Cost, inadequate reimbursement and confusion about healthcare systems are preventing expats from accessing care – even when they have health insurance.
More than half (53%) the 6,400 expats surveyed across more than 80 countries said they had delayed or forgone care that they needed.
April International’s 2026 Expat Health Barometer, conducted in partnership with Expat Communication and Caisse des Français de l’Étranger (CFE), found 93% of respondents had health cover but many were still missing out on treatment.
The findings indicated insufficient reimbursement was the most frequently cited reason for delaying or avoiding care, reported by 51% of those affected, closely followed by the high cost of treatment at 48%.
Healthcare costs difficult to navigate
The research found the financial burden fell heavily on individuals: 71% of respondents fund their own health cover, while 56% pay more than €200 per month.
And despite investing in cover, almost six in ten respondents (59%) said they did not understand healthcare costs in their country of residence, and 19% had received an unexpected medical bill.
The findings also showed that while 83% of respondents could see a GP within three days and 79% could access a specialist within two weeks, this relatively fast access did not necessarily translate into confidence.
Almost four in ten (39%) believed access to healthcare was worse than in their home country, while 21% said they had felt medically at risk while living abroad.
The research also highlighted a continuing gap in mental health support.
Only 11% of respondents had access to psychological support, while 40% lacked access despite potentially needing it.
More than one in ten (12%) said their psychological wellbeing had deteriorated since moving abroad.
Low understanding of cover
Complexity surrounding health cover was also highlighted as a significant concern.
Respondents’ average understanding of different aspects of their insurance contract did not exceed six out of ten.
Repatriation was the least understood area, with an average score of just 4.7 out of ten.
Respondents also wanted clearer reimbursement information, wider access to direct billing and a named person they could reach when they needed guidance.
Important distinction
Isabelle Moins, CEO 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.”
Moins added that 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,“ she continued.
“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.”
