More than half of insured expatriates have delayed or gone without necessary healthcare because of reimbursement concerns, treatment costs and confusion about overseas health systems, research has found.
Some 93% of expatriates surveyed had health cover, but 53% had postponed or forgone care they needed, according to the 2026 Expat Health Barometer.
The research, conducted by APRIL International in partnership with Expat Communication and Caisse des Français de l’Étranger, drew responses from more than 6,400 expatriates living in over 80 countries.
Among those who had delayed or avoided treatment, 51% blamed insufficient reimbursement and 48% cited the cost of care.
HEALTHCARE COSTS REMAIN UNCLEAR
The findings indicate that holding an insurance policy does not necessarily give expatriates confidence that they can afford or navigate healthcare in their country of residence.
Individuals funded their own health cover in 71% of cases, while 56% paid more than €200 a month. Despite that expenditure, 59% said they did not understand healthcare costs in their country of residence and 19% had received an unexpected medical bill.
APRIL International said customers needed clearer information about premiums, out-of-pocket expenses and reimbursement levels. It added that direct billing and virtual payment services could reduce the need for patients to pay substantial sums upfront.
FAST ACCESS FAILS TO REASSURE
Although 83% of respondents could see a GP within three days and 79% could consult a specialist within two weeks, 39% believed that access to healthcare was worse than in their home country.
More than one in five respondents, or 21%, said they had felt medically at risk while living abroad.
Understanding of insurance cover was also limited. Average scores for respondents’ knowledge of different parts of their contracts did not exceed six out of ten, while repatriation received the lowest average score at 4.7.
Respondents called for clearer reimbursement information, broader access to direct billing and a named contact who could offer guidance.
Isabelle Moins, chief executive of APRIL International Care Europe and Africa, said: “These findings reveal an important distinction between being insured and feeling genuinely protected. A policy can offer extensive benefits, but its value is limited if customers do not understand how to use it, are worried about paying for treatment upfront or cannot confidently navigate the local healthcare system.
“International health insurance providers must look beyond the benefits listed in a policy and consider the entire healthcare journey. Clear information, practical provider guidance, direct payment solutions and accessible human support can all make the difference between having insurance and being able to seek care when it is needed.”
MENTAL-HEALTH COVER REMAINS LIMITED
Only 11% of respondents had access to psychological support, while 40% lacked access despite potentially needing it. Some 12% said their psychological wellbeing had deteriorated since moving abroad.
The research said relocation could bring isolation, cultural adjustment, language barriers and separation from established support networks.
Moins added: “International mobility has changed significantly, but healthcare protection has not always evolved at the same pace.
“Today’s expat population includes employees and their families, but also entrepreneurs, remote workers, digital nomads, retirees and people relocating independently.
“Their circumstances differ, but they share a need for healthcare that is understandable, accessible and designed to work across borders. The industry’s next challenge is not simply to insure more people – it is to ensure that those who are insured can confidently use their cover.”
