Expat health insurance in Europe: what you need to know

How does healthcare work for expats in Europe?

Europe has some of the best public healthcare systems in the world, so you may wonder whether you need expat health insurance in Europe at all. The answer depends on where you live, whether you work there, your nationality and your visa. Each country runs its own system, with its own rules on who can join and when.

In most countries, public care is funded by taxes or by compulsory contributions, and residents who are part of the system pay little or nothing at the point of care. Newcomers, however, may face a waiting period before they can register, may only be partly covered, or may not qualify at all if they don't work locally. Waiting lists for non-urgent treatment can also be long.

Private health insurance fills those gaps. It can cover you before you join the public system, give faster access to specialists and private hospitals, and protect you across borders. Our guide to international, local and travel insurance explains the differences.

Public and private healthcare: a few country examples

United Kingdom

The NHS provides care free at the point of use for people who are ordinarily resident. Most visa applicants coming for more than six months pay the Immigration Health Surcharge with their application, which gives access to the NHS. Because of waiting lists, many people also use private hospitals, such as The London Clinic, The Wellington Hospital or Cromwell Hospital in London.

France

France has a universal system. Workers usually join it quickly, and other residents can generally join after three months of stable residence. It reimburses a large part of costs, and most residents add a complementary policy, known as a mutuelle. In Paris, the American Hospital of Paris is a long-established private hospital known to international patients.

Germany

Health insurance is compulsory for everyone living in Germany. Many employees join the statutory system, while higher earners and many self-employed people can choose German private insurance. An international expat plan is not always accepted as proof of cover for a residence permit, so check before relying on one.

Netherlands and Switzerland

In the Netherlands, people who live or work in the country are generally required to take out Dutch basic health insurance, even if they already have an international plan. In Switzerland, basic health insurance is compulsory for residents, who usually have three months from arrival to join; exemptions are possible in some cases but must be requested from the canton.

Spain and Portugal

Both have good public systems, and private care is generally more affordable than in Northern Europe, with private hospital groups in all the main cities. Some residence routes, such as Spain's non-lucrative visa, ask for private health insurance that meets conditions set by the consulate, which can be strict, for example on co-payments.

Hospital names above are examples, not recommendations. Always check a plan's network and whether direct billing is available.

Do you need health insurance for a European visa?

Often, yes. For short stays, the Schengen visa requires travel medical insurance with a minimum cover of EUR 30,000, valid across the Schengen area. For long stays, many national visas and residence permits ask for proof of health insurance, especially for people who will not work locally, such as retirees, students and those with independent means.

Each country, and sometimes each consulate, sets its own conditions on what counts: the level of cover, co-payments, the length of the policy, or where the insurer is authorised. Check the latest official requirements before you apply, and ask for a certificate of insurance in the format the authority expects.

Retiring to Europe? EU pensioners moving within the EU may be able to use an S1 form from their home country. Others usually need private cover; read our guide to health insurance after 60.

Is the EHIC enough for expats in Europe?

No. The European Health Insurance Card (EHIC), and the UK's Global Health Insurance Card (GHIC), give access to medically necessary state healthcare during a temporary stay in another country covered by the scheme, on the same terms as locals. They are only for people insured in a European state system, they don't cover private care, and they don't pay for repatriation.

Once you move to another country, you need to register in its system, if you are eligible, or hold private cover.

The cost of private care and the need for evacuation

Private care costs vary widely across Europe. Switzerland and the UK are among the most expensive places for private treatment, while prices in Southern and Eastern Europe are generally lower. Inside the public system, you may still pay part of the bill, depending on the country.

Evacuation is needed less often in Western Europe, because good hospitals are rarely far away. It still matters if you live on an island, in the mountains or in a rural area, and in some countries mountain rescue is charged to the patient. Repatriation to your home country after a serious illness or accident is another reason to have an international plan.

What to look for in an expat health plan for Europe

• Local rules first: where a local insurance is compulsory, an international plan may complement it rather than replace it.
• Area of cover: Europe-only plans can be cheaper; worldwide cover excluding the USA suits people who travel to other continents or have family elsewhere.
• Portability: an international plan can move with you from one country to another, which suits people who relocate often.
• Outpatient, maternity and mental health cover, depending on your needs; maternity often has a waiting period.
• Deductible and currency: choose a deductible you can afford, and a currency that matches your income.
• Visa documents: make sure the insurer can provide a certificate that meets your consulate's requirements.

Our international health insurance page explains these options in more detail.

Practical tips for expats moving to Europe

• Register with the local system as soon as you are eligible, and keep private cover until you are fully registered.
• Find a local GP early; in some countries, you need a GP referral to see a specialist.
• Bring a summary of your medical history and prescriptions, translated if possible.
• Ask for pre-authorisation before planned treatment in a private hospital.

Not sure how private cover fits with the public system where you are going? Answer a few questions and get your instant quote: you will receive a personalised comparison of plans from 20+ international insurers by e-mail in about 2 minutes, and our advisors can talk it through with you on WhatsApp or by video call.

Useful resource: WHO Regional Office for Europe