Expat Health Insurance Over 65: Your Real Options Abroad

Written by Steffan Grund · Insurance specialist (Versicherungsfachmann BWV) · Updated October 28, 2026Facts checked: October 28, 2026

Can you get expat health insurance over 65?

Yes, but the options narrow: some international insurers stop taking new members at a set age, Care Expat World among them, so over-65s can build their cover from a public system in the new country, a home-country route such as the UK S1, and travel cover for trips.

This page is written for people who are already 65 or older, or who will turn 65 in the year their cover would start. We are a site that earns money when readers buy Care Expat World, and that plan does not accept you, so we will not try to sell it to you here. What we can do is set out the routes we have verified from official sources for our country guides, show where each one has gaps, and help you prepare the questions to ask any insurer that does accept new members at your age.

The key distinction at this age is between three kinds of cover. A public scheme in your new country is usually based on residence, not age, and often costs a fixed fee or an income-based contribution. A home-country route such as the UK S1 depends on your pension, not your age. Private international cover depends on the insurer's entry rules, which vary. The overview below shows how the three compare; the pillar guide to expat health insurance explains how long-term plans work in general.

Key facts for over-65s moving abroad

The table collects the facts on this page that are most likely to decide your plan, each taken from an official source listed at the end.

Why is Care Expat World closed to new customers over 65?

Care Expat World only accepts people whose cover starts before the calendar year in which they turn 65, so if you are 65 or older this year, or turn 65 this year, you can no longer join as a new customer.

The plan counts age as the calendar year minus your year of birth. Someone born in 1961 therefore counts as 65 for the whole of 2026, even if their birthday is in December, and could only have joined with a start date of 1 December 2025 at the latest. The binding German terms speak of the 65th birthday rather than the calendar year, but the application form applies the stricter calendar-year rule, so that is the one that decides in practice. The full explanation, with a deadline calculator, is on our page about the international health insurance age limit.

Two groups are not affected. People who already hold Care Expat World keep it after 65: the contract has no end date, no exit age, and the insurer has waived its right to cancel with ordinary notice; members simply move into the 65–69 band and later the 70+ band on 1 January. And a younger partner can still join on their own, because each insured person's own year of birth counts. The older partner cannot be added.

We say this plainly because it shapes everything else on this page. Already 65 or older in the year cover would start? This plan is closed to you. We are preparing a comparison of plans without an entry-age limit.

Does Medicare cover you abroad after 65?

Generally no: Medicare starts at 65, but beneficiaries cannot use most Medicare benefits outside the United States, and Medigap only adds a limited emergency benefit for trips.

Medicare pays abroad only in narrow cases, such as an emergency that begins in the US where a foreign hospital is closer than the nearest US one, or certain trips through Canada to Alaska. Part D does not pay for prescription drugs bought outside the US. Medicare Advantage plans may cover more abroad, but this varies from plan to plan, so read your own plan's documents. For an American who lives in Mexico, Portugal or Thailand, Medicare is therefore cover for visits home, not for daily life abroad.

The US State Department notes that a medical evacuation can cost USD 20,000 to 200,000, which is one reason Americans abroad look closely at the local public scheme and at any private plan that will accept them. Whether to keep Part B is a separate cost decision, worked through in our guide to health insurance for Americans living abroad. One rule applies to every plan we feature: Care Expat World never covers a US citizen in the USA, because the USA is their declared home country.

How does the S1 work for British pensioners over 65?

Once your UK State Pension is in payment, the S1 gives you the same state healthcare as residents of an EU country, Switzerland, Norway, Iceland or Liechtenstein, with the UK paying, but it covers no private care and nothing outside those countries.

You apply to NHSBSA, online up to 90 days before you move, and register the S1 with the health service of your new country. In France, for example, you register with the local CPAM and are treated on the same basis as French citizens, which includes the usual co-payments. In Spain you cannot join the convenio especial while the UK pays through an S1. If you need the S1 for a visa application, NHSBSA can send it to your UK address. Ireland needs no S1 at all for UK citizens.

The age that matters is your State Pension age, not 65. People born between 6 March 1961 and 5 April 1977 reach it at 67, and those born between 6 April 1960 and 5 March 1961 at 66 plus one to eleven months. A Briton who moves at 65 may therefore wait one or two years for the S1, and Care Expat World is already closed by then. That gap is covered in our guide to S1 gap health insurance, and the application itself in our S1 form guide. Outside Europe, in Mexico, Thailand or Costa Rica, there is no S1, and the local scheme is the main public route.

Which countries let resident retirees over 65 join the public system?

In every country we have researched for our guides, access to public healthcare depends on legal residence and the scheme's own rules, and we found no upper age in France, Portugal, Spain, Mexico or the Philippines; the details below decide whether a route works for you.

Spain: what the convenio especial costs after 65

Spain's convenio especial is one of the few public schemes with a published fee for people over 65, which makes it easy to budget.

After five years of legal residence, Spain's health ministry says you are entitled to free public care without a convenio. More on the retirement side is in our guide to the Spain retirement visa.

Mexico: IMSS fees by age group

Mexico's IMSS voluntary scheme sets a yearly fee per person by age group, and its 2026 table runs to 80 and over.

USD at the Banxico FIX rate used in our Mexico guides (our conversion). IMSS: Seguro de Salud para la Familia, fees from 1 March 2026.

The fee is modest, but the scheme has conditions that matter more after 65. Before cover starts, each person fills in an IMSS medical questionnaire, and IMSS can ask for exams. Pre-existing conditions are excluded, and if IMSS finds one in the first year, it cancels the cover without refunding the fee. Waiting periods of six months to two years apply to listed treatments, such as two years for orthopaedic surgery. We found no official rule on which migration status a foreigner needs, so bring your residence card and ask. See retiring in Mexico for the wider picture.

How do entry ages vary between international insurers?

Each insurer sets its own maximum entry age and renewal rules, and we have not verified any other insurer's limits from its own documents, so check each insurer's maximum entry age before you spend time on an application.

We found no official statistic or regulator survey that compares entry and exit ages across international health insurers, so we make no claim about what "most" insurers do. What we can say from the plan we know best is that the age rules come in two kinds: an entry age, the latest age at which you can join, and an exit age, the age at which cover stops or can no longer be renewed. A plan with no entry-age limit is only useful if it also has no exit age, or if the exit age is far enough away for your plans.

When you ask an insurer about a policy, ask for the answers in writing and check them in the terms, not only in a brochure. The table lists the questions that matter most after 65.

We are preparing a comparison of plans without an entry-age limit. We will only publish it once each claim in it is backed by the insurers' own documents.

What about Thailand and visas that require insurance?

Thailand is the hardest case for over-65s: its universal coverage scheme is for Thai citizens, the health ministry has said Thai insurers historically would not cover people over 70, and the O-A retirement visa sets a minimum sum insured.

For a first O-A application, the policy must cover at least 3,000,000 THB or USD 100,000 per policy year, from a Thai or a foreign insurer. If insurers refuse you, the rules accept a denial letter plus proof of a deposit or other cover of at least 3,000,000 THB. The LTR visa's Wealthy Pensioner route asks for at least USD 50,000 of hospitalisation cover, does not accept life-only or travel insurance, and alternatively accepts a deposit of at least USD 100,000 held for at least 12 months. Since 2019, rules from the health ministry have also let public hospitals charge foreigners by group, with retirees in the top price tier, reported at up to double the Thai price.

If you are over 70 and set on Thailand, read the renewal terms of any local policy carefully, because we found no official Thai age limit and no renewal guarantee. The full rules are in our guides to expat health insurance in Thailand and the Thailand retirement visa, and the decision itself in retiring in Thailand. For other countries' visa rules, see visa health insurance requirements by country.

What should you prepare before you apply over 65?

Prepare your residence papers, your medical records and your home-country documents before you move, because public schemes and insurers both ask for them, and gaps cost the most at this age.

• Residence permit or visa decision, and proof of address (Portugal's SNS needs a residence permit with a valid expiry; Spain needs a padrón registration)
• Local tax number where needed, such as the Portuguese NIF
• Briton: proof that your State Pension is in payment, then the S1 application to NHSBSA up to 90 days before the move
• American: your decision on Medicare Part B, with the penalty rule in mind
• Medical reports, test results and a list of current medicines, in case of a questionnaire or exam (IMSS, CSS, private insurers)
• A supply plan for prescriptions: Medicare Part D does not pay abroad, and Spain's convenio does not pay outpatient medicines
• Written answers from any insurer on entry age, renewal, exit age and pre-existing conditions
• Travel cover for trips, including visits home, kept separate from your residence cover
• Keep your current cover running until the new scheme is confirmed in writing

If you are still choosing a country, our guides to healthcare systems by country and retirement visas by country compare the routes side by side. For the pension and budget side of a move after 65, see retiring in Portugal, retiring in Panama and retiring in Costa Rica.

Worked example: an American aged 67 and a Briton aged 68

Linda, from Ohio, born in 1959, is 67 in 2026 and moves to Mexico. Care Expat World is closed to her as a new customer. She looks at Mexico's IMSS voluntary scheme: in her age group, 60–69, the fee is 20,600 MXN a year (about USD 1,109), rising to 21,500 MXN (about USD 1,157) from the 70–79 group, a difference of 900 MXN a year at 2026 fees. She completes the medical questionnaire knowing that a pre-existing condition would be excluded, and that any orthopaedic surgery would fall under a two-year waiting period. She keeps Medicare Part A for visits to her children in Ohio and weighs whether to keep Part B at USD 202.90 a month; her Medigap plan would only pay for emergencies in the first 60 days of a trip, which is no help for daily life in Mexico. Next she asks two insurers, in writing, for their maximum entry age and their renewal terms.

Graham, from Leeds, born in 1958, is 68 in 2026, already receives his UK State Pension and moves to Spain. He applies to NHSBSA for an S1 online about two months before his move, then registers it in Spain, which gives him Spanish state healthcare on the same basis as residents, with the UK paying. Because the UK pays through the S1, he cannot join the convenio especial, and does not need to. Had he not had an S1, the convenio would have cost him €157 a month, or €1,884 a year, after a year of residence. The S1 covers no private care, so for faster private treatment he asks insurers, in writing, about their entry age for someone of 68.

Both follow the same order: the public or home-country route first, then any private cover on top, each confirmed in writing before the old cover ends.

Are you still under 65? Your Care Expat World window

If you turn 64 or younger this year, Care Expat World is still open to you, but the window closes on 1 December of the year you turn 64, the latest possible start date.

Cover starts on the 1st of a month, never before you cross the border, and the start date can be at most four months ahead. In Zone 1, the 60–64 band starts at €325 a month. Once accepted, the plan has no exit age, so a policy started at 63 can run into your 80s. For the deadline in your own case, use the calculator on our age limit page; for prices by band, see the international health insurance cost guide; and for the plan's benefits, our Care Expat World guide. If you are planning a retirement move more generally, our page on expat health insurance for retirees covers the choice before 65, and freelancers working abroad can read health insurance for freelancers abroad.

Which over-65 myths should you ignore?

The most costly misunderstandings are about Medicare abroad, the reach of the S1 and what an existing policy does at 65.

Where these facts come from

• Care Concept / Barmenia: Care Expat World terms VB-KV 2026_05, English FAQ, brochure, application form and premium table (read October 2026)
• United States: Social Security Administration, POMS GN 02605.200; Medicare.gov, "Travel outside the U.S.", "Medicare costs" and "Avoid penalties" (2026); Medicare fact sheet 11037 (Medigap foreign travel emergency); US State Department on medical evacuation costs
• United Kingdom: NHSBSA, healthcare cover for people living abroad (S1) and knowledge-base articles KA-01285 and KA-26718; DWP State Pension age timetable; GOV.UK, Healthcare in Spain
• France: service-public.fr, Protection universelle maladie (PUMa); LFSS 2026
• Portugal: gov.pt, "Migrantes – cuidados de saúde em Portugal" (23 June 2026)
• Spain: Ministry of Health, convenio especial page (read October 2026)
• Mexico: IMSS, Seguro de Salud para la Familia fees from 1 March 2026; Ley del Seguro Social Arts. 240–242; IMSS regulation RACERF Arts. 81–85; USD at the Banxico FIX rate used in our Mexico guides
• Costa Rica: GOV.UK, Living in Costa Rica (27 February 2026); Ley General de Migración y Extranjería 8764, Arts. 78 and 80
• Panama: Caja de Seguro Social, voluntary insurance group B2; Ley 6 of 1987 (pensionado discounts)
• Philippines: PhilHealth Citizen's Charter 2024 (foreign nationals); Philippine Retirement Authority, Expanded SRRV Program (August 2025)
• Thailand: Ministry of Public Health / Ministry of Foreign Affairs, O-A visa guideline (2021 amendment); Thai General Insurance Association long-stay portal; LTR visa rules; World Bank case study on Thailand's universal coverage scheme

We found no official statistic on entry or exit ages across the international health insurance market and name no other insurer's limits. Yearly sums are our own arithmetic on the official fees.