What About Insurance When Moving Abroad? A Thorough Guide to Medical Insurance Usable in Overseas Hospitals
For those considering moving abroad after achieving FIRE, I highly recommend thinking carefully about enrolling in medical insurance beforehand.
In Japan, by paying monthly health insurance (National Health Insurance) premiums, you can receive medical services at any hospital with only a 30% co-pay, but expecting the same overseas is difficult.
It is not uncommon to go to a hospital casually and see tens of thousands of yen fly away on consultation fees and medicine.
So, what should you do?
The answer is simple: "Enroll in medical insurance that can be used at overseas hospitals."
In this article, I will explain the medical insurance options available for use abroad so that you can live with peace of mind after moving overseas.
Why Do You Need Medical Insurance When Moving Abroad?
You have probably often heard that medical costs in the United States are high, but Southeast Asia—a popular destination for post-FIRE relocation—is no exception.
In Southeast Asia particularly, there are massive differences in medical standards depending on the hospital, and the cost of medical care is proportional to the hospital's level.
Since most people are likely not fluent in the local language, they need to use hospitals that offer English or Japanese support, or those with a good reputation among foreign residents.
Naturally, these hospitals are more expensive than the ones frequented by locals (though, of course, the medical standard is also higher). Because of this, expats and those working locally enroll in medical insurance so they don't have to pay exorbitant medical fees out of pocket every single time.
Since insurance and medical systems vary by country, fully understanding your destination country's system is of utmost importance. With that understanding in mind, let's classify the insurance options you might consider into three broad categories and explain them in the next section.
Medical Insurance Usable at Overseas Hospitals
Medical insurance that can be used at overseas hospitals can be broadly classified into the following three categories:
- 1. Japanese Overseas Travel Insurance
- 2. Local Health Insurance
- 3. Japan's National Health Insurance (NHI)
Let me explain the mechanisms and characteristics of each.
1. Japanese Overseas Travel Insurance
This is the Japanese overseas travel insurance you typically enroll in for short trips, but it also offers plans for long-term stayers, such as expats.
The maximum enrollment period is one year, but it can be renewed annually.
While plans vary by insurance company, the baseline premise is that it is "for overseas travelers."
Therefore, its appeal lies in the fact that coverage applies not only to medical expenses but also to emergency temporary returns to Japan, property damage, and theft.
You can carefully consider it before moving, and of course, being able to complete all procedures in Japanese provides a great sense of security.
By presenting a credit card or insurance card, you can receive cashless medical examinations, eliminating the need to temporarily pay out-of-pocket for treatment costs.
While its convenience and extensive coverage are attractive, it has the highest annual premiums among the three categories. A common price range is 300,000 to 400,000 yen per year.
2. Local Health Insurance
Although the hurdle is slightly higher in terms of confirming the details and communicating with staff, local medical insurance often offers more comprehensive plans than travel insurance.
Depending on the insurance company, the screening process may be more lenient, and the annual premiums can feel more affordable.
Speaking specifically about Thailand, where I live, there are several companies that allow inquiries and document requests in Japanese, making the hurdle to enroll relatively low.
However, depending on the country you move to, there may be no insurance companies with Japanese support. That said, English support is basically available everywhere, so as long as you communicate carefully, it shouldn't be too difficult.
When comparing service levels to Japan, they often fall short. I occasionally—though not often—hear about post-enrollment troubles (e.g., upfront treatment costs not being reimbursed by the insurance company, or finding out you were enrolled in a more expensive plan than initially thought).
When choosing a company, I recommend being more cautious than with the aforementioned Japanese travel insurance, referencing the reputations and experiences of fellow expats around you. The general price range is 200,000 to 300,000 yen per year.
3. Japan's National Health Insurance (NHI)
The last option is to continue paying for Japan's health insurance (National Health Insurance) even after moving abroad. With this method, you have to pay the consultation fees yourself at local hospitals overseas, but if you file the paperwork upon temporarily returning to Japan, 70% of the incurred costs will be refunded.
For those who still generate some form of income in Japan after FIRE, it is a good idea to maintain this insurance using that income.
Although premiums vary depending on the municipality, age, and income, the monthly expense can be as low as a few thousand yen, making it cheaper than enrolling in other insurances.
Also, since you can naturally continue to use the insurance system at Japanese hospitals, you can easily visit your regular doctor when returning to Japan temporarily.
One thing to be careful about is that the treatments covered by insurance differ between Japan and overseas.
There is a possibility that you might receive treatment at an overseas hospital that is not covered by Japanese insurance, meaning you won't get your money back even if you file the paperwork in Japan. You should be especially careful regarding dental treatments.
Summary
In this article, I explained the medical insurance you should definitely consider when moving abroad after FIRE.
Whether you enroll in Japanese overseas travel insurance or local medical insurance, you typically have to pay for a full year upfront at the time of enrollment, making it a relatively large temporary expense.
Therefore, I recommend adding this to your estimated relocation costs.
If you want to keep insurance costs as low as possible, I personally think continuing your enrollment in Japan's National Health Insurance after moving is a safe choice.
However, since National Health Insurance premiums are calculated based on your previous year's income, if you earned a high income right before achieving FIRE, the cost might end up being higher than the other two options.
Because the amount varies by municipality, you should confirm the exact amount you would have to pay to continue your National Health Insurance, and then judge which option is closest to what you are looking for in terms of cost and coverage.
n an unfamiliar overseas life, unexpected illnesses and injuries can occur. Keeping in mind that things won't proceed as smoothly as in Japan, considering insurance enrollment is an absolute must so you can start your overseas life with peace of mind.
(I have also summarized details about medical costs in Thailand, where I live, in the following article, so if you are interested, please check it out as well.)
Author: Yuki Ishida
Writer based in Thailand
In 2017, I fulfilled my long-cherished desire to move to Thailand and have been working as a sales and career consultant at a Japanese staffing company there.
I began my activities as a writer in 2019 and mainly share information useful for living in Thailand and moving abroad through both domestic and international media. Based on my own experience of relocating overseas, I strive to provide realistic information to help those planning to move abroad avoid regrets, and I write with this motto every day.
The media I have contributed to so far are not limited to Thailand-related topics, but also cover a wide range including domestic and international travel, local governments, food manufacturers, and educational institutions.
