Written by
John Spencer
John Spencer is the founder of Compare Expat Plans, where he focuses on helping people compare health plans for life abroad. He emphasizes clear information, neutral analysis, and practical decision support.
Our Top Picks
Retiring abroad is increasingly popular, but healthcare planning becomes critical. Medicare doesn't cover you outside the US (except rare border exceptions), and finding insurance gets harder—and more expensive—as you age. Here are our recommendations:
- Aetna International: Best for American retirees who visit family in the US. Full Aetna network included, no separate add-on cost.
- GeoBlue: Best for retirees who want Blue Cross Blue Shield familiarity. 96% of US hospitals in network.
- Cigna Global: Best comprehensive option with strong global network. Good for retirees who travel frequently.
- BUPA Global: Best for older retirees—accepts applicants up to age 85. Premium coverage with no-claims discounts.
- AXA Global: Best for non-US retirees. Lower premiums when you don't need US coverage.
- IMG Global: Best budget option. High-deductible plans make premiums manageable.
Age Matters
Insurance gets harder to find after 65, and much harder after 70. If you're planning to retire abroad, secure coverage before you hit these thresholds.
See ComparisonWe may earn a commission when you apply through our links. This does not affect our recommendations.
The Medicare Reality
Here's what many retirees don't realize until it's too late: US Medicare provides almost no coverage abroad. This creates a significant gap for the growing number of Americans retiring overseas.
What Medicare Doesn't Cover Abroad
- Doctor visits in foreign countries
- Hospital stays outside the US
- Prescriptions filled abroad
- Routine care, preventive services
- Medical evacuation back to the US
The Few Exceptions
Medicare may cover emergency care if you're near the US border and a US hospital isn't reasonably accessible, or on a direct cruise between US ports. These exceptions are narrow and unreliable for expat life.
The Hard Truth
If you're living abroad, Medicare is essentially useless. You need international health insurance to replace it. Many retirees maintain Medicare Part A (free if you have 40 quarters) as backup for US emergencies, but rely on international insurance for day-to-day coverage abroad.
Public Healthcare in Your Destination
Many retirement destinations have public healthcare systems, but access varies:
- Costa Rica: CAJA mandatory for all residents (~$75-275/month)
- Mexico: IMSS optional for residents (~$500/year)
- Portugal: SNS available after residency
- Spain: Public system after residency
- France: PUMA after 3+ months residency
- Thailand: Private insurance required for retirement visas
Even with public access, most expat retirees carry private insurance for faster care, English-speaking doctors, and coverage when traveling.
How We Evaluated
We focused on what matters most to retirees abroad:
- Age acceptance: Can you apply at 65? 70? 75+?
- US coverage: Does it include the US for visits home?
- Pre-existing conditions: How are they handled?
- Renewal guarantee: Will they drop you if you get sick?
- Claims experience: How easy is it to get reimbursed?
- Network quality: Can you find doctors easily?
- Price at older ages: What do premiums actually cost at 60, 65, 70?
Quick Comparison
Here's how the top options compare for retirees. Note: prices shown are estimates for age 60—premiums increase significantly with age.
| Provider | Best For | Max Entry Age | US Network | Age 60 Price |
|---|---|---|---|---|
| Aetna International | US retirees | 74 | Full Aetna | $350-500/mo |
| GeoBlue | BCBS familiar | Varies | 96% BCBS | $380-520/mo |
| Cigna Global | Comprehensive | 74 | Add-on | $320-450/mo |
| BUPA Global | Premium coverage | 85 | Add-on | $400-600/mo |
| AXA Global | Non-US retirees | 74 | Optional | $280-400/mo |
| IMG Global | Budget option | 74 | Optional | $200-350/mo |
Prices Vary Significantly
A 60-year-old pays 2-3x what a 40-year-old pays. Get actual quotes for your age and situation.
Get Your QuoteWe may earn a commission when you apply through our links. This does not affect our recommendations.
Detailed Reviews
Aetna International
The top choice for American retirees who maintain ties to the US. Aetna International includes full US network access in the base price—no expensive add-on required.
Why retirees like it: Seamless US coverage when visiting family. Works like Medicare replacement abroad. 24/7 English support. Strong in Latin America and Europe.
Things to consider: Accepts applicants up to age 74. Medical underwriting applies—pre-existing conditions may be excluded. Higher premiums than non-US-inclusive options.
Best for: American retirees who visit the US annually and want their insurance to work in both places.
Read our full Aetna International review →
GeoBlue
Blue Cross Blue Shield's international brand. If you've had BCBS coverage your whole career, GeoBlue offers continuity with the network you know.
Why retirees like it: 96% of US hospitals in network. Familiar Blue Cross experience. Excellent mobile app for finding care abroad. Direct billing at many facilities.
Things to consider: Requires US citizenship or permanent residency. Age limits vary by plan—verify before applying.
Best for: Retirees who want to keep Blue Cross coverage while living abroad.
Read our full GeoBlue review →
Cigna Global
A comprehensive international option with a massive global network. Good for retirees who travel frequently or live in multiple countries.
Why retirees like it: 1.65M+ providers worldwide. Strong customer service. Flexible plan tiers. Good coverage for chronic conditions once enrolled.
Things to consider: US coverage is an add-on, not included. Accepts applicants up to 74. Premiums can be high at older ages.
Best for: Retirees who prioritize global coverage over US network access.
Read our full Cigna Global review →
BUPA Global
The premium option with the highest age acceptance—BUPA accepts applicants up to 85. If other insurers won't take you, BUPA might.
Why retirees like it: Accepts older applicants. Lifetime renewal guarantee. Up to 30% no-claims discount. Mental health parity. Moratorium underwriting option.
Things to consider: Premium pricing. US coverage costs extra. UK-based insurer—may be unfamiliar to Americans.
Best for: Older retirees (70+) who need coverage and can't find it elsewhere.
Read our full BUPA Global review →
AXA Global
A strong choice for non-US retirees—Europeans, Canadians, Australians—who don't need US network access. Lower premiums when you exclude US coverage.
Why retirees like it: EU-regulated (Solvency II protection). 15-25% savings without US coverage. Euro billing. Strong European network.
Things to consider: US coverage adds 40-50% to premiums. Accepts applicants up to 74.
Best for: Non-US retirees or Americans who never visit the US.
Read our full AXA Global review →
IMG Global
The budget-friendly option for retirees willing to take higher deductibles. IMG's Global Medical Insurance offers high coverage limits at lower premiums.
Why retirees like it: 50% deductible waived outside US. High-deductible plans significantly reduce premiums. Coverage up to $8M.
Things to consider: Accepts applicants up to 74. Higher deductibles mean more out-of-pocket before coverage kicks in.
Best for: Budget-conscious retirees who want catastrophic protection.
Read our full IMG Global review →
Choosing the Right Plan
If you're a US citizen who visits family in the States:
Aetna International or GeoBlue. Both include US coverage in the base price—you won't pay extra when visiting grandchildren.
If you're over 70 and struggling to find coverage:
BUPA Global accepts applicants up to 85. Yes, premiums are high, but coverage exists when others say no.
If you're European, Canadian, or don't need US coverage:
AXA Global offers better value when you exclude US networks. Why pay for something you won't use?
If budget is the primary concern:
IMG Global with a high deductible ($5,000-10,000) keeps premiums manageable. Use local healthcare for routine care, save insurance for big expenses.
If you'll also use local public healthcare:
Consider a high-deductible international plan as a supplement. Use CAJA (Costa Rica), IMSS (Mexico), or SNS (Portugal) for routine care; use your international plan for private hospitals and travel.
Don't Wait Too Long
Insurance is easier to get at 62 than 72. Secure coverage before health issues arise or you age out of eligibility.
Compare OptionsWe may earn a commission when you apply through our links. This does not affect our recommendations.
Common Questions
Can I get insurance if I'm over 70?
Yes, but options narrow significantly. Most international insurers accept applicants up to 74. BUPA Global accepts up to 85. Some local insurers (like INS in Costa Rica) stop accepting new applicants at 70. Apply before you hit these thresholds.
What about pre-existing conditions?
Most insurers apply medical underwriting—pre-existing conditions may be excluded or covered after a waiting period. BUPA offers "moratorium underwriting" where conditions are excluded for 2 years, then covered if symptom-free. Disclose everything honestly; non-disclosure can void your policy.
Should I keep Medicare if I'm living abroad?
Many expat retirees keep Medicare Part A (free if you have 40 quarters) as emergency backup for US visits. Part B has monthly premiums and late enrollment penalties—decide whether it's worth maintaining based on how often you'll be in the US.
How much should I budget for health insurance?
At age 60-65: expect $300-500/month for comprehensive international coverage. At 70+: expect $500-800+/month. Higher deductibles reduce premiums significantly. Local public healthcare (where available) is much cheaper but may have limitations.
What if I get sick after enrolling—can they cancel me?
Reputable insurers offer lifetime renewal guarantees—they can't cancel you for getting sick. However, they can raise premiums for your entire age group. This is why early enrollment matters.
Can I use international insurance for visa requirements?
Usually yes. Thailand requires TGIA-approved insurance for retirement visas. Portugal's D7 visa requires EU-compliant coverage. France requires €30,000+ coverage. Most major international insurers can provide documentation for visa applications.
What's the difference between "inpatient only" and "comprehensive" plans?
Inpatient-only covers hospital stays and emergencies. Comprehensive adds outpatient visits, prescriptions, and preventive care. For retirees, comprehensive is usually worth it—you'll have more doctor visits as you age.
Disclaimer: This content is for informational purposes only. We are not insurance brokers or licensed agents. Coverage details, prices, and availability change—especially as you age. Always verify information directly with insurance providers and consult a financial advisor about Medicare decisions.
