International vs Local Health Plans: Which Is Right for You?
Local health cover is cheaper but stops at the border and is not open to every foreigner. International cover follows you between countries. What local options exist in Spain, Portugal, Mexico, Thailand, Vietnam, Malaysia and the UAE, and when each is the better choice, checked October 2026.
The Short Answer
Choose international health insurance if you move between countries, want private hospitals and evacuation cover, or live somewhere foreigners cannot join the public system. Choose a local plan if you are settled in one country that lets foreigners in and the cover meets your needs, or if your visa requires it. In our 24 September 2026 quotes, an international mid-level plan for a 32-year-old cost a median of £247 a month. Local options can cost far less: Spain's public Convenio Especial is EUR 60 a month under 65. Many expats combine the two.
The Real Difference
International health insurance covers you in many countries, usually worldwide or worldwide excluding the USA. It pays private hospitals, often directly, includes or offers medical evacuation, and keeps going when you move.
Local cover means a country's public scheme or a domestic private policy. It is cheaper and is sometimes required for a visa, but it only works in that country, and not every country lets foreigners join.
International plan
- Moves with you between countries
- Private hospitals worldwide
- Medical evacuation
- Higher premiums
- May not meet local insurance rules
Local plan
- Often much cheaper
- Meets local requirements
- May cover pre-existing conditions
- Stops at the border
- Quality varies by country
What Local Options Exist for Foreigners
Spain: residents not covered through social security can join the public system through a regional Convenio Especial after a year living in Spain or the EU. It costs EUR 60 a month under 65 and EUR 157 from 65, and prescriptions are paid in full. Spain's telework and non-lucrative visas need cover from an insurer authorised to operate in Spain; travel insurance is not accepted. Spain guide
Portugal: with a residence authorisation and a user number, foreigners use the SNS on the same terms as Portuguese nationals. Portugal guide
Mexico: people living in Mexico with no other social security can buy IMSS family health insurance, paid yearly in advance: MXN 12,350 a year at ages 30 to 39 in 2026. You cannot enrol with certain pre-existing conditions, including cancer and heart failure. Mexico guide
Thailand: foreigners cannot join the universal coverage scheme. Foreign employees with a work permit join the Social Security Fund and are treated at one registered hospital. Thailand guide
Vietnam: foreign employees on a labour contract of 12 months or more must join compulsory health insurance. Other foreign residents pay as private patients. Vietnam guide
Malaysia: foreigners cannot join a state health insurance scheme. SOCSO covers work injuries for foreign workers, not general medical care. Malaysia guide
UAE: employers in Dubai and Abu Dhabi must insure their staff, and since 2025 private-sector workers in the other emirates need insurance before a residence permit is issued. The basic plans are designed as a minimum. UAE guide
When International Cover Is the Better Choice
You move between countries. Local cover ends when you leave; international cover goes with you.
You cannot join the public system. In Thailand, Malaysia and Vietnam, foreigners without a qualifying job pay private prices for everything.
You want private hospitals and direct billing. Leading private hospitals in Bangkok, Kuala Lumpur and Ho Chi Minh City ask for a deposit or an insurer's guarantee before admission.
You may need evacuation or treatment at home. Local plans do not move you to another country for care.
When Local Cover Is the Better Choice
You are settled and the public system is open to you, as in Portugal with residence, or Spain through the Convenio Especial.
Your visa requires it. Spain's visas need a Spanish-authorised insurer, so an international plan alone may not be accepted. Check our digital nomad visa insurance guide.
Cost is the deciding factor and you accept public waiting times and that the cover stops at the border.
Using Both
A common set-up is local cover for routine care and an international plan with a high deductible for hospital stays, serious illness and evacuation. The deductible keeps the international premium down; see our deductibles guide. You can compare international plans from 14 insurers, and see local costs in our cost guides.
Checked 3 October 2026 against the government and hospital sources linked in each cost guide. This is general information, not personal advice.
Common questions
Is international or local health insurance better for expats?
International cover is better if you move between countries, cannot join the local public system, or want private hospitals and evacuation. Local cover is better if you are settled in a country that accepts foreigners and it meets your needs, or if your visa requires it.
Can foreigners join the public health system?
It depends on the country. Portugal and Spain let foreign residents join on set terms. Thailand and Malaysia do not let foreigners join their universal schemes, though employees may be covered through social security.
How much cheaper is local cover?
Often much cheaper. Spain's Convenio Especial is EUR 60 a month under 65, while the median international mid-level plan in our index was £247 a month for a 32-year-old. Local cover stops at the border and may have waiting times.
Does an international plan meet visa requirements?
Often, but not always. Spain requires an insurer authorised to operate in Spain for its telework and non-lucrative visas. Check the rule for your visa before you buy.
Can I have both local and international cover?
Yes. Many expats use local cover for routine care and an international plan with a high deductible for hospital stays, serious illness and evacuation.