You can find quality, affordable healthcare if you retire abroad. Here’s where to look.

Healthcare is expensive, and the costs only grow as people age. Someone retiring at age 65 in 2025 can expect to spend another $172,500 on healthcare in their lifetime, not including any expenses for long-term care, according to Fidelity Investments. Endless mountain views and warm ocean breezes are alluring, but so is the reassurance that quality healthcare will be available when times are tough.

When we announced we were moving to Ecuador 15 years ago, a relative asked what we planned to do if we got sick. And while an increasing number of Americans are dissatisfied with their healthcare coverage, it is prudent to wonder about the quality of care in other countries before making a decision as big as moving overseas.

Are such concerns legitimate? Let’s take a look.

Healthcare abroad

The 2025 midyear global healthcare index from Numbeo, a platform that compares costs in different countries, ranks the U.S. at No. 39. Our home country of Ecuador is considerably higher, at No. 7. Other popular expat destinations like Spain (No. 9), Thailand (No. 10), Mexico (No. 21) and Portugal (No. 23) also shine.

In these countries and many others, there are modern hospitals and clinics with bilingual doctors in major cities. As is true most everywhere, the quality of care decreases in less populated areas.

Because of rising costs, long wait times and unavailability of specialized treatments, 14 million Americans travel to other countries each year for everything from dental work and cosmetic surgery to organ transplants, according to the Medical Tourism Association.

Affordable healthcare (no, really!)

Rising healthcare premiums are already straining the budgets of many Americans. Without action from Congress, plans in the Affordable Care Act marketplace could more than double in price next year.

Meanwhile, costs abroad are often so low that expats choose to pay out of pocket for their healthcare needs.

Office visits cost about $40 in Ecuador and half that in Thailand. A hip replacement that averages $30,000 in the U.S. costs around $10,000 in Mexico.

It should come as no surprise that brand-name prescription medications are far more expensive in the U.S. than elsewhere in the world. Many drugs in other countries are priced much lower and are often available over the counter, with no prescription required.

Employers negotiate with drug providers when determining the cost of medical benefits for their employees, which means people in the U.S. with a company health-insurance plan can pay different prices for the same prescription medication.

Without insurance, Prozac costs around $330 a month in the U.S. In Portugal, you’ll pay $1.22 (not a typo). A 30-day supply of Lipitor that runs $330 in the U.S. is less than $5 in France.

Coverage options in other countries

Expats seeking healthcare coverage generally choose between public and private plans. Many countries allow foreigners to enroll in their public health system after qualifying for residency. These plans typically have very affordable premiums, but they don’t allow you to choose your doctor and sometimes involve long wait times for treatment.

Private plans eliminate those issues at a higher cost (although nowhere near the almost $500 a month for an individual plan in the United States). However, international plans, which offer comprehensive global coverage, can run from $500 to $1,000 or more a month.

We use a hybrid approach for our personal healthcare that has served us well and offers the best of both worlds. We belong to Ecuador’s social security health-insurance program, which offers 100% coverage with $0 deductible and no restrictions for age or pre-existing conditions. But we also pay out of pocket for periodic visits with specialists like our ophthalmologist and dentist, with whom we’ve developed relationships over the years.

What about Medicare?

It is commonly stated that “Medicare doesn’t travel outside U.S. borders.” This is true for traditional Medicare, but numerous Medicare Advantage plans provide for generous levels of emergency care in other countries. 

This nugget of information is not highly publicized, so Medicare Advantage plan members should check the fine print of their coverage.

We always recommend that expats retain their Medicare coverage even if they are enrolled in a private or public plan in their new country. We have known too many people who were certain they’d “never go back” but who, in fact, returned home because of — you guessed it — catastrophic health issues.

Opting out of Medicare and then re-enrolling involves lifelong penalties of 10% for each year a person was eligible but not enrolled. Plus you cannot renew coverage whenever you wish — you can only do it during Medicare’s open-enrollment period, which runs from Oct. 15 through Dec. 7 each year.

Finding the right location for you

The next step is to ensure your health profile is a good match for the locations you find most suitable.

We recently wrote about 10 questions you should ask yourself before retiring abroad. At the top of the list are considerations about your level of fitness and mobility, prescription medications and dietary needs. As part of your research, your scouting trip should include visiting a physician (get a referral through Facebook groups), a pharmacy and a supermarket or natural-foods store.

Moving abroad offers the opportunity to stretch your retirement dollars much further than is possible in the United States. If the choice makes sense for you, be sure to find a location that supports your healthcare requirements as well.