Living Abroad Without Health Insurance: A Guide for Expatriates

Versatile and experienced as I am, I can proudly say that my wife and I moved to Europe in 2017, largely due to the escalating healthcare troubles in the United States. We decided to forego our US health insurance coverage, a decision grounded in the understanding that 'you never use something you don’t need,' given our plans to remain overseas permanently.

Health Insurance: A Choice, Not a Necessity?

Living abroad without health insurance is a subject that often sparks debate. The answer to whether you can live without it largely hinges on your specific circumstances. If you are working in a foreign country with no plans to return to the United States, you must consider several factors:

Employer-provided insurance: Many employers, especially in countries like Switzerland, are legally required to provide health insurance for their employees. In such cases, relying on your employer for coverage might be the most straightforward option. National health insurance: Countries like the UK, Canada, and certain European nations offer comprehensive health coverage through national programs, which can be a viable alternative. Local insurance: Buying local health insurance can be a good option if your employer does not provide coverage. However, it's essential to research the local options thoroughly to ensure you get appropriate coverage suited to your needs.

States with Mandatory Health Insurance

There are exceptions to the no-insurance rule, particularly in certain states or administrations within the US. For instance, some states and the District of Columbia have implemented laws requiring all residents to have health insurance. In such cases, you might need to consider options like California Covered, which is designed to help residents of California afford health insurance.

Travel Insurance: A Safety Net

While you can choose not to have health insurance, it's always a prudent idea to invest in reliable travel insurance. This can provide coverage for unexpected medical emergencies or medical evacuation should you decide to travel home to the US at any point. As young and healthy as you may feel, life is full of uncertainties. A car accident or sudden illness can put you in intensive care, and the associated costs can be astronomical.

Tax Considerations

Regardless of your health insurance decisions, don't forget about your tax obligations. Even if you are living abroad and not in the US, you must continue to file a tax return. The IRS requires this, and the requirement to file depends on your earnings, passive income, and other factors. It's advisable to consult with a professional, such as an Enrolled Agent (EA) or Certified Public Accountant (CPA), to ensure full compliance.

Conclusion

Deciding to live abroad without health insurance is a personal choice that should be made with full awareness of the potential risks and benefits. Whether you opt to rely on your employer, explore local insurance options, or combine multiple strategies, the key is to have a comprehensive understanding of your health and financial situation.

Although the decision to forgo health insurance can be financially beneficial, it's crucial to maintain a safety net, particularly through travel insurance. Life often takes unexpected turns, and being prepared for the worst can save you a lot of stress and financial strain.

In summary, while it is possible to live without health insurance as an expatriate, prudence and preparation are essential for a smooth and stress-free transition into your new life.