International health insurance cost: what decides it (and what does not)

1. Your age

Premiums are set by age band and rise as you get older, because the chance of a claim rises. Most insurers price children cheaply, adults in their twenties and thirties at the bottom of the adult scale, and step up through the fifties and sixties. Some insurers stop taking new members at a certain age: Allianz Care accepts new applicants up to the day before their 76th birthday with full medical underwriting, while Cigna Global has no upper age limit to join. Our country guides show how the median quote moves by age for the same plan, so you can see the slope rather than guess it.

2. The country you call home

International plans are priced on your country of residence, because that is where most of your treatment will happen and medical prices differ enormously between countries. The same insurer, plan and age can be quoted very differently in Thailand, Portugal and Hong Kong. Nomads with no fixed base have to name a country anyway; which one you name changes the price. See moving between countries with no fixed home.

3. Area of cover, above all the USA

Every international insurer sells at least two areas: worldwide, and worldwide excluding the USA. The USA is excluded from the cheaper area because its treatment costs are the highest in the world, and including it raises the premium more than any other single choice. Allianz Care also sells Europe-only and Africa-only areas, and Bupa Global a Europe-including-UK area on some plans, each priced for that region. If you will not spend time in the USA, do not pay for it.

4. Plan level and limits

Insurers sell tiers: Cigna's Silver, Gold and Platinum; Allianz Care's Base, Enhanced and Signature; Bupa Global's Major Medical up to Ultimate. Each step up raises the overall limit and adds benefits such as maternity, higher rehabilitation and nursing limits, or no limit at all. The top tier is not automatically the right one; the entry tier of a strong insurer still pays for hospital treatment, surgery and cancer care.

5. The modules you add

Core cover is hospital cover. Outpatient cover (GP and specialist visits, tests, prescriptions) is a separate module or plan with its own limit, and it is usually the biggest optional cost because it is used most. Dental, vision and wellbeing modules add more. Medical evacuation is included on every Allianz Care and Bupa Global plan but is an optional, separately priced module with Cigna Global. Maternity comes with the mid or top tiers rather than as a module, and always with a waiting period.

6. Deductible and cost share

A deductible is the amount you pay each year before the insurer pays; a cost share is a percentage of each bill you pay, usually with an out-of-pocket maximum. Both lower the premium. Allianz Care publishes the discount: 10%, 20% or 30% off the core premium for its three deductible levels, and the same scale on the out-patient plan. Cigna Global offers a range of deductibles and cost shares of 10% to 30% with a capped out-of-pocket maximum. If you have savings to cover a small bill, a deductible is the cleanest way to cut the price without cutting cover. See deductibles explained.

7. Your medical history

With full medical underwriting you declare your history and the insurer may exclude a condition, add a loading to the premium, or both. With moratorium underwriting (Allianz Care) there is no questionnaire; past conditions are excluded until 24 clear months have passed. Continued terms from a previous insurer carry your old terms across. The premium itself is not usually higher for moratorium, but what it pays for is narrower at first. See pre-existing conditions.

Smaller levers

How you pay. Annual payment is the cheapest; Allianz Care and Cigna Global both charge more for monthly or quarterly instalments. Currency. Limits and premiums are offered in US dollars, euros, pounds and, with Allianz, Swiss francs; the plan is the same, the exchange rate is not. Family. Adding a partner and children multiplies the premium, though some insurers include children on top tiers at no extra cost. Discounts. Insurers run time-limited promotions on their own sites; these change monthly and are not a reason to choose an insurer.

What does not decide it

Your nationality (residence does), your job in most cases, and whether you buy direct or through an intermediary: HealthiNomad is paid commission by the insurer, and the price you pay is the insurer's price either way.

And medical inflation, every year

Premiums rise at renewal with medical inflation, which has run far ahead of general inflation for years, and with your age band. The renewal letter, not the first-year price, is the cost of the policy. Our medical inflation data bank tracks the insurers' and brokers' own forecasts.

Where to see the actual numbers

Our Health Insurance Cost Index shows the median quote by country for one fixed profile, from real insurer rate engines, with the date the quotes were taken. Each country cost guide adds the price by age and what hospitals there charge. Both are indicative; only an insurer confirms your premium. Get a quote to see your own.