rising in number

Liz Weston is a columnist for personal finance website NerdWallet.com. Photo: File
Liz Weston is a columnist for personal finance website NerdWallet.com. Photo: File

Health care outside the U.S. that’s both good and cheap is a foreign notion to many Americans.

But Kathleen Peddicord, who runs Live and Invest Overseas, a site for people curious about living abroad, says she just paid US$20 for treatment after a motorbike accident in Panama. That’s just one example cited in a recent NerdWallet column by Liz Weston.

Emergency dental surgery that might cost $10,000 or more in the U.S. was $4,500 in Paris. In many countries, medications that would require a prescription in the States are available directly from licensed pharmacies at low prices, thanks to government subsidies or regulation.

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“The health care in a lot of places around the world is very good, as good as in the United States,” says Peddicord, who currently divides her time between Paris and Panama. “Some places, it is better.”

Low-cost, quality health care usually isn’t the main reason people move abroad, says Valladolid resident Don Murray, an expat in Yucatan who writes for rival site International Living. But reduced medical expenses are part of the lower living costs that prompt many Americans to relocate, he says.

Expat numbers are on the rise

About 9 million Americans live outside the U.S., according to State Department estimates that don’t include military personnel. That has increased considerably from its 1999 estimate of 3 – 6 million. And the number could rise.

Health care is a particular concern for Americans who want to retire before 65, when Medicare kicks in. The Affordable Care Act has an uncertain future and isn’t necessarily affordable.

Cheaper health care also may appeal to gig economy workers like freelance science writer Erica Rex. She recently wrote an opinion column for the New York Times about moving to the United Kingdom and then France after a cancer diagnosis 10 years ago.

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“Moving to Europe was a choice weighed against other, grimmer options for health care, which included the strong possibility of being bankrupted by cancer treatment and winding up at the mercy of New York state’s welfare system,” she wrote.

Health care quality varies by destination

Not all expat havens have great health care systems. Expats in Belize, for example, often cross the border to Mexico for health care, Peddicord says.

Sparsely populated areas aren’t always ideal, either. Murray and his wife, Diane, left their first retirement destination, a small town in Ecuador, after encountering broken equipment and few doctors. They’re much happier with the care near their Yucatan Peninsula home, where next-day appointments are the norm and doctors are typically trained in the U.S. or Europe, he says.

“It’s like in the U.S. — if you live in Possum Belly, Alabama, and they don’t have a hospital and the nearest one is an hour and a half away, the health care isn’t going to be the same” as in a major city, Murray says.

France, Mexico, Malaysia and larger population centers in Ecuador get top marks for health care from both International Living and Live and Invest Overseas.

Options for health care access

Expats may be able to qualify for a country’s public health care system if they become residents. Otherwise, there’s typically a private system in which people can pay out of pocket and get reimbursed if they have private health insurance.

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Peddicord and her husband, Lief Simon, who are in their 50s, have an international health insurance policy that covers them whether they’re traveling or at home in France or Panama. The annual cost is about $3,000 for both of them, she says.

Murray, 69, says he and his wife pay about $80 each month for Mexico’s public health system, but use private doctors and pay out of pocket for most care (including $8 for a recent hospital visit to treat an eye infection).

“My personal budget no longer contains a line for health care expenses,” Murray says. “They are so inconsequential there is no need.”


Adapted from an Associated Press article that originated with NerdWallet’s Liz Weston, a certified financial planner and author of “Your Credit Score.” Email: lweston@nerdwallet.com. Twitter: @lizweston.

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