International health insurance for American digital nomads
Your home cover does not follow you abroad
American digital nomads' US employer or marketplace health insurance almost never covers routine care abroad and only covers emergencies under tight, plan-specific time limits. Some employer business-travel riders, for example, cover trips of up to six months, while standard US group plans treat routine care abroad as non-covered entirely. Your own number is in your Summary of Benefits and Coverage.
How long your home cover lasts abroad
Plan-specific. Some employer business-travel riders cover international trips of up to six months. Standard US group plans treat routine care abroad as non-covered entirely, and emergency-only windows vary by plan. Read your own Summary of Benefits and Coverage for the exact number.
What breaks when you leave
No routine care abroad: no annual physical, no chronic-disease management, no prescription refills, no specialist visits. Emergency care abroad is reimbursable under most group plans, but only as out-of-network, meaning you pay the foreign hospital upfront in cash or credit card, submit documentation (translated to English at your cost), and wait weeks to months for partial reimbursement.
What you need instead
For trips under ~6 months: a dedicated travel-medical policy alongside your US employer plan (keep COBRA / employer plan running for US continuity). For trips over 6 months or open-ended nomadism: a full international IPMI plan and a deliberate decision about whether to also keep COBRA, usually only worth it for pre-existing conditions or imminent return.
Common mistakes
- Assuming COBRA extends coverage abroad; it doesn't, COBRA is the same US-domestic plan
- Assuming Medicare follows you abroad; Original Medicare does not cover care outside the US except in narrow border-region edge cases
- Buying a cheap travel-medical subscription, then discovering routine care isn't covered
- Cancelling the US employer plan before securing the international plan, which leaves an underwriting gap if you have pre-existing conditions
- Not declaring the move to the US plan, then losing reimbursement on the one emergency claim because the carrier views the trip as a relocation
- Choosing reimbursement-only cover for Bali, Bangkok, or CDMX where private hospitals demand cash deposit on admission
Our take
For Americans, the cleanest pattern is: keep the US employer plan running for the first 90 days abroad (it overlaps with most carriers' emergency window), layer travel-medical on top, and only switch to a full international IPMI once you commit to staying out for 6+ months. The decision point that matters most is pre-existing conditions: if you have any, never let coverage lapse between policies.
FAQ
Only if you accept that almost nothing abroad will be covered. COBRA continues your US employer plan; it does not add international coverage. Use COBRA for US-side continuity and pair it with a real international plan for the country you're actually in.
Original Medicare (Parts A and B) does not cover health care received outside the US, with narrow exceptions for medical emergencies near US borders. Some Medigap policies (C, D, F, G, M, N) include limited foreign-travel emergency coverage, typically 80% reimbursement up to a $50 000 lifetime cap, with a deductible. For sustained time abroad, you need a separate international plan.
Heavily dependent on whether the policy includes US coverage. Plans that exclude the US are dramatically cheaper than worldwide-including-US plans. Request specific quotes from the matching form; fair ranges are wide enough that a published number would mislead.
If you're physically outside the US for 330+ days in any 12-month period, you're considered to have minimum essential coverage and the ACA individual-mandate considerations don't apply. Under that threshold, depending on residency status, US tax-side coverage rules may still apply, so talk to a tax professional, not to us.
Reviewed by Lukas Schönberg, Founder & researcher, Nomad Insurance Broker OÜ
Nomad Insurance Broker OÜ (Estonia) is an information and matching platform, not currently registered as a regulated insurance intermediary in any jurisdiction. See /how-it-works for the full disclosure.
Source: aetnainternational.comLast verified
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