Access health systems abroad

Access health systems abroad for free (or nearly free)

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As health care costs continue to skyrocket in the US, more and more Americans are moving abroad to stretch their incomes and retirement savings. when it comes to health care abroad, socialized medicine is your best friend. We've highlighted 8 countries below where you can access health systems for free or just pennies on the dollar!
Whether you're a digital nomad, an entrepreneur, or a retiree, health care is often a crucial factor that must be taken into account when deciding where to live. If you have a pre-existing condition or are over the age of 65, you're likely to find expat health insurance unaffordable or unobtainable while Medicare and private insurance typically limit coverage to the lower 48, Alaska, and Hawaii.
While there's a long list of countries with socialized medicine, only a few extend these benefits to expats. We've picked the best of the bunch below and give you the down low on what they have to offer:
Mexico
Mexico has two distinct public health care systems, IMSS (Instituto Mexicano del Seguro Social) and INSABI (Instituto de Salud para el Bienestar).
The IMSS system covers employees (including expats) of Mexican companies and residents with a CURP (Clave Única de Registro de Población) ID but excludes serious pre-existing conditions like cancer, late-stage diabetes, chronic liver or kidney disease, and heart disease. If this isn't a deal-breaker, then for up to approx. $600/yr., you'll be covered for accidents and medical emergencies, surgery, loss of work (partial reimbursement for up to 52 weeks), and prescription medications. As wait times for procedures can be long and practitioners often don't speak English, you may need to brush up on your Spanish or hire a local interpreter to accompany you to appointments.
INSABI is the public hospital system and covers the poorest residents who can't otherwise afford health care coverage. If you don't qualify for IMSS due to e.g. a pre-existing condition and don't carry private insurance, then this is your last resort. You do get what you pay for here: long waits and crowded unsanitary conditions.
 
Costa Rica
Costa Rica's health care system was rated by the UN as the best in Latin America and one of the top 20 in the world.
The public health system, Costaricense de Seguro Social or CAJA for short, is open to all permanent residents, including expats. Unlike Mexico's IMSS, there are no restrictions for pre-existing conditions and premiums actually go down as you age. Not entirely free, you can expect to pay up to 11.5% of the income you declare in your visa application or tax return. Like most other public healthcare systems in Latin America, expect long lines for service and understaffed facilities. Outside of San Jose, it can also be a challenge to find an English-speaking doctor.
If you prefer to spend a little more to be able to access private hospitals and clinics, the Instituto de Seguro Nacional (INS), run by the Costa Rican government, provides very affordable local private health insurance. The plans cover 80% of the cost of doctor visits, medical imaging, and hospitalization at costs ranging from $60-130/month, depending on your age and health.
Colombia
With a public healthcare system that's consistently ranked among the best in the world and some of the top hospitals in Latin America, Colombia offers high-quality health care at a fraction of the cost you would expect to pay in the US or Europe.
The Entidadas Promotoras de Salud (EPS) system doesn't exclude anyone on the basis of pre-existing conditions or age and is open to expats with permanent residency and a cedula (identification card). The cost is just 12.5% of your declared monthly income. The plan is similar to an HMO - the choice of doctors is limited and you need a referral from your GP to see a specialist. As the plans are administered though local private insurance companies and many of these are currently in financial distress, it's advisable to pick a sound company like Sura (just our opinion - do your own research).
Chile
The Chilean health care system is rated as one of the best in Latin America. In order to qualify for the highly-subsidized Fondo Nacional de Salud (FONASA) public insurance, you must be a permanent resident with a tax ID. Since Chile taxes worldwide income (initially at a flat 15%, eventually at a graduated rate up to 35%), whether you're working from home or are receiving a pension, you'll be dealing with the tax man anyway. However, the monthly premiums amount to just 7% of your taxable income, and the insurance covers doctor visits, prescription drugs, surgery, hospitalization, and even dental and vision.
If you don't qualify for a FONASA plan, you can always purchase private insurance from an ISAPRE (Instituciones de Salud Previsional). While more expensive, this eliminates the long waits and allows you to visit private clinics where the doctors are more likely to speak English.
Ecuador
Ecuador, which now requires proof of insurance coverage from visitors and residents alike, offers very affordable universal health care coverage through the public Instituto Ecuatoriano de Seguridad Social (IESS). The cost is 17.6% of your declared income (3.41% additional for a spouse), and retirees aged 65 and older are covered at the minimum premium (approximately around $100/month). There are no out-of-pocket costs and the program is open to all resident expats (you can sign up online on the IESS website). Pre-existing conditions are covered after a 90-day waiting period, and the plan also includes dental and vision. However, as with public healthcare in most third-world countries, expect a prolonged wait for major procedures and be prepared to supply toiletries and other basic necessities if you're hospitalized.
If you're staying in the country under a tourist visa, you can still enjoy medical treatment at around 15-35% of the cost of comparable care in the US. Many physicians have been trained in Western countries and speak English fluently. Finally, if you're concerned about the quality of care, don't be (at least not in the major urban centers). Ecuador's health care system was recently ranked ahead of that of the US in a Bloomberg survey.
Brazil
Under the country's constitution, legal residents, including expats, are entitled to universal public health care via the Sistema Único de Saúde (SUS) system. If you're employed by a Brazilian company, 8-11% of your wages are deducted. If you're self-employed or are staying in the country under a retirement visa, you can pay 20% of your declared income each month or, if you forego your right to the "length of contribution" pension, just 11% of the Brazilian monthly minimum wage (currently around $250). However, due to the ongoing financial crisis, hospitals and clinics in rural or impoverished areas are often understaffed and equipment is outdated or in disrepair. Aside from Sao Paolo and the southern region, this is true throughout the country (even in Rio de Janeiro). Wait times can be long and English-speaking doctors are few and far between (you can find a list of them at the US Embassy in Brazil).
If you're staying in Brazil under a tourist visa, you'll find the cost of private insurance to be around half of what you would expect to pay back home. While the quality of the private health care system is comparable to that of the US and Europe, the costs can be quite high if you're uninsured, and hospitals require payment in advance.
Cuba
If you're the adventurous type and don't mind the restrictions of life in a Communist state, Cuba offers free public healthcare to permanent residents, including expats. However, there's a caveat: aside from the "snowbird" visa, which allows you to spend up to 6 months at a time in the country, the only surefire way to gain permanent residency is to either marry a Cuban or have a baby with one. While health care in Cuba lived up to high standards in the past, physicians have been fleeing the country en masse, and many hospitals and clinics are now run down.
But fret not: if you can't find a Cuban to marry and failed to leave a little pudding behind on your last visit, you can still buy reasonably-priced local health insurance on arrival (typically around $125-175/month) and enjoy preferential treatment at one of the special hospitals and clinics for foreigners, such as the Hospital Clínico-Quirúrgico Hermanos Ameijeiras or the Clínica Cira García in Havana.
Last but not least, as all visitors to Cuba are required to show proof of travel insurance for the duration of their stay, make sure to purchase this before you arrive (the policy must include coverage for medical evacuation, emergencies and repatriation of remains).
Thailand
While many people, due to the salacious headlines, associate trips to Thai medical facilities with sex change operations, in recent years, as the country's healthcare standards have continued to rise, it's become one of the most popular destinations in the world for medical tourism.
So how can you get covered by the country's free healthcare system? If you're employed by a Thai company under a long-term visa, the country's public Universal Health Care (UHC) has got you covered. Just enroll and make the requisite 5% monthly social security contributions, and you'll be eligible for free public medical care, including check-ups (once annually), imaging exams, hospitalization, rehab, medical supplies, ambulance trips, and even dental expenses up to THB 900 (around $25 - maybe enough for a basic cleaning?). Pre-existing conditions are fully covered and there are no co-payments. While some expats have been able to skirt these requirements by setting up dummy corporations, and this has reportedly been tolerated by the authorities, we don't recommend this approach as it's still technically against the law for foreigners to own a company in Thailand. Should the local authorities decide to crack down on this, you might suddenly find yourself without any access to medical care.
If you're staying in the country under a retirment visa, such as the 1-year O-A visa, or a tourist visa, you're now required to show proof of medical coverage in a minimum amount of THB 400,000 (around $11,500) for inpatient care and THB 40,000 (around $1,150) for outpatient care. Like almost everything else in the Land of Smiles, the rules are constantly in flux, and enforcement is sporadic at best.

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