Health Insurance for Americans Abroad

Questions and answers about international health insurance

For more than 15 years, American Citizens Abroad (ACA) has helped Americans living abroad to find health and other insurance plans to fit their needs. Experience has shown that no single plan is appropriate for the wide geographic, age and financial range of ACA’s membership.

jabrams.jpgFor the past decade, ACA has collaborated with Jacqueline M. Abrams, an insurance broker operating as Abrams Insurance Agency (AIA) in Arlington, Virginia. “Jackie” has served as ACA’s Washington-area office since 1990. A dual national, she is also very involved with an association of French living in the US. And, she would insist we add, don’t forget her long-standing involvement with the Arlington County Fair!










General questions

ACA: Jackie, what is an insurance broker as opposed to an insurance agent?
An insurance broker is an insurance agent who represents and can sell the products of many different companies, as opposed to a captive agent who MUST sell the products of his/her company exclusively. The agent who is a broker has the opportunity to choose for the client the product that suits his/her needs with the company that offers the best product for the best price.

My role as the insurance broker is to give the client the best coverage and the best service he/she deserves. I work for the client and not for the insurance company. I am the one that the client comes to with requests or problems. I give him/her advice and any help needed.

How does one choose health insurance when based abroad?
Several companies sell health insurance to expatriates. All of them have their own plan design and set their own premiums. However, they are ALL underwritten by Lloyd's of London. The broker compares all the plans and matches them to the client's needs.

If you are long-term resident in a specific country, also investigate whether you can join that country’s national health plan. Investigate whether that will provide coverage when you are outside the country.

When I return to the US, I’ll have no trouble getting health insurance then, will I?
American insurance companies will not cover someone who has not lived in the United States for at least six months prior to applying for coverage. Make sure any health insurance plan you enroll in will cover you for those first six months after your return to the US.

What if I don’t have insurance to cover my first six months in the States?
I can provide you with a temporary health insurance plan with a non-US company to cover for fifteen days, one month, two months....up to one year.


Basic comprehensive plans proposed by Abrams Insurance Agency

Do you offer expatriate health insurance from one firm, or several?
I have access to several plans but I always sell the one that is cheaper for the given client for the best coverage.

What countries will the offered expatriate health insurance cover?
It will cover American citizens anywhere in the world including six months in the United States. The comprehensive plan will also offer protection to citizens of other countries. They may reside anywhere, including their country of citizenship.

What does the plan cover?
Claims for health care outside the US, are reimbursed at 100% after the deductible; claims for health care within the US are reimbursed at 80% after the deductible (insured co-pays 20%).

What about pre-existing conditions?
Pre-existing conditions will either be excluded or have limited coverage at the discretion of the insurance company. Policies vary somewhat among companies. Full disclosure is important.

Does such a policy cover children?
Yes, in fact there is no additional premium for the first two children under 9. To be insured alone, the child will be charged as an 18 year old.

Can one purchase this insurance at any age?
No, you can only purchase it until age 75. However, if you already have the insurance, the coverage will continue for as long as you pay the premium. The insurance renews without medical questions.

And when I move/return to the States?
When someone moves back to the United States and has an American passport, the expatriate insurance will cover that person for as long as six months. This is very helpful because the American insurance companies will not cover someone who has not lived in the United States for at least six months prior to applying for coverage. Someone with a passport other than a US passport will be covered immediately because this plan is not a US product.

Will the premium remain the same?
No, the premium will automatically increase slightly every year, at the anniversary date. The policy is age banded. It may also increase, at the anniversary date, if you go into another age bracket.

What about the rates?
They can be found on the web at or you can email Jacqueline Abrams at

How do you apply for the insurance?
You can go on line and apply directly at Or you can email Jacqueline Abrams at

How are the claims filed?
Filing a claim is easy. You will find a form in your kit, once you have been approved. Just complete it and attach the original itemized bills or paid receipts and forward them to the Company. The Company will make payment directly to the hospital. All plans include pre-notification before a planned hospitalization or surgical procedure.

Other health insurance coverage

What do you do if you are over age 75 and want to buy health insurance?
You can purchase a different policy at any age which will cover you only for three years.

What if you do not need coverage in the US, only abroad?
The Company offers a second choice. The premium is much less. It will cover you 100% anywhere in the world, after the deductible, except in the United States where there will be NO coverage at all.

BE AWARE, however: If one has purchased the policy that excludes coverage in the United States, that person will not be able to purchase health insurance in the US for the first six months.

What about health insurance coverage while travelling to/from the US?
If someone wants to travel to or from the United States, they can purchase a policy that will cover medical expenses except pre-existing conditions. It will also cover emergency medical evacuation, emergency reunion, return of minor children, terrorism (a new coverage), trip interruption, lost checked luggage and several other minor coverages. With some policies you can choose to cover trip cancellation as well.


Related basic Medicare information

Does Medicare cover medical bills outside the US?
No, Medicare only covers if you are physically in the US. In an emergency, Medicare will also cover someone in Canada and Mexico if the hospital is closer to their home than the United States.

What if we live abroad, have Medicare, and come back to the US for treatment?
Yes, Medicare will cover you. Make sure you have part A and B and perhaps a supplement which AIA can provide for you with a US address.

How do I know if I have Medicare coverage?
You have to sign up to be inscribed. If you qualify to receive US Social Security, you will get Medicare Part A (hospital coverage) automatically, at no cost to you. If you do not have sufficient quarters to qualify for Social Security, you can purchase Part A coverage with the cost based on how many quarters you have contributed to Social Security (for details see: should sign up for both prior to turning 65. If you live abroad at that time, contact the Federal Benefits Unit at the American Embassy which serves you.

If you sign up for the optional Part B (doctor visits), the premium will be deducted from your Social Security payments. Part B premiums vary, depending on your income. You can sign up for Part B swhen turning 65, regardless of health conditions. One can sign up after 65, but at permanently increased premiums (an additional 10% for each year you could have signed up but did not). For more information on Medicare, see or


Other insurances and services offered by Abrams Insurance Agency

For information concerning life insurance, disability insurance or annuities:

Email Jacqueline Abrams at;

Visit the websiteAIA-International-Insurance

Or write to:

Abrams Insurance Agency

1051 N George Mason Drive

Arlington, VA 22205



Last Updated July 22, 2014