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 Choice
Largest global network with excellent US Cigna domestic integration. Best balance of worldwide coverage and US healthcare access.
Learn MoreBupa Global
Best Without US
Most competitive pricing when US coverage isn't needed. Strong international network with optional US add-on.
Learn MoreAetna International
Best US Integration
Seamless Aetna domestic network access with best Medicare coordination. Ideal for frequent US travel.
Learn MoreSide-by-Side Comparison
| Feature | Cigna Global | Bupa Global | Aetna International |
|---|---|---|---|
| US Network Size | Cigna domestic network | PPO network access | Aetna domestic network |
| US Coverage Options | Included or excluded | Add-on available | Included standard |
| US Prescription Coverage | Full US formulary | Good | Full US formulary |
| Medicare Coordination | Available | Limited | Excellent |
| US Home Leave Coverage | 180 days/year | 90-180 days | 180 days/year |
| ACA Compliance | Plans available | Not compliant | Plans available |
| Global Network | 1.5M+ providers | 1.3M+ providers | 1.2M+ providers |
| US Customer Service | US-based team | UK-based primarily | US-based team |
Cigna Global
Cigna Global offers US expats the best of both worlds—access to Cigna's domestic US network when home, combined with their massive international network of 1.5 million+ providers worldwide. American expats can choose plans that include or exclude US coverage, providing flexibility based on how often they return.
Their US-based customer service team understands American healthcare expectations and can coordinate care across both domestic and international providers. For expats who maintain US prescriptions, Cigna's formulary integration means your medications are covered seamlessly.
Strengths for US Expats
- • Cigna domestic network access
- • Flexible US include/exclude options
- • Full US prescription formulary
- • 180 days/year home leave coverage
- • US-based customer service
Considerations
- • Premiums higher with US included
- • ACA compliance varies by plan
- • Medicare coordination less seamless than Aetna
- • 12-month minimum commitment
Bupa Global
Bupa Global offers the most competitive pricing for US expats who don't need comprehensive US coverage. Their base plans exclude the US, keeping premiums significantly lower. For those who do return occasionally, an optional US treatment add-on provides coverage during home visits.
While Bupa is UK-based, they've developed strong US partnerships for expat coverage. Their international network is excellent, particularly in Europe, Asia, and the Middle East where many American expats live. The service quality is premium, though customer support hours may not always align with US time zones.
Strengths for US Expats
- • Lowest premiums (excluding US)
- • Optional US coverage add-on
- • Excellent international network
- • Premium service quality
- • Strong chronic condition management
Considerations
- • Limited US network compared to Cigna/Aetna
- • UK-based support (time zone challenges)
- • No Medicare coordination
- • Not ACA compliant
Aetna International
Aetna International provides the most seamless US healthcare integration for American expats. As a major US health insurer, your coverage works directly with Aetna's extensive domestic network—no coordination headaches when you return home. Their Medicare coordination is industry-leading for expat retirees.
All Aetna International plans include US coverage by default, reflecting their understanding that American expats typically maintain strong ties to US healthcare. Their US-based team is available during American business hours and understands the nuances of coordinating international and domestic care.
Strengths for US Expats
- • Full Aetna domestic network access
- • US coverage included standard
- • Best Medicare coordination
- • US-based customer service
- • ACA-compliant plans available
Considerations
- • Highest premiums (US always included)
- • Cannot exclude US for savings
- • Smaller global network than Cigna
- • Less presence in some regions
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Pricing Comparison
US coverage significantly impacts pricing. These estimates show comprehensive plans with $1,000 deductible:
| Profile | Cigna Global | Bupa Global | Aetna International |
|---|---|---|---|
| Individual (35) with US | $450-600/mo | $400-550/mo | $480-650/mo |
| Individual (35) excl. US | $280-380/mo | $300-420/mo | N/A (US included) |
| Family with US coverage | $1,200-1,600/mo | $1,100-1,450/mo | $1,300-1,700/mo |
| Senior (62) with US | $850-1,100/mo | $780-1,000/mo | $900-1,200/mo |
*Premiums are 40-60% higher with US coverage included due to American healthcare costs. Bupa offers the lowest non-US rates.
US Healthcare Integration
Home Leave Coverage
All three providers cover healthcare during visits to the US:
- • Cigna: Up to 180 days/year in US
- • Bupa: 90-180 days (plan dependent)
- • Aetna: Up to 180 days/year in US
Note: Extended US stays may require different coverage.
Medicare Coordination
For expats 65+ maintaining Medicare:
- • Cigna: Coordinates with Medicare A/B
- • Bupa: Limited coordination
- • Aetna: Best coordination—acts as supplement
Medicare only covers care in the US.
ACA Compliance & Tax Considerations
Important for US expats maintaining tax residency:
Cigna
ACA-compliant plans available. Provides 1095-B forms for US tax filing. Check specific plan compliance.
Bupa
Not ACA compliant. Expats with US tax obligations may need supplemental coverage or exemption.
Aetna
ACA-compliant plans available. Provides documentation for US tax requirements. Best for tax compliance.
Which Is Best For You?
Choose Cigna Global if:
- • You want the largest global network with US access
- • You need flexibility to include or exclude US coverage
- • US prescription formulary access is important
- • You want comprehensive worldwide coverage
Choose Bupa Global if:
- • You rarely return to the US for healthcare
- • Budget is a significant consideration
- • You're based in Europe, Asia, or Middle East
- • You only need occasional US coverage via add-on
Choose Aetna International if:
- • Seamless US healthcare access is your priority
- • You're 65+ and need Medicare coordination
- • ACA compliance is required for tax purposes
- • You return to the US frequently
Frequently Asked Questions
Should I keep my US health insurance while abroad?
It depends on your situation. If you're permanently relocating with no plans to return soon, international coverage alone may suffice. If you maintain US tax residency, return frequently, or want to preserve domestic coverage options, keeping a US plan or choosing an ACA-compliant international plan makes sense. Cigna and Aetna offer good bridges between worlds.
What happens if I need emergency care during a US visit?
All three providers cover emergencies in the US as long as you have US coverage included. Cigna and Aetna provide direct network access, meaning you can go to in-network facilities just like domestic insurance. Bupa's US coverage works more like international coverage—you may need to pay and file for reimbursement.
How does Medicare work for expats?
Medicare only covers care in the US. Many expats maintain Medicare Part A (free if you paid Medicare taxes) and use international insurance abroad. Aetna offers the best coordination—their plans can work as Medicare supplements during US visits. You can delay Part B enrollment without penalty while covered by qualifying expat insurance.
Can I use my US prescriptions abroad?
Yes, all three providers cover prescriptions internationally. Cigna and Aetna maintain the same formularies as their US plans, making transitions seamless. You may need to work with your provider to ensure your medications are available in your destination country, as brand names and formulations sometimes differ.
Disclaimer: Insurance pricing and coverage details change frequently. US healthcare costs significantly impact international insurance premiums. Tax and Medicare implications vary by individual situation—consult a tax professional. This comparison is for informational purposes only and does not constitute financial, tax, or insurance advice.
