6 Best Countries for Expat Retiree Health Care: 2022

3. Portugal (tied)

Score: 96

Portugal has some of the finest doctors and medical training in the world, according to International Living. Many, if not most, graduates of top medical programs study and complete residencies in the U.K. and other European countries. In addition, many of their upper-level courses are taught in English, resulting in some level of fluency among most medical professionals.

Sixteen Portuguese health facilities, including nine hospitals, have received Joint Commission International stamps of approval.

Pharmacists generally speak English. Most medications available in the U.S. or an equivalent can be found in Portugal for less money. Medications for chronic conditions, such as diabetes, are provided free to residents. Costs for private health insurance begin around $50 a person, but increase with age, preexisting conditions and how comprehensive the plan is.

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2. Spain (tied)

Score: 96

Expats settling in Spain can look forward to better health care than that available in the U.S. In 2021, World Population Review ranked Spain’s public health care system No. 7, 30 places ahead of the U.S.

Spain’s public health care system, the Seguridad Social, covers general medicine, family practice, pediatrics, nursing and physical therapy. The Seguridad Social normally pays most or all the cost of medical treatment and hospitalization and up to 40% of the cost of prescriptions. The patient pays the remainder or buys supplemental insurance to cover the difference.

Spain also has excellent, affordable private health care, with the same doctors often working in both systems. Joint Commission International has accredited 24 Spanish facilities. The private system allows expats to request English-speaking doctors when making an appointment, while the public system offers the option of booking a translator when booking a doctor’s visit.

Those applying for a retirement visa in Spain are required to buy private Spanish health insurance. Complete coverage, with no copays and including basic dental care, may cost less than Medicare A and B, Medigap and Plan D in the U.S. Private insurance is required for at least the first year of residence. Some municipalities allow expats to buy into the public system after one year. If accepted, the monthly fee is $70 for those under 65, $157 for 65 and older. After five years, all expats are welcomed into the public system.

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1. Costa Rica

Score: 97

Costa Rica’s national health care system, the Caja Costarricense de Seguro Social, offers nationalized health care for all of its citizens and legal residents. The World Health Organization places Costa Rica in the top rankings for life expectancy, and the United Nations ranks the country’s public health care system in the top 20 worldwide. The Caja operates 30 public hospitals, as well as 250 clinics across the country, plus 1,000 smaller units to cover rural areas.

Once their residency application is approved, expats qualify to join the Caja. They typically pay between 7% and 11% of their reported monthly income. There are no additional copays, no age restrictions and no rejection because of preexisting conditions.

The public system has a couple of downsides. Most of the staff speak only Spanish, and apps and their website do not have an English option. Wait times are long for nonemergency procedures, which prompts many expats to blend both the public and the private health care systems. Many Costa Rican doctors work in both sectors and have studied in North America or Europe, and most in the private field speak English. The country has three Joint Commission International-certified medical centers in San José.

It’s possible to purchase health insurance policies from familiar companies such as Blue Cross Blue Shield, CIGNA, BMI/Aetna or the local Costa Rican private insurance, INS, from agents there. As an alternative, the country offers a private health care discount program called Medismart for as little as $14 per person per month.

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