Expats move in search of free healthcare but where do they get it? (2024)

Free healthcare is a major reason that people move abroad, new research has revealed.

70 per cent of those surveyed in the US by Expatsi said they hoped to benefit from free healthcare in their target countries.

The high cost of healthcare in the US is likely a major contributing factor. Half of American adults say it's a challenge to keep up with healthcare costs and one in four say they or a family member has struggled to pay healthcare bills in the last 12 months, according to KFF.

Free medical care isn't the only reason people move abroad. 15 per cent of those polled by Gallup said they want to leave the country within the next year, up from 10 per cent a decade ago. The main reason they gave: "for adventure and personal growth".

Jen Barnett, co-founder of Expatsi, a company that's helped thousands of Americans move abroad, gives her advice on what she recommended soon-to-be expats focus on. "You need to find a place with the right weather, culture, laws, and language, but at the end of the day, it's all about vibes. We recommend scouting trips to find out what most feels like home."

What visas are would-be expats applying for?

Moving abroad isn't as difficult as it used to be. A laptop and a WiFi connection are often all that expat hopefuls think they'll need.

But being able to live and work legally in your target country is also essential if you don't want to run into problems with immigration or tax authorities.

Despite this, only 21 per cent of want-to-be expats surveyed said they are planning to apply for skilled work visas. More than 50 per cent planned to get a digital nomad visa or weren't sure which visa they would need.

Check out our full guide to European countries with digital nomad visas.

Is healthcare free for expats in Europe?

Countries with universal or so-called 'free healthcare' do not necessarily offer it to everyone.

Many countries offer it first to their own citizens. In some countries, residents, including expats, are also entitled to free healthcare. Tourists are less likely to benefit from a country's free health system.

Read on for the rules in the most popular European countries for expats.

Note that this guide applies to expats who have moved to the country long-term, not visiting tourists.

Is healthcare free for foreigners in the United Kingdom?

As a foreigner, can you walk into a clinic or hospital in the UK and expect free healthcare? No. Outside of emergency treatment, 'medical tourists' need to pay for the health systems in those countries their citizens get for free.

If you have residency, you do gain access to Britain's National Health System (NHS). However, it's not completely free. Resident visas include an NHS contribution of £1,035 (€1,207) per year for full access to Britain's 'free' healthcare.

Is healthcare free in France?

Healthcare in France is not provided ‘free’ by the state, which is why French law requires all residents to have health insurance.

In most cases, this is provided by the French state’s social security system, known as the 'Assurance maladie'.

The state system, however, does not pay for 100% of all health costs. Most French residents also purchase top-up insurance from a company or a non-profit-making organisation, known as a 'complémentaire santé' or 'mutuelle'.

Bear in mind that if you are living in France but not employed there - like retirees or digital nomads - you may get an annual healthcare bill, known as the 'cotisation subsidiaire maladie'.

Is healthcare free in Spain?

Spain's Sistema Nacional de Salud (SNS) is similar to the UK's NHS. Citizens are covered for doctor appointments and treatment without the need to pay. Legal residents are also eligible for the system.

However, like in the UK, don't expect to get treatments such as dental, eye care, or mental health professionals using the free health system. Private health insurance is necessary in those cases.

Is healthcare free in Italy?

When it comes to healthcare, Italy divides foreign residents into two categories: those who must register with the national health service ('Servizio sanitario nazionale', or SSN) on a 'mandatory' basis, and those who have the option of registering on a 'voluntary' basis.

Broadly, anyone employed in Italy falls into the 'mandatory' category, as well as those waiting for residency or citizenship. Those in the 'mandatory' category have the right to register with the SSN for free, while those who fall into the 'voluntary' category must pay to register.

To find out which category you fall into it's best to consult an Italian 'commercialista' (accountant).

Most of those who are registered with the SSN free usually have to pay for prescriptions and sometimes have to pay top-up fees at hospital appointments or procedures.

Is healthcare free in Germany?

Germany's healthcare system is regarded as one of the best in the world but it's not free.

Whether resident or citizen, health insurance is compulsory. Public health insurance, or 'Gesetzliche Krankenversicherung' (GKV), is the most common form of health insurance. If you opt for public insurance, you’ll pay a monthly premium to your health insurance provider, which is calculated according to your income. Your employer will also pay mandatory contributions to your insurance.

Private health insurance, or 'Private Krankenversicherung; (PKV), is the other form of health insurance in Germany.

If you’re self-employed, a small business owner, a freelancer, or work in the public service, you’ll most likely have to sign up for PKV, although there are still notable exceptions to this. Premiums for PKV are calculated based on a risk assessment done by the insurer, and generally vary based on your age and health.

Do you know the only country in the world where healthcare is free for everyone?

Brazil is the only country in the world with a genuinely universal and free health system available to everyone, including tourists. Healthcare is considered a human right in the Brazilian constitution and, as such, is available to all free of charge.