Something has shifted in how Americans think about where to live. For a long time, moving abroad was mostly a lifestyle choice – chasing sunshine, lower rent, or adventure. Today, a growing number of people are packing up for a much more practical reason: they simply can’t afford to get sick at home anymore. In 2025, a family health insurance plan in the United States averaged nearly $27,000 per year, a six percent increase from 2024. Rising costs and access to healthcare are top of mind for many Americans, with nearly half of adults worried they can’t afford medication or health-related expenses.
That anxiety is pushing people to look elsewhere. In a recent American Expats Survey by The Harris Poll, roughly four in ten respondents cited cheaper, better healthcare as a reason for considering leaving the United States. The countries on this list aren’t exotic gambles. They’re well-established destinations with functioning, often world-class systems that welcome legal residents – including Americans willing to make the move.
1. Portugal: Universal Coverage With a Quality-to-Cost Ratio That’s Hard to Beat
Portugal consistently ranks among the best healthcare systems for expats due to its combination of universal healthcare coverage, affordability, and high-quality medical services. The public healthcare system, known as the SNS, provides comprehensive medical care including hospital treatment, GP visits, and prescriptions to legal residents who contribute to social security. Healthcare costs are low compared to many Western nations, with co-payments for consultations averaging between roughly five and ten euros. Many expats also opt for private health insurance to reduce wait times and access English-speaking specialists, with premiums starting at around 40 euros per month.
One of the reasons Portugal is one of the hottest expat and retiree destinations worldwide is the excellent quality-to-cost ratio, and that includes its universal healthcare system. The public system provides universal healthcare that is free or very low-cost for most services. The country performs better than the OECD average on seven out of ten vital indicators measuring health status, according to the OECD healthcare report. For Americans who have spent years paying thousands every month just to stay covered, those numbers are genuinely striking.
2. Spain: Strong Preventive Care and One of Europe’s Highest Life Expectancies
Spain’s public healthcare system, the Sistema Nacional de Salud, provides universal healthcare coverage to all legal residents, including expats who register and contribute to social security. Alternatively, the Convenio Especial program offers full coverage for a low monthly fee starting at around 60 euros. Spain offers one of the best healthcare systems in Europe, particularly appealing to retirees and digital nomads, and the system places a strong emphasis on preventive care with a well-established primary care network.
Ranked among the best in OECD reports, Spain also enjoys one of the world’s highest life expectancies at 83 years. Spain’s Sistema Nacional de Salud is a Beveridge-style system similar in structure to the UK’s NHS, and legal residents can register for free healthcare, which includes free doctor visits and most tests, services, and procedures at no charge. English-speaking doctors are more common in the private system and in areas with large expat populations, including Madrid, Barcelona, Málaga, and along the Costa del Sol.
3. France: The Gold Standard for Universal Healthcare Access
France’s universal healthcare system, known as PUMA, is among the best in the world due to its accessibility, quality care, and efficiency. Healthcare services such as hospital care, doctor’s visits, and prescription medications are available for both French citizens and legal residents. Beyond that, French healthcare services are also available to visitors residing in France for over three months. France consistently ranks among the countries with the best healthcare for expats, and expats can access the public system after registering with French social security. Many also opt for supplementary private insurance to help cover costs like dental, vision, and specialist care.
Individuals residing in France for more than three months are required to enroll in the country’s healthcare system, which features limited copays for most services. The contrast with the American system is especially sharp here. France’s strengths for expats include affordable prescriptions, excellent public hospitals, and comprehensive care for chronic illnesses. For people managing ongoing conditions, that last point can make the difference between financial stability and debt.
4. South Korea: Modern Hospitals, Short Wait Times, and Mandatory Coverage for Residents
South Korea’s healthcare system is renowned for its efficiency, modernity, and affordability, making it an excellent option for expats, especially digital nomads and professionals. The country operates under a universal healthcare model known as the National Health Insurance, and expatriates can typically join the system after becoming residents. With few exceptions, all residents must pay into the National Health Insurance System, and after six months in South Korea, residents are automatically enrolled. They also pay small fees when they receive medical care, but costs are generally low.
As one of the OECD countries, South Korea ranks second in its healthcare system, and it operates through a National Health Insurance Service. Public healthcare is not free but offers reasonable costs and typically covers between half and four fifths of medical costs. The system’s particular strengths include short wait times, tech-forward hospitals, and low out-of-pocket costs. For Americans used to scheduling an appointment weeks out and then receiving a bill they didn’t expect, South Korea’s approach can feel like a completely different world.
5. Taiwan: The Top-Ranked System That Costs a Fraction of What Americans Pay
According to CEOWORLD Magazine’s Health Care Index in 2024, Taiwan has the best healthcare system in the world. It offers universal health coverage through its National Health Insurance system, and almost everyone, including expats with residency cards, can access it. Taiwan boasts one of the most efficient and accessible healthcare systems in the world, and its National Health Insurance, launched in 1995, covers nearly 99 percent of the population and enjoys very high satisfaction rates, including among expatriates.
The average insured person in Taiwan pays around 42 US dollars per month in NHI premiums. That figure alone tends to stop Americans in their tracks. For context, knee surgery that costs around 50,000 US dollars in the United States is available for less than 5,000 dollars under Taiwan’s NHI. Unlike some other Asian countries, the system is fast, efficient, and affordable. You can see a doctor quickly. Hospitals and clinics are modern, and most doctors are well-trained, with many speaking English, especially in big cities.
6. Costa Rica: Universal Coverage in Latin America, With Private Options That Still Beat U.S. Prices
The healthcare system in Costa Rica is frequently cited as one of the best in the world. The country is ranked 36th in the world by the World Health Organization, above the United States, Cuba, and New Zealand. The United Nations also ranks Costa Rica’s healthcare among the top 20 in the world. Universal healthcare and social security have been a part of Costa Rican society since the 1940s, and universal care is provided through the CAJA system, the Caja Costarricense de Seguro Social.
Permanent residents in Costa Rica pay as little as 45 dollars per month per family for public healthcare coverage, making it one of the most affordable healthcare options in the world. Healthcare costs in Costa Rica are very reasonable, especially compared to other countries, with medical visits, tests, and even complex surgeries costing roughly one quarter to one third of what they would in the United States. For expats, healthcare in Costa Rica is generally considered high quality and accessible, with many physicians trained internationally and private hospitals offering modern facilities.
7. Germany: No Exclusions for Pre-Existing Conditions and Comprehensive Coverage From Day One
Germany requires all citizens and residents to have health insurance, either through the public statutory health insurance or a private health insurance plan depending on their income. Contributions are made through wages, and residents can select statutory health insurance providers of their choice. Germany offers one of the most accessible comprehensive healthcare systems for expats with pre-existing conditions. Social security contributions are split equally between employer and employee, and paying roughly seven and a half percent of salary gives immediate access to world-class healthcare with minimal co-pays and no exclusions for pre-existing conditions.
Countries like Germany dedicate over 10 percent of their GDP to healthcare, and those investments pay off – the continent dominates global healthcare rankings. That no-exclusions rule is worth dwelling on. In the United States, a pre-existing condition can still mean higher premiums, coverage gaps, or outright obstacles to certain treatments. In 2024, total health expenditure in Germany reached over 538 billion euros, representing 12.4 percent of GDP, and this expenditure remains comparable to other high-income Western European nations but is still lower than the percentage of GDP spent in the United States. Germany spends significantly, but it spends it on actual coverage for everyone who lives there.
The decision to leave the United States for better healthcare is rarely easy, and it involves real tradeoffs – language, distance from family, navigating new legal systems. Despite those challenges, healthcare in nearly all major relocation destinations remains far more affordable than in the U.S. What’s changed in recent years is that more Americans are running the numbers and concluding the tradeoff is worth it. The countries on this list aren’t offering a compromise. For many who’ve made the move, they’re offering something better.
