When considering a move to Europe, one of the crucial aspects Americans need to plan for is healthcare. Unlike the United States, where health insurance is often tied to employment and can be quite costly, European countries have a variety of healthcare systems that are generally more accessible and affordable. However, this doesn’t mean that Americans can ignore the need for health insurance when moving to Europe. Here’s what you need to know about health insurance as an American expatriate in Europe.

Understanding European Healthcare Systems

European countries predominantly operate on a universal healthcare system. This means that residents have access to publicly funded healthcare services, which are often supplemented by private healthcare options. The quality of healthcare in Europe is typically high, with many countries boasting advanced medical facilities and highly trained professionals.

However, the extent to which an American expat can access these services depends on several factors, including residency status, the specific country’s regulations, and whether the expat is part of the local social security system.

Do You Need Health Insurance?

  1. Short-term Visits
    • If you’re visiting Europe for a short period, travel insurance that includes health coverage is highly recommended. Travel insurance can cover emergency medical expenses, hospital stays, and even medical evacuation if necessary. Many European countries require proof of travel insurance when applying for a visa.
  2. Long-term Stays
    • For those planning to stay longer, the need for health insurance becomes more nuanced. If you’re moving to Europe for work, your employer might provide health insurance or facilitate your enrollment in the national healthcare system.
    • Retirees or self-employed individuals need to secure their own health insurance. Some countries allow expats to join their public healthcare system, often requiring proof of income and residency.
  3. Enrollment in Public Healthcare
    • Countries like France, Germany, and Spain have provisions for expats to join their public healthcare systems. This usually involves paying into the system either through taxes or direct contributions. Residency permits often require proof of health insurance, and in many cases, expats are advised to get private health insurance until they are fully integrated into the public system.
  4. Private Health Insurance
    • In some countries, or while you wait to qualify for public healthcare, private health insurance is a viable option. Private insurance can offer faster access to specialists, shorter waiting times for procedures, and access to private facilities. Companies like Cigna Global, Allianz Care, and Aetna International provide tailored plans for expats.

Country-specific Considerations

  • France: Offers the PUMA (Protection Universelle Maladie), allowing expats to access public healthcare after three months of residency. However, private insurance is recommended during the initial period.
  • Germany: Requires proof of health insurance as part of the residency permit process. Expats can choose between public (gesetzliche Krankenversicherung) and private (private Krankenversicherung) health insurance.
  • Spain: Has a public healthcare system that expats can access if they contribute to the social security system. Private health insurance is recommended, especially for those who do not initially qualify for public healthcare.

Tips for Choosing Health Insurance in Europe

  1. Research Requirements: Each country has specific requirements and procedures for enrolling in their healthcare system. Research these thoroughly.
  2. Compare Plans: Look at both public and private options. Consider factors like coverage limits, network of hospitals, and cost.
  3. Check for Pre-existing Conditions: Ensure that the plan covers any pre-existing conditions, as this can be a significant issue.
  4. Emergency Coverage: Make sure your insurance includes emergency medical coverage and medical evacuation, especially if you travel frequently within Europe.


While Europe’s healthcare systems are robust and generally more accessible than in the U.S., Americans moving to Europe still need health insurance. Whether through public systems or private providers, securing adequate health coverage is essential for peace of mind and financial protection. Plan ahead, understand the specific requirements of your destination country, and choose a health insurance plan that meets your needs to ensure a smooth and healthy transition to your new life in Europe.

Ready to travel abroad or make your move? Explore your health insurance options with Agora Expat and get personalized advice tailored to your needs. Visit Agora Expat today to find the best plan for you and take the first step toward a secure and healthy future in Europe!