What Happens to Your Health Insurance When You Leave the US? (& What We’re Doing Instead)

What happens to your health insurance when you leave the US?

As an American considering a move abroad, this is the question I kept putting off answering. Health insurance is already a pain point for most Americans – add the thought of leaving the country entirely and I had no idea where to start.

If you’ve been following along on Instagram, you already know that my partner has started the process of applying for his Mexican citizenship. We don’t have a move date locked in yet, but we’re weighing our options and figuring out what this actually looks like for us in real life.

I’ve spent 20+ years traveling internationally, but there’s a big difference between a two-week trip and actually relocating your life to another country.

So I did what I always do when I’m trying to make a real decision: I researched it thoroughly, talked to professionals, and spoke with people who have actually made the move.

What I found out surprised me, and made the decision a lot clearer than I expected. Here’s the reality of what happens to your US health insurance when you leave, and what we’re planning to do instead.

What Happens to Your Health Insurance When You Leave the US?

Does US Health Insurance Cover You Abroad?

This is the part a lot of people don’t fully want to accept until they have to.

Most domestic US health insurance plans are built for the US. Employer plans, marketplace plans, even Medicare – they’re designed around a domestic network, and the moment you step outside of it for an extended period, you’re largely on your own. Some plans technically offer international emergency coverage, but in practice that usually means paying out of pocket upfront and filing for reimbursement later, with no guarantee of what you’ll actually get back.

I talked to a few people who had already made the move abroad, and the one thing that came up over and over was that there’s no one-size-fits-all answer for healthcare. Most expats end up buying annual policies based on their specific situation and where they’re living. Nobody was still trying to make their US plan work from another country. They had all moved on to something that was actually built for the life they were living.

What Happens to Medicare When You Move Abroad?

If you’re on Medicare, the situation is even more straightforward – and not in a good way. Medicare does not cover medical care outside of the United States, with very limited exceptions.

You can keep your Medicare coverage while living abroad, but it won’t pay for care you receive in another country. If you’re approaching 65 and planning a move, it’s still worth enrolling in Medicare Part A since most people qualify for it premium-free, but you’ll need separate international coverage for any actual healthcare you receive abroad.

This is one of the most common questions that comes up in expat communities, and the answer is pretty consistent: Medicare only covers you in the United States.

What We’ve Decided to Do for Our Health Insurance Abroad

What is Expat Health Insurance?

Expat health insurance is coverage designed specifically for people who are living outside their home country for an extended period – not just visiting, but actually relocating. Unlike standard travel insurance, which is built around short trips and emergencies, expat health insurance is designed to function more like the coverage you’d have at home: routine care, ongoing prescriptions, preventive visits, and long-term health management.

The key difference is that it travels with you. Whether you’re based in one country or moving between several, a good expat plan keeps you covered without being tied to a domestic network that doesn’t exist where you’re living.

Travel Insurance vs. International Health Insurance: What’s the Difference?

This is where a lot of people get confused.

Travel insurance is designed for trips. It covers emergencies, unexpected illness, trip cancellations, lost luggage – the kinds of things that go wrong on a vacation. It’s not built for someone who is living abroad full time, and most travel insurance plans have time limits that make them impractical for long-term relocation.

International health insurance (or expat health insurance) is built for people who have actually made the move. It covers routine care, ongoing health conditions that develop after your policy starts, and preventative visits. It functions more like a regular health insurance plan.

The reason this distinction matters is that the right answer for you depends entirely on where you are in the process. If you’re still in the planning stage and traveling back and forth, travel medical insurance makes sense. Once you’ve committed to a permanent or semi-permanent move, you’ll want to look at proper international health coverage.

Why We’re Using SafetyWing

I’ve been familiar with SafetyWing for years – it gets mentioned constantly in nomad and expat circles, and I’ve used it myself for a shorter international trip.

When we started seriously looking at options for a longer-term move, I went back and looked at what they offer. They have two plans: Nomad Insurance Essential and Nomad Insurance Complete. Depending on where you are in your move abroad journey, one is going to make more sense than the other.

Nomad Insurance Essential is travel medical insurance for people living or traveling outside their home country. You can buy it for as little as 5 days or run it as an ongoing subscription up to 364 days. It covers emergency medical treatment, unexpected illness, and travel mishaps – and there’s no deductible.

For families traveling with children: you can add a child under ten years of age per adult for free (up to two children).

As a US citizen, you can purchase it as long as you’re living or traveling outside the US. For us right now, in the planning and transition phase, this is the right fit. It’s flexible enough to cover the in-between period without locking us into a full annual commitment before we’ve actually made the move.

Nomad Insurance Complete is a different category. It’s not travel insurance – it’s closer to actual health insurance for people who have relocated. On top of emergency coverage, it adds routine care, annual check-ups, vaccinations, and treatment for conditions that develop after your policy starts. It also covers you in your home country without time restrictions, which matters once you’re living abroad full time and traveling back to visit family.

One important thing to know: the Complete plan is not available to US residents. Once you’ve established your primary residence abroad and are living outside the US for more than six months of the year, you become eligible.

How Much Does Health Insurance Abroad Cost?

This is usually the question that surprises people the most, because it’s significantly more affordable than what most of us are used to paying in the US.

For SafetyWing’s Nomad Insurance Essential, pricing starts at $62.72 per four weeks for travelers aged 10–39. For travelers aged 60–69, you can expect to pay upwards of $218 per month – which is still competitive compared to most alternatives. The Nomad Insurance Complete plan starts at around $177.50 per month, with the cost varying based on age and any add-ons you choose such as dental coverage or electronics theft protection.

To put that in context: the average marketplace health insurance premium in the US runs several hundred dollars a month before you factor in deductibles and copays. The idea that you could have solid international coverage for $60–$177 a month takes some getting used to, but that’s consistently what people who’ve made the move report paying – and it is often one of the reasons Americans actually decide to move abroad.

Pricing varies based on your age and the length of your coverage, so SafetyWing has a quote tool on their site that lets you see exact numbers for your situation before committing to anything.

What I’d Suggest Based on Where You Are

After all the research, the conversations with professionals, and talking to people who’ve been through it – here’s how I’d think about it:

If you’re in the planning stage, still figuring out the logistics of a move, or just spending a lot of time internationally without a fixed base yet, start with the Essential plan. It’s flexible, affordable, and you can adjust as your situation evolves.

If you’ve already relocated or are about to make a permanent move and you’re not a US citizen or resident, look at the Complete plan. The difference between travel medical coverage and actual health insurance matters a lot once you’re living somewhere full time.

Either way, sort this out before you go. It may feel like something you can figure out later, but it’s absolutely something that should be factored into any budget plans for your eventual move abroad.

I’ll be documenting our entire move abroad process, starting with my partner’s Mexican citizenship journey. If you want to follow along, subscribe here so you don’t miss any of it.