Expat health insurance: private medical cover when you live abroad

Moving abroad changes your healthcare cover more than almost anything else about your money. The travel insurance that served you on holiday is not built for living overseas: government guidance is explicit that foreign travel insurance "is not intended to cover you if you live abroad permanently"¹. And the NHS stops being free at the point of use once you are no longer a UK resident, even if you have paid National Insurance and taxes all your working life².

Expat health insurance, more often called international private medical insurance, is the product designed to fill that gap. Health insurance of this kind "covers the costs of private medical treatment, providing access to private healthcare services"³, but arranged so the treatment can happen in the country where you actually live, rather than on a short trip. This page explains how it differs from travel cover, what international plans include, how remote doctor services work, how claims in foreign currency are settled, and where to complain if an insurer based outside the UK lets you down.

Expat health insurance is not travel insurance

The two products look similar because both pay medical bills abroad, but they answer different questions. Travel insurance is built around a trip: it typically covers medical costs while you are away, cancellation, baggage and personal belongings, personal liability and delays⁸. Its medical cover exists to get you treated and, if needed, brought home. Expat health insurance is built around a residence: it pays for private medical treatment where you live, including treatment that is planned rather than emergency, and it is not designed to fly you back to the UK.

The distinction matters because travel policies stop paying at the point a traveller would normally return. Among the common exclusions ABTA lists are "medical costs if you stay abroad after being fit to return"⁴. For someone who lives there, that is every day. Government guidance closes the door firmly: foreign travel insurance "is not intended to cover you if you live abroad permanently"¹.

Travel insurance also carries conditions an expat cannot meet. Insurers need to be told about past or current health issues, even if you have recovered, and an undeclared condition can void a claim⁹. Marie Curie's checklist for travellers with serious illness shows what a travel policy is expected to do: pay for medical treatment while you are away, bring you home early if you fall ill, and repatriate you if you die abroad¹⁰. An expat policy instead asks where you live, what treatment you are likely to need there, and whether you want add-ons such as dental or maternity cover.

Costs also run on a different scale. Scope notes that one example travel policy carried an excess of £250 on a medical claim in Europe¹¹, while emergency treatment abroad can reach very large sums: one case reported by Which? ran to £66,000⁹. Expat premiums are priced like a health policy, on your age, location and the level of cover, not like a one-off trip policy.

International health insurance plans: what they offer

International private medical insurance is one of the recognised types of private medical policy. The Financial Ombudsman Service, which handles complaints about them, lists the main forms these policies take: individual policies paid by annual or monthly premium, group policies, cash plans, dental policies, 6-week plans, and international private medical insurance policies¹². The international form is the one aimed at people living outside their home country.

What sits inside a plan is broader than many people expect. Health insurance policies typically cover "a wide range of medical services, from consultations with specialists to surgeries and hospital stays"³. Some plans add preventative services such as regular health assessments, mental health support and lifestyle advice, and many offer flexible benefits including access to virtual GP services³. Core cover on private health policies commonly includes inpatient and day-patient treatment, full cancer cover and virtual GP access¹³.

Two features shape what you pay. The first is the excess, the amount you contribute towards each claim. On private health insurance, excesses can vary between £0 and more than £1,000, and choosing a higher excess lowers the premium⁵. The second is underwriting of your medical history: when you switch provider, some insurers might not cover illnesses or injuries you have experienced recently or conditions you currently have, even if these are covered by your existing insurer³. That is covered further in the switching section below.

When you apply, you also keep some control over your medical information. You are entitled to talk with your GP or hospital doctor before medical reports are sent to the insurance company¹⁴. If a policy is arranged through an employer, added health benefits often include virtual GP services, vocational rehabilitation, mental health support and Employee Assistance Programmes¹⁵.

Telehealth and remote GP access: video and phone doctors

Remote consultations are one of the fastest-growing parts of health cover, and they matter doubly for expats, for whom an English-speaking doctor may not be easy to find locally. Many health insurance policies offer access to virtual GP services as a flexible benefit³, and protection policies often include added health benefits like virtual GP services alongside mental health support¹⁵. Core private health cover commonly bundles virtual GP access with inpatient and day-patient treatment¹³.

Travel insurers have moved the same way. ABTA's travel insurance includes free access to an online English-speaking doctor via the Doctor Please app¹⁶. These services let you talk to a doctor by video or phone from wherever you are, which can settle minor illnesses quickly and tell you whether something needs in-person care.

Two practical points are worth knowing. First, a remote consultation is a consultation, not a treatment guarantee: the doctor can advise and refer, but any hospital care that follows is paid for under your insurance policy's terms, not by the video service. Second, if the insurer asks for medical reports as part of underwriting a condition, you are entitled to talk with your GP or hospital doctor before those reports are sent to the insurance company¹⁴.

Medical Assistance Plus: up to 3 medical events per person

One example of how remote access works in practice is Medical Assistance Plus, a service that comes free with all Post Office travel insurance policies and is powered by Air Doctor¹⁷. It shows the shape these services take: a consultation service, a limit on use, and a handover point when serious care is needed.

The service allows up to 3 separate medical events per person listed on the policy, and up to 3 appointments per event¹⁷. To use it while away you need access to the website or optional app using Wi-Fi or data on your device, your travel insurance policy number, the email address you used for the policy, and your date of birth¹⁷. If you have single-trip or backpacker cover, you get an SMS reminder to launch the service the day before you travel; for annual multi-trip cover, the reminder comes the day before your policy starts¹⁷.

The limit that matters most is the handover. If an online or in-person consultation concludes you need inpatient care, the team hands your case to the emergency medical team in the UK¹⁷. From that point, what is paid and by whom depends on the insurance policy behind the service, which is why the terms of the policy itself, not the convenience of the app, are what to check before you rely on it.

Paying for treatment abroad: prescriptions, excess and currency

How you pay, and how you get repaid, differs by country and by policy. Most travel insurance policies require you to pay a small excess towards the cost of treatment and medicines¹⁸, and travel policies usually charge separate excesses for each individual claiming under the policy and each section of the policy being claimed under¹⁹. Some insurers also apply an excess per item, for example a passport, wallet or luggage²⁰. On private medical insurance the excess is the amount you pay towards the cost of a claim, and a higher excess lowers the premium²¹; in other words, an excess means you pay for the first part of any cost of private medical care²².

Prescriptions are a separate question from treatment. In England you usually pay for prescriptions, at £9.90 each, while prescriptions are free in Northern Ireland, Scotland and Wales²³. Those are UK charges: abroad, what you pay for medicines depends on the country's system and your cover. Even with a GHIC, "even if the state-provided care is free, you might have to pay upfront and claim the money back once you return home", for example in France for certain services⁷. In the UK, help with health costs schemes can cover prescriptions, sight tests, dental treatment and travel to receive NHS treatment²⁴, and full help can even extend to travel costs if travelling abroad for treatment²⁴, but these schemes are for people using the NHS, not for expats.

Currency is where expat claims get technical. If you pay hospital bills in a different currency, the Financial Ombudsman would usually ask the insurer to calculate the settlement based on the rate of exchange on the date you paid the expenses⁶. Keep every receipt and note the date you paid. If you pay by card, be aware that you will be charged interest on cash withdrawals straight away²⁵, so withdrawing local currency to pay a bill can cost more than the bill itself.

The ombudsman also sets out when using a private hospital abroad may be reasonable on a travel policy: when emergency treatment could not wait, when you were taken to a private hospital without being able to check with the insurer first, when the treatment was not available in any public hospital within a reasonable distance, when the standard of care at a public hospital was unacceptable, or when the insurer did not explain clearly that private treatment would not be covered⁶. Expat policies, by contrast, are often built around private care in the first place, which is one reason they cost more than travel cover.

UK health cash plans only work if you live in the UK

Health cash plans are a popular, cheap UK product: they pay cash back towards everyday health costs such as prescriptions, sight tests and dental treatment²⁴. The premise is that you are using the NHS and claiming contributions towards the charges. Move abroad and the premise fails.

The NHS provides healthcare for people who reside in the UK. If you move abroad, you are not automatically entitled to use the NHS free of charge, even if you have paid National Insurance contributions and taxes in the UK². Government guidance repeats the warning: you may not be entitled to free medical treatment in the UK if you move abroad permanently¹. And if you come back to the UK specifically to get hospital treatment, or an NHS check-up for an existing illness or injury, you will normally have to pay, unless there is a healthcare agreement with your new country of residence or you qualify for another exemption².

A cash plan that reimburses NHS charges therefore has nothing to reimburse. Check the plan's terms for a residency condition before assuming it travels with you. The realistic options for an expat are the state system of the country of residence, an international private medical insurance policy, or both. For the NHS side of the picture, see losing free NHS treatment when you move abroad, and for the wider picture of which UK policies survive a move, see insurance when you move abroad.

Where UK cover stops overseas

Even cover that sounds European does not stretch as far as people hope. ABTA warns that popular holiday destinations like Turkey, Dubai, Egypt, Morocco and Tunisia will not be covered by a European policy⁴. A policy or card built around the EU and EEA stops at those borders, and the GHIC cannot be used for state-provided healthcare in non-EU countries such as the US and Australia⁷.

Reciprocal arrangements have their own edges. The agreement between the UK and Guernsey, Alderney, Sark and Herm does not cover repatriation, ongoing treatment, or additional travel and accommodation costs²⁰. On the slopes, a GHIC or valid EHIC applies to state-provided care only, and many injury clinics on the slopes are private²⁶.

Two changes affect people planning a long move. Voluntary National Insurance contributions do not cover your health insurance in the country where you live²⁷, so paying to protect a UK State Pension does nothing for your healthcare abroad. And from 6 April 2026, workers living abroad will no longer be able to pay Class 2 voluntary National Insurance contributions to build their UK State Pension²⁸, a change that matters to anyone budgeting for a move. Finally, EHICs are no longer being issued or renewed in the UK, except to a few groups⁷, so the card many expats still carry is on its way out.

Switching or cancelling cover

A policyholder can cancel their policy and set up a new one with a different insurer whenever they want, even if a claim is ongoing, though the claim will affect their no-claims bonus²⁹. That principle, set out by the Financial Ombudsman Service in the context of motor insurance, applies to the mechanics of switching generally: you are not locked in.

The trap is medical underwriting. When you switch health insurer, some insurers might not cover illnesses or injuries you have experienced recently or any conditions you currently have, even if these are covered by your existing insurer³. A condition that is covered today can become excluded tomorrow, so the terms of the new policy need checking against your medical history before you cancel anything.

Rules on cancellation and renewal give some protection. When a firm proposes the renewal of a travel insurance policy, FCA rules say it should disclose whether any medical condition exclusion can be removed from the policy, in whole or in part, and if so how, and on what terms³⁰. The statutory right to cancel has limits, though: it does not apply to a travel and baggage policy or similar short-term policy of less than one month's duration, to a policy fully performed at the consumer's request, or to various general insurance contracts that are not distance contracts³¹. Note also that changing your mind about travelling, or missing your flight, is usually not covered: cover is normally provided only if a cancellation or missed flight is caused by a specific insured event³².

Travellers with ongoing health issues have a route to better terms: use a specialist medical travel insurer, call the insurer before buying, check policy exclusions and compare policies carefully³³.

EHIC to GHIC: what changed for UK residents in Europe

Britain left the EU in January 2021 and EHIC cards were replaced with the GHIC, the UK Global Health Insurance Card⁷. If you already have an EHIC, it remains valid until the expiry date on the card¹¹, but EHICs are no longer being issued or renewed in the UK except to a few groups, such as nationals of the EEA or Switzerland who have legally resided in the UK since before 1 January 2021 and are covered by the Withdrawal Agreement⁷.

What the cards do is narrow but real. A GHIC is a free medical card that gives you access to "necessary healthcare" in EU countries at the same price as citizens of that country⁷. Necessary healthcare includes treatment that cannot wait for you to return to the UK, such as emergency treatment, routine medical care for pre-existing conditions, routine maternity care (unless you are going to a country to give birth), and oxygen and kidney dialysis⁷. Both the GHIC and a valid EHIC cover treatment of a chronic or pre-existing condition if symptoms flare up during your trip⁷.

What the cards do not do is just as important. They cannot be used for any medical treatment at a private hospital or clinic, repatriation to the UK, or rescue, and they do not cover state healthcare in non-EU countries such as the US and Australia⁷. An EHIC or GHIC is not a replacement for travel insurance³⁴, because it will not cover all the medical bills incurred if someone falls ill or is injured abroad, for example an air ambulance, treatment in a private facility, ski or mountain rescue, or being flown back to the UK⁴. Few EU countries pay for the full cost of treatment anyway¹⁸. Government guidance for travellers to the EU states that travel insurance is needed before going away³⁵.

For UK residents the GHIC is free and worth carrying; the full detail is on our GHIC and EHIC page. But it is a resident's card, not an expat's: you can apply only if you are resident in the UK and do not have healthcare cover provided by an EEA country or Switzerland⁷. Someone who has moved to the EU permanently accesses that country's own system as a resident instead.

Where to get help

If a dispute arises with a health insurer, the first step is the insurer's own complaints process, in writing. If it cannot resolve the complaint, the Financial Ombudsman Service can look at complaints about private medical insurance, including international private medical insurance policies¹², and about travel insurance policies, including how excesses and limits were applied¹⁹ and how medical expenses and repatriation claims were handled⁶. The ombudsman's insight on travel insurance problems also flags what insurers need to be told about past or current health issues, even if you have recovered⁹, which is the most common ground for a declined claim.

The ombudsman can only help with firms within its jurisdiction. If your expat policy is written by an insurer based outside the UK, check before you buy who regulates it and which complaints body applies in its home country, because UK protections such as the Financial Ombudsman may not follow the policy abroad. The British Insurance Brokers' Association publishes guidance on travel insurance, including travelling to Europe after Brexit³⁴, and its checklist is a useful pre-purchase reference¹⁸.

For the money around a move rather than the cover itself, our money abroad section covers keeping a UK bank account while you live abroad, paying for things with a debit card overseas and emergency financial help abroad.