April 14, 2024

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For many expats, choosing a retirement destination is dependent on the standard of healthcare that country provides—and understandably so. In this next stage of your life, you want to ensure you have access to the best care possible, at reasonable prices you can afford.

Measuring the quality of healthcare is difficult, and it’s hard to put a number on it. We can, however, put a number on the price of medical procedures. And these costs (as well as quality) helped us score each country. We have scored the 17 countries in our healthcare category to determine which rank highly when it comes to medical costs, efficiency, accessibility, expat experiences, and overall standard of care. With many expat havens offering world-class, affordable healthcare, you can move abroad with the knowledge that your medical needs will be catered to.

The five finalists below all have something in common—modern, high-quality healthcare services and facilities that you can easily afford on your Social Security check.

©iStock/Arturo Rosenow

By Michelle Thompson

The quality of healthcare in Colombia is a top priority for new arrivals who want to make the country their permanent home. IL contributor Erin Donaldson explains, “One of the first questions that new arrivals or interested travelers ask is ‘can I get the care and attention I need if I get sick or injured while living in Pereira,’ and the short answer is a resounding YES!”

In 2023, the healthcare system in Colombia ranked one point higher than the US on the World Health Organization Healthcare Index, admittedly slipping from 22 to 35 out of 191 countries. For context, Canada currently ranks 29th, and the US is 36th on the list. According to the WHO, on average, Colombians live longer than Americans (79.3 vs 78.5 years). For context, life expectancy in Canada is higher at 82.2 years.

The quality and cost of care somewhat depend on whether you access care through the public or private system. Private clinics and hospitals in Colombia tend to have shorter wait times, and their services are often more expensive. Canadian and US revenue sources can go a long way to making sure you can afford the highest quality care, though there are many globally-accredited medical centers in Colombia. Centro Médico Imbanaco in Cali, Hospital Pablo Tobón Uribe in Medellin, Hospital Universitario Fundación Santa Fé in Bogota, and Hospital Internacional de Colombia in Bucaramanga are just a few examples.

“Pereira, where I live, is one of the best cities in the coffee axis to live in, particularly because of their hospital system, which is the biggest in the region,” says Donaldson. The city has a private hospital called Comfamiliar and a medical complex featuring urgent care and specialists called MegaCentro. Both are located in popular neighborhoods for foreign residents: Los Alpes and Pinares. She adds, “Pereira also has its own oncology center for cancer treatment and is building a new medical complex which will expand its resources significantly, including medical tourism.”

The quality of care in Colombia is comparable to North American hospitals and clinics. “As a retired healthcare executive from the US, I know quality healthcare when I see it,” says Nancy Kiernan, who spent over 30 years working in the US healthcare system before she retired in Medellín, Colombia, in 2012. She gets annual exams, mammograms, and prescriptions for minor health issues a few times a year.

Michelle Thompson has lived in Bogota and Cartagena since 2018 and prefers the Colombian healthcare system. “Canadian doctors have become risk-averse and pressed for time. The level of care and attention I receive from my Colombian doctor is better than what I became accustomed to in Canada. My doctor will take a few extra minutes to explain the ‘why’ and has even recommended natural remedies,” she says.

While speaking Spanish certainly helps you navigate the system, you will still receive excellent care. Many hospitals in large and medium-sized cities have at least one English-speaking person on staff; some facilities even have a certified translation department. Connecting with other expats is also a great way to find a quality doctor or specialist. “I have helped some of my expat friends navigate the system for surgeries, inpatient hospital stays, and high-tech outpatient services such as CT scans, MRIs, and vascular studies. The quality of care and protocols are as good or better than what I worked with back in the States,” says Kiernan.

One thing that may surprise you is that Colombia offers universal health care. A foreigner with permanent residency status can enroll in the national government-subsidized EPS program and receive free socialized healthcare. Travelers and visitors on extended stay visas will need to purchase a private international health insurance plan. Those who don’t have EPS or private insurance will still find healthcare is relatively affordable, even when paying out of pocket. “Early on, I had to visit the emergency room but didn’t have health coverage yet. The visit cost me $35, including the exam and tests. It turns out I had a severe kidney infection,” says Michelle Thompson.

Major medical issues aside, Colombia is exceptionally cheap and efficient when it comes to vision and dental care-related costs. The average eye exam will set you back around $7, while a new set of glasses might cost you $75 for a modest pair and $100 for a high-end brand. Contacts, which are a bit pricier in Colombia, are around $40 per box. Dental care is cheap enough to pay out of pocket. A standard cleaning is about $45, while a filling might cost you $60. While most pharmacies carry generic medication brands, Colombian pharmacists are familiar with popular North American brands. You can confidently rely on their advice.

Full Guide to Healthcare in Colombia here.

©iStock/StevanZZ

©iStock/StevanZZ

France is not only a beautiful and culturally rich place to live, but it also has some of the best healthcare in the world.

For a country rich in the finer things in life—like exquisite cuisine and first-rate wines that have been savored the world over—the French government does all it can to ensure its residents live long and healthy lives.

Everyone in France is guaranteed healthcare, no matter age, occupation, or income level. There are no pre-existing condition restrictions, and anyone who has lived in the country for three months can apply to be part of the system. France just needs to be your place of residence for six months of the year.

This is especially exciting news for people looking to retire abroad. In order to obtain legal residency in France, you’ll need to apply for a Long-Stay Visa—which is not difficult to obtain.

After arriving in France, you will complete an online form at the three-month mark and be given a temporary healthcare number. This would be equivalent to a Social Security number back at home. Your healthcare card will arrive at your home shortly thereafter.

You will then be eligible to get 70% to 80% off medical services and up to 100% off prescription drugs—which are already at rock bottom prices compared to the United States. The fees to see a general practitioner are already incredibly low at €25, about $29 a visit, without the reduction.

Once on the system, you qualify for a 70% reimbursement on that same doctor’s visit—meaning that you’ll pay about $9 to see a doctor in France. Since prices are fixed by the government, that fee has not been changed in over 10 years, with no foreseeable increases for the near future. The cost to see a specialist is €50 ($55), which comes out to around $13 out-of-pocket after the 70% reimbursement. Hospital stays are covered at 80%, and any stays over a month are 100% reimbursed for the duration of the treatment.

“It’s a lot to get your head around,” says Tuula Rampont, IL’s France Correspondent. “It took me a few years to believe that the system was the real deal. I kept expecting hidden fees to pop up, but they never came.”

Another amazing benefit to France’s healthcare system is that you can see any doctor anywhere in the country. More often than not, there are no networks to join, and public healthcare is just as good as a private facility. With a little bit of research, you can visit any top-notch provider in your area.

“I look mainly for reviews online,” says Tuula Rampont. “If someone has a four- or five-star rating, it’s a pretty good bet that you’re going to receive good care. My current doctor is incredible. Somehow, she always manages to squeeze me in for same-day appointments. I recently called her at around 8 a.m. one morning about a stubborn cold I had. She managed to fit me in between two appointments at 11 a.m. By midday, I was back from the pharmacy and on the road to recovery.”

In the past few years, it’s become even easier for expats to make doctor’s appointments in France. A private company created the website Doctolib, which is an online scheduling service. Doctors all around the country have adopted the service, and it’s a breeze to use. You can search by region, city, medical specialty, and preferred language—a boon for English speakers. The website sends you an email confirmation once the appointment is booked, and a reminder text message the day before your visit. You can also book dentist appointments, blood tests, MRIs, physical therapists, and chiropractic visits on Doctolib.

“I have the application on my phone, so I can track my upcoming appointments and reschedule anything if necessary,” says Rampont. “It’s incredibly convenient.”

Another outstanding feature of French healthcare is their policy on long-term illnesses. Anyone who has cancer, recurrent ulcers, heart disease, certain forms of diabetes, Parkinson’s disease, Alzheimer’s (and a host of other illnesses) is eligible for 100% coverage on healthcare services for the duration of the treatment.

Patients only need to ask their general practitioner to submit a form for long-term coverage. A list of long-term illnesses covered under the French system can be found on the official healthcare website.

French healthcare costs do not increase with age. Someone 40 years old will pay the same rate as a 65-year-old or an 80-year-old. It’s an all-inclusive system that covers salaried employees, retirees, job seekers, and those unable to work. There is a once-yearly fee based on your taxable income—on average $2,200 to $2,700 per couple—but it can be considerably less since France cannot tax any passive income, i.e., pensions, social security benefits, or retirement accounts. Due to a tax treaty with the United States, individuals cannot be double-taxed on monies paid to the US—another plus of the system which is particularly attractive for those looking to retire in France.

Full Guide to Healthcare in France here.

©iStock/Eloi_Omella

©iStock/Eloi_Omella

By Sally Pederson

Spain has become an increasingly attractive destination for retirees and remote workers, not just for its sun-soaked beaches, vibrant culture, and delectable cuisine but primarily due to its impressive healthcare system. This healthcare model stands in stark contrast to what many Americans experience, offering a quality of care at more affordable rates.

In a recent 2023 survey by the World Population Review, Spain’s public healthcare earned the esteemed ranking of the 8th best globally. This is a noteworthy achievement, especially considering that the US placed 30th and Canada 23rd in the same survey. Moreover, Spain houses 23 medical facilities that have received accreditation from the Joint Commission International—the hallmark of exceptional hospital care.

The healthcare accessibility in Spain is truly commendable. With a ratio of four doctors for every 1,000 citizens, residents are typically a short 15-minute journey away from medical facilities. Of course, if you are living in the beautiful countryside, it will take you longer to get medical attention. This impressive healthcare infrastructure is one of many reasons why thousands of expats call Spain home.

Funding for Spain’s public healthcare comes from taxpayer contributions. It is called Seguridad Social. But if you’re an expat considering moving to or retiring in Spain, don’t expect to access the public system instantly. Why? Simply because you haven’t been contributing through taxes all your life. However, there’s a solution. Upon applying for retirement visas, such as the non-lucrative or “golden visa,” Spain mandates that retirees secure private health insurance. The time required for this varies depending on the autonomous region you live in. Some will need it until you get your residency card, while others require it for at least the first full year. The exciting part? Comprehensive insurance, covering basic dental care, and in one case that I know of covers Lasik eye surgery, can cost you less in Spain than Medicare, Medigap, and Plan D back in the US. For example, a plan for a healthy couple aged 64 from Sanitas (one of Spain’s leading private insurers) would cost around €280 per month. Yes, that is for a couple.

But, as always, there are caveats. As you age, the premiums rise, and those over 74 or with existing health conditions might find it challenging to get coverage. Brokers, however, can guide you to insurers willing to take on higher-risk clients, albeit at premium rates. However, these rates can still be substantially less than you pay in the US.

Prescription drugs might not fall under private insurance, but they’re relatively affordable compared to US and Canadian prices. Moreover, once you’ve spent a year in Spain (depending on your specific visa), most autonomous regions allow you to opt into the public system for free. Again, another caveat: if you are a retiree, you must wait a little longer. You may access healthcare for a small fee after the first year; after five years, all retirees can fully access it. This robust public system extends its coverage from general medicine to pediatrics, physical therapy, and more.

And while it’s true that dental care isn’t generally covered and specific treatments might involve out-of-pocket expenses, the private healthcare you pay for may cover these other expenses.

Additionally, in regions with a high expatriate population, translators are available to bridge any language barriers if the doctor doesn’t speak English. They may also be available in smaller cities but not towns and villages.

Those already in the public system can choose to convert their private insurance into a supplementary plan, granting them perks like quick appointments with specialists or consultations with English-speaking doctors. Many local companies offer their employees this dual benefit of public and private healthcare, a testament to the efficiency of this combination.

In addition to retirees, European expats benefit from reciprocal healthcare agreements, allowing them access to Spanish public healthcare. And for those from the US or Canada working in Spain? They, too, can access all these public services after receiving their visa or residency card.

The fruits of Spain’s healthcare efforts are evident in its health statistics. The World Economic Forum highlights a significant decline in heart-related ailments and cancer deaths in the country over the past decade, thanks to proactive public health initiatives focused on early detection and preventive measures. It’s no surprise that Spain, as Macrotrends.net reported, is second only to Switzerland in European life expectancy and ranks sixth globally.

“The blend of affordable, high-quality public and private healthcare in Spain paves the way for a more holistic living experience,” says Sally Pederson, IL Spain Correspondent. “The contentment and security derived from this healthcare model benefit all the people living in Spain and contribute to the joyful, secure, and festive ambiance Spain is renowned for. You can enjoy a more fulfilling life when you don’t have to worry about healthcare access and costs.”

Full Guide to Healthcare in Spain here.

©iStock/miroslav_1

©iStock/miroslav_1

By Bekah Bottone

“Decade after decade, Costa Rica continues to be a popular option for retirees moving abroad. And nowadays, many digital nomads and entrepreneurs, with and without families, searching for a calmer, healthier, outdoor lifestyle are flocking to Costa Rica,” shares Bekah Bottone, IL’s Costa Rica Correspondent. She has been living by the beach in Tamarindo since 2012.

“There are many factors that make Costa Rica so appealing. There’s good healthcare at an affordable rate (costs are about a third to a fifth of what you’d pay in the US). And we have an agreeably warm climate, a stable government, numerous opportunities to choose from for residency, and stunning biodiversity.”

Costa Rica’s national healthcare system, the Caja Costarricense de Seguro Social (simply known as the Caja), offers universal healthcare for all 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 healthcare system in the top 20 worldwide. The government has taken the program to the next level with a healthcare app (EDUS)—making your medical records and appointments available with a few taps on your phone.

The Caja operates 30 public hospitals across the country. Most larger hospitals are in and around the nation’s capital, San José. They also run 250 clinics across the country and 1000 smaller “attention units” called EBAIS to cover the rural areas. Even those who live remotely have access to above-average healthcare nearby. The government maintains an annual budget for improvements and new equipment.

As a foreigner, once your residency is approved, you must join the Caja to keep your legal status. The cost is typically between 14% and 16% of your reported monthly income on your residency application. There are no additional Caja co-pays and no age restrictions, and they will not deny you for pre-existing conditions.

Attorney Roger Peterson shares an example of a monthly Caja payment. “A rentista with a monthly income of $2,500 will pay just over 15% and owe around $392 each month.” Remember, the pensionista category only needs proof of a minimum of $1,000 monthly income from a retirement fund or permanent pension source, so monthly Caja payments would be less.

“Although the system isn’t perfect, I have had great experiences using the Caja,” says Bekah. “My children were born in Calderón, a public hospital in San Jose, and both children were admitted to the public hospital in Nicoya for different issues over the years. The personalized and caring treatment from the nursing staff has always impressed me.”

However, it is often difficult for new expats to figure out the system, especially if they aren’t fluent in Spanish. “New expats find it difficult to navigate as most staff only speak Spanish. Additionally, wait times are long for non-emergency treatment. Yet, by blending the public and private healthcare systems, it is possible to get the best out of both worlds. For example, when I need blood work, I ask my private primary care doctor for a prescription in the public system,” shares Bekah Bottone.

Many Costa Rican doctors work in both sectors. The country has three JCI-certified medical centers in San José, the highest worldwide accreditation that medical centers can receive. These private hospitals and clinics offer private rooms, modern equipment, and air conditioning. However, there’s a need for private insurance or an immediate out-of-pocket payment before treatment.

Kelly Clayton, who moved her family to Santa Ana in the Central Valley in March 2020, was drawn to the country because of the Caja healthcare system. “We have found that the price of medical care is much lower here than in the US. All our doctors have been US-educated and speak English. Annual checkups are between $25 and $150 (depending on if we use the doctor in the MediSmart plan), and a full blood workup was approximately $150. For women, mammograms are about $150.”

Costa Rica offers a private healthcare discount program called Medismart. For as little as $14 per person per month, you buy into a discounted rate on private in-network hospitals, clinics, doctors, specialists, and even prescriptions.

Many expats purchase private health insurance policies from familiar companies like CIGNA and Aetna or the local Costa Rican private insurance, INS, from agents locally in Costa Rica. This option is the most expensive route, but these policies are still significantly cheaper than purchasing a similar one in the US. If you need coverage for pre-existing conditions or are over a certain age, you may not qualify.

Some expats also choose to “self-insure” or pay out of pocket for all their healthcare needs at private hospitals and clinics, especially if they are younger or in good health.

Costa Rica has also become a top destination for medical procedures that may not be covered by insurance or elective procedures. Many people travel to Costa Rica for weight loss procedures like lap bands, knee and hip replacements, cosmetic procedures like facelifts, angioplasty, heart valve replacements, and much more.

Restorative and cosmetic dentistry are also popular, including crowns, root canals, and implants. Even factoring in travel costs, medical and dental treatment in Costa Rica is usually much cheaper than it would be in the US. It’s estimated that patients save between 30% and 70% on care, depending on the procedure.

Roxana Buonomo bought a restaurant, moved her family down to Playa Tamarindo from Canada in 2022, and opened a school. They jumped right into life in Costa Rica… and convenient and affordable healthcare was a perk. Roxana shares, “The dental care is more advanced than we’ve seen at a dental office in Canada. Our dentist is very efficient, clean, friendly, and professional. My daughter had to get some x-rays, which cost $30, and the appointment was $25.”

Thanks to a fully established medical tourism infrastructure in Costa Rica, traveling to this Central American country for care is easy. Medical tour companies will arrange your flight, introduce you to doctors, pick you up at the airport, drive you to doctor visits, and arrange pre-and post-procedure stays at a hotel. Sometimes, they’ll even set up tours of the rainforest, beach, coffee plantations, or other tourist attractions if your medical needs allow it.

Full Guide to Healthcare in Costa Rica here.

©iStock/miroslav_1

©iStock/miroslav_1

By Terry Coles

Portugal has some of the best healthcare in the world that consistently ranks high by the World Health Organization. Doctors are unhurried, willing to listen, answer questions, and offer a solution. “I have never felt rushed like I did when I’d see a doctor in the US,” said Terry Coles, a frequent contributor to IL.

Training to become a physician in Portugal happens at several medical schools, including the School of Health Services at the University of Minho in the north, the Faculty of Medicine at the University of Coimbra in the central region, world-renowned for its expansive research fields and Ph.D. programs, and the Faculty of Medical Sciences of the New University of Lisbon in the south. Many doctors who complete these programs continue to residencies in the UK or other European countries where top-level courses are taught in English, giving them a strong base in the language.

Ten hospitals and 16 health facilities in the country hold the Joint Commission International “gold stamp of approval.”

Portugal has an extensive tax-funded public healthcare system run by the Serviço Nacional de Saúde (SNS), along with a sizeable private healthcare network. Foreigners who reside full-time in Portugal have access to both. Private health insurance in Portugal is easily accessible and affordable, with plans starting at around $50 a person. But just like anywhere else, cost does increase with age, pre-existing conditions, and level of coverage.

While both the public and private healthcare systems offer excellent care, there are some differences. In the private system, one can call or go online to make an appointment with an English-speaking doctor of their choice. The cost varies from €50 for a general practitioner to €90 for a specialist. In the public system, patients would enter their local clinic, take a number, and wait to be seen by whatever doctor is available. The cost would be minimal, starting around €7, but the doctor may or may not speak English.

Portugal has an emergency response system, The National Institute of Medical Emergency (INEM), with a fleet of yellow ambulances accessed by calling 112, the equivalent of 911 in North America. Patients will be taken to their nearest public hospital best suited for handling major trauma. If the patient is stable, they can request a transfer to a private hospital of their choice.

Local fire departments also have ambulances that can be called and can transport patients to a hospital of their choice for a small fee. Private hospital ambulances are used for non-urgent transfers only.

“Twelve years ago, when my husband Clyde retired from the fire department in Corpus Christi, Texas, our health insurance was going to cost a whopping $1,400 a month for the two of us because we retired early, ages 57 and 51,” says Terry Coles, Portugal Contributor. “Here in Portugal, we pay just €340 a month for a high-end, comprehensive policy that even covers us for emergencies abroad for up to sixty days. We pay just €15 every time we see a doctor regardless of their specialty if they are in network. To see an out-of-network doctor, we pay the full amount, submit the bill, and are reimbursed at 80% of the cost.”

“Clyde spent six days in a JCI-accredited private hospital in the Algarve for post-COVID-related issues. He was admitted through the emergency room, taken into a triage unit much like those in the US, put into a private room with intravenous antibiotics, received a vegetarian diet of his choice, had blood drawn daily, a CT scan, along with many other tests and the total cost was €1,400 before we submitted the bill to our insurance company and just €250 afterward. Every doctor, nurse, and staff member spoke English, so there was no need for him to practice his Portuguese.”

In public hospitals, patients are triaged in a large room or hallway with other beds and patients nearby. When moved into a room they are placed in a ward with other beds and patients offering little to no privacy. This makes it easier for the nursing staff to care for many patients at the same time. For those over the age of 65 hospital costs are totally free in the public system.

Several large private hospitals throughout the country offer top-notch care, with physicians’ offices on-site. Centro Neurológico Sénior, situated in the city of Torres Vedras is a specialty clinic offering the latest care for Parkinson’s and Alzheimer’s patients. Residential long-term care is available at CNS with costs starting at around €2,000 a month.

Expat Rhonda Pearce says, “Back in Houston, my husband’s doctors told him to go home and have a glass of wine because there was nothing more they could do for his neurological issues. In Portugal, at CNS, his doctor said there is always more that can be done. We have been so happy with the care that Ben has received.”

“My friend’s husband has Parkinson’s, so finding the best care abroad for him was a big concern before moving. His doctors in the US encouraged them to make the move to Portugal where he could find some of the best Parkinson’s care in the world, and they feel that he has,” says Terry Coles.

Pharmacies, known locally as farmácias, can be found in even the smallest towns throughout the country. Pharmacists are well trained, usually speak English, and are eager to help or answer questions when asked. Simply describe your symptoms and a pharmacist can advise on what medication to use. Larger pharmacies often have a doctor on hand to administer injectables or give vaccines too.

“In the past 12 years of living abroad, my husband and I have seen doctors, been hospitalized, and received medical care around the world. All of the care we received has been equal to, if not better than, any US healthcare, at a fraction of the cost,” Terry says.

Full Guide to Healthcare in Portugal here.

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