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.
Quick Verdict
Cigna Global
Best Overall for Retirees
Strong European network, generous home country visits, and solid age acceptance up to 74. The balanced choice for most European retirees.
Learn MoreBupa Global
Best for Older Retirees
Accepts new members up to age 85—unmatched in the industry. Excellent UK-Europe corridor and premium hospital network.
Learn MoreAetna International
Best Under 65
Most affordable option for early retirees under 65. Limited entry age but competitive pricing while eligible.
Learn MoreSide-by-Side Comparison
| Feature | Cigna Global | Bupa Global | Aetna International |
|---|---|---|---|
| Max Entry Age | 74 years | 85 years | 64 years |
| Coverage Limit | Unlimited | Unlimited | Up to $5M |
| Pre-existing Conditions | Moratorium or exclusion | Moratorium available | Limited options |
| Chronic Condition Mgmt | Comprehensive | Comprehensive | Good |
| European Network | Excellent | Excellent (UK focus) | Good |
| Home Country Visits | Up to 180 days | Up to 180 days | Up to 90 days |
| Wellness/Preventive | Included | Included | Optional |
| Lifetime Renewal | Guaranteed | Guaranteed | To age 99 |
Cigna Global
Cigna Global is the most well-rounded choice for European retirees. Their network across Spain, Portugal, France, and Italy is excellent, with direct billing at major hospitals in all popular retirement destinations. The 180-day home country coverage means you can spend substantial time visiting family without gaps in coverage.
Pre-existing conditions are handled via moratorium (conditions must be symptom-free for two years) or medical underwriting with exclusions. Chronic condition management is comprehensive once covered—important for managing diabetes, heart conditions, or other age-related health issues. Lifetime renewal is guaranteed.
Retiree Strengths
- • Excellent Spanish/Portuguese network
- • 180 days home country coverage
- • Comprehensive chronic care
- • Wellness screenings included
- • Guaranteed lifetime renewal
Considerations
- • Max entry age 74
- • Pre-existing condition limitations
- • Premium increases with age
- • US coverage adds significant cost
Bupa Global
Bupa Global's standout feature for retirees is age acceptance up to 85—allowing seniors who may have aged out of other options to still obtain quality coverage. This makes Bupa the only realistic choice for many older retirees just beginning their European adventure.
Their European network is particularly strong in the UK and France, with excellent coverage across the EU. For British expats retiring to Spain or Portugal (post-Brexit), Bupa offers seamless continuation of familiar coverage. The moratorium option for pre-existing conditions means you can get covered without exclusions if conditions remain stable.
Retiree Strengths
- • Highest entry age (85)
- • Strong UK-Europe connections
- • Premium hospital partnerships
- • Care coordinator for complex cases
- • Moratorium for pre-existing
Considerations
- • Highest premiums
- • Age-based increases significant
- • US coverage limited/expensive
- • Some regions have fewer providers
Aetna International
Aetna International is best suited for early retirees under 65. If you're retiring at 55 or 60, Aetna offers competitive premiums and familiar US brand backing. Their European network is adequate, with strongest coverage in major cities and popular expat destinations.
The key limitation is the 64-year entry age maximum—once you turn 65, you cannot purchase new coverage (though existing members can renew to 99). Home country visits are capped at 90 days, shorter than competitors. For early retirees seeking value, Aetna delivers; for older retirees, look elsewhere.
Retiree Strengths
- • Most affordable for under-65
- • Familiar US brand
- • Good major city coverage
- • Renewal to age 99
- • Straightforward plans
Considerations
- • Must apply before age 65
- • Only 90 days home visits
- • Less comprehensive chronic care
- • Smaller European network
Get European Retiree Quotes
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Pricing Comparison
Retiree premiums are significant—budget accordingly:
| Profile | Cigna Global | Bupa Global | Aetna International |
|---|---|---|---|
| Individual (60) | $650-900/mo | $700-950/mo | $550-750/mo |
| Individual (70) | $1,100-1,500/mo | $1,200-1,600/mo | Not available |
| Couple (both 65) | $1,300-1,750/mo | $1,400-1,850/mo | Not available |
| With $2,500 deductible | -20-25% | -20-25% | -15-20% |
*Premiums increase annually with age. Higher deductibles ($2,500-5,000) can reduce costs 20-30%. US coverage adds 30-50% to base premiums.
European Retirement Considerations
Popular Destinations
- • Spain: Costa del Sol, Valencia—all three have strong networks
- • Portugal: Algarve, Lisbon—Cigna best network
- • France: Provence, Côte d'Azur—Bupa strongest
- • Italy: Tuscany, Lake regions—variable coverage
- • Greece: Islands challenging for direct billing
Visa Requirements
Most European retirement visas require proof of health insurance:
- • Spain Non-Lucrative Visa: Full coverage required
- • Portugal D7 Visa: Health insurance mandatory
- • France Long-Stay Visa: Coverage proof needed
- • All three providers issue visa-compliant letters
Public Healthcare Access
Understanding your options alongside private insurance:
EU Public Systems
- • Spain: Excellent public system, some regions allow expat access
- • Portugal: Affordable public healthcare
- • France: World-class but requires contributions
- • S1 form for UK pensioners (post-Brexit limits)
Why Keep Private?
- • Skip public system wait times
- • English-speaking providers
- • Private rooms in hospital
- • Choice of specialists
Which Is Best For You?
Choose Cigna Global if:
- • You're retiring to Spain or Portugal
- • Home country visits are important (180 days)
- • You're under 75 and want balanced coverage
- • Chronic condition management matters
Choose Bupa Global if:
- • You're over 75 or approaching that age
- • You're a British expat familiar with Bupa
- • France or UK are your destinations
- • Premium hospital access matters most
Choose Aetna International if:
- • You're retiring before age 65
- • Budget is a primary concern
- • You prefer a US-based insurer
- • 90 days home visits is sufficient
Frequently Asked Questions
Can I still get Medicare while retired abroad?
Medicare only covers care in the US—it doesn't work abroad. However, you can keep Part A (free if you qualify) and suspend Part B while overseas, then restart when/if you return. Many retirees maintain both Medicare and international coverage for US visits.
How do pre-existing conditions work?
Each insurer handles pre-existing conditions differently. Cigna and Bupa offer moratorium options—conditions not requiring treatment for 2 years become covered. Alternatively, medical underwriting may exclude specific conditions permanently. Disclose everything; undisclosed conditions void coverage.
What happens to premiums as I age?
Premiums increase annually, typically 5-10% per year due to age and medical inflation. Budget for significant increases—coverage costing $600/month at 65 may cost $1,200+ at 75. Guaranteed renewal means you can't be dropped, but costs will rise.
Can I use public healthcare and keep private insurance?
Yes, and this is common. Many retirees use public systems for routine care (GP visits, prescriptions) and keep private insurance for specialists, diagnostics, and hospital care. This hybrid approach can reduce out-of-pocket costs while maintaining choice and speed.
Disclaimer: Insurance pricing, entry ages, and coverage details change frequently and vary by specific plan. Healthcare systems and visa requirements differ by country. Always verify current requirements with insurers and immigration authorities. This comparison is for informational purposes only and does not constitute financial, insurance, or legal advice.
