Liz Weston: Should you move abroad for health care?

The notion that health care outside the U.S. could be good as well as cheap is a foreign one to many Americans.

Kathleen Peddicord frequently hears from such skeptics as founder of Live and Invest Overseas, a site for people curious about living abroad. Actual expats like her, however, tell of good-quality care at a fraction of the U.S. price. Treatment for a motorbike accident in Panama cost her $20. Emergency dental surgery that might cost $10,000 or more in the U.S. was $4,500 in Paris. In many countries, medications that would require a prescription in the States are available directly from licensed pharmacies at low prices, thanks to government subsidies or regulation.

"The health care in a lot of places around the world is very good, as good as in the United States," says Peddicord, who currently divides her time between Paris and Panama. "Some places, it is better."

Low-cost, quality health care usually isn't the main reason people move abroad, says expat and Mexico resident Don Murray, who writes for rival site International Living. But reduced medical expenses are part of the lower living costs that prompt many Americans to relocate, he says.

EXPAT NUMBERS ARE ON THE RISE

About 9 million Americans who aren't in the military live outside the U.S., according to State Department estimates. That's increased considerably from its 1999 estimate of 3 million to 6 million. The number could rise in coming years as millions more Americans barrel toward retirement without enough income to maintain their standard of living at home.

Health care is a particular concern for Americans who want to retire before age 65, when Medicare, the government health program for seniors, kicks in. Currently, early retirees can buy coverage through the Affordable Care Act, but it's not always truly affordable and its future is uncertain.

Some who would otherwise retire plan to keep working, rather than risk being uninsured. But a move abroad could be an option for those intrepid enough to try it.

Cheaper health care also may appeal to gig economy workers who aren't tied to stateside jobs. Freelance science writer Erica Rex, for example, recently wrote an opinion column for The New York Times about moving to the United Kingdom and then France after her 2009 cancer diagnosis. "Moving to Europe was a choice weighed against other, grimmer options for health care, which included the strong possibility of being bankrupted by cancer treatment and winding up at the mercy of New York State's welfare system," she wrote.

HEALTH CARE QUALITY VARIES BY DESTINATION

Not all expat havens have great health care systems. Belize, for example, encourages immigration by exempting retirees from most income taxes — but many expats there cross the border to Mexico for health care, Peddicord says.

France, on the other hand, is known for its excellent health care system. International Living and Live and Invest Overseas give the country top marks, along with Mexico, Ecuador and Malaysia. International Living praises Thailand and Costa Rica as well, while Live and Invest Overseas says Portugal, Italy and Malta have admirable health care.

With any country, quality can vary — especially in sparsely populated areas. Murray and his wife, Diane, left their first retirement destination, a small town in Ecuador, after encountering broken equipment and few doctors. They're much happier with the care near their Yucatan Peninsula home, where next-day appointments are the norm and doctors are typically trained in the U.S. or Europe, he says.

"It's like in the U.S. — if you live in Possum Belly, Alabama, and they don't have a hospital and the nearest one is an hour and a half away, the health care isn't going to be the same" as in a major city, Murray says.

OPTIONS FOR HEALTH CARE ACCESS

Expats may be able to qualify for a country's public health care system if they become residents. Otherwise, there's typically a private system in which people can pay out of pocket and get reimbursed if they have private health insurance.

Peddicord and her husband, Lief Simon, who are in their 50s, have an international health insurance policy that covers them whether they're traveling or at home in France or Panama. The annual cost is about $3,000 for both of them, she says. Murray, 69, says he and his wife pay about $80 each month for Mexico's public health system, but use private doctors and pay out of pocket for most care (including $8 for a recent hospital visit to treat an eye infection).

"My personal budget no longer contains a line for health care expenses," Murray says. "They are so inconsequential there is no need."

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This column was provided to The Associated Press by the personal finance website NerdWallet. Liz Weston is a columnist at NerdWallet, a certified financial planner and author of "Your Credit Score." Email: [email protected]. Twitter: @lizweston.

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NerdWallet: Retirement calculator https://bit.ly/nerdwallet-retirement-calculator