The Dream of Moving Abroad in Later Life, With Good Health Care (Published 2014)

FOR the well-traveled, the idea of retirement abroad can seem an idyll. You pick a place you’ve loved visiting, whether it’s the thrumming avenues of Paris or the sunny strands of Panama, and jet off for the perfect permanent vacation.

But the fantasy can become less carefree if you haven’t figured out in advance what to do about health insurance. The best policies, those offering the broadest coverage and giving access to the best hospitals, can be jarringly costly. More affordable alternatives can come with exceptions that may surprise people accustomed to the comprehensive coverage offered through many United States employers. Many countries offer high-quality care — France is a prominent example — but retirees won’t be able to access it without insurance or paying out of pocket. And in almost all cases, Medicare doesn’t pay for health care provided outside of the United States.

“Health insurance really is a primary consideration when retiring overseas,” said Brendan Sharkey, director of individual products for HTH, which sells and administers GeoBlue international health insurance. “People may want sunshine and affordable living, but they’ll also want to make sure they’ll be covered adequately.” That means not just buying a policy, but also assessing the quality of health care in the country where they plan to settle.

“If you’ve had two heart attacks, you have to ask yourself if it makes sense to retire in Nicaragua, where the underlying quality of care just isn’t there,” Mr. Sharkey said. More practical alternatives might be Panama or Thailand — warm, affordable countries known for better-quality care, he said.

For health insurers, age equals risk — senescence brings sickness. So older people can expect to pay up for international health insurance, especially as they reach their middle to late 70s. “It’s the same everywhere in the world — the older you get, the more expensive the premiums,” said Steve Nelson, product development manager at Medibroker, an insurance brokerage in North Shields, England.

At Cigna, international health premiums can range from a couple of hundred dollars a month for the most basic plan to several thousand for a comprehensive one, said James T. O’Brien, head of the Americas region for Cigna’s global individual plans.