Expat health insurance: what to check

Moving abroad in principle ends membership of the French health insurance scheme, except in specific situations such as secondment or under certain social security agreements.

Three routes then exist. Joining the local scheme of the host country, where this is possible and offers an adequate level of cover. Joining the Caisse des Français de l'étranger, which restores a French base cover. And international private insurance.

These three routes are not mutually exclusive: combining public base cover with private top-up insurance is common, and often the most economical option.

In several countries, joining the local scheme is compulsory and a condition of the residence permit. Costa Rica requires membership of its scheme, and both Switzerland and the Emirates require insurance whose purchase is checked.

A point of vocabulary avoids many misunderstandings: travel insurance, often included with a bank card, does not cover living abroad. It is designed for short stays, caps reimbursements and excludes most planned treatment. Confusing it with health cover is a common and sometimes serious mistake.

The first is the area of cover. A policy excluding the United States costs significantly less, and this exclusion is of no consequence for those who do not go there — but it is a deal-breaker from the Bahamas or Mexico, where evacuations are made to Florida.

The second is medical evacuation. It is essential from destinations where major procedures cannot be performed locally: Vanuatu, the Philippines, Cape Verde, the Pacific islands. Its cost and the conditions that trigger it must be read in detail.

The third is the treatment of pre-existing conditions. This is the point on which most applications fail after the age of fifty, and it must be checked before leaving, not after.

The fourth is how the premium rises with age. A policy that is attractive at fifty can become unaffordable at seventy, and switching insurer then becomes impossible because of the medical history accumulated.

The fifth is the renewal guarantee. A contract that the insurer can cancel or reprice individually after a claim does not offer the same security as a guaranteed-renewal contract.

We do not publish premium ranges: they depend on age, area, level of cover and medical history, and we have not found an official source allowing them to be quantified without being misleading.

What can be said is that this cost rises with age to an extent that upsets the projections made at the time of departure. This is particularly true of retirement abroad, whose horizon often exceeds twenty years.

In destinations where the public system is weak or closed to foreigners — the Gulf, South-East Asia, the Caribbean — private insurance is not an option but a condition for the project to be feasible at all.

In those where a public system exists and is accessible, the issue becomes waiting times for specialists, which push a large share of expats towards the private sector despite their membership.

1. Check whether joining the local scheme is compulsory and whether it is a condition of the residence permit.
2. Assess how accessible the public system is to foreigners in the target country.
3. Get a projection of the premium over ten and twenty years, not just the first year.
4. Check pre-existing conditions and the renewal guarantee before leaving.
5. Match the area of cover and evacuation to the project's actual geography.

This item deserves to be treated on the same footing as tax, and generally earlier. A tax advantage can be quantified and compared; being unable to get treatment or insurance cannot be offset. Yet most expatriation projects follow the opposite order.