93% insured, yet 53% go without care: the protection gap facing expats
New research from APRIL International reveals that cost, inadequate reimbursement and confusion about healthcare systems are preventing expats from accessing care - even when they have health insurance.
An overwhelming 93% of expatriates surveyed stated that they have health cover, yet more than half (53%) have delayed or forgone care that they needed, according to the 2026 Expat Health Barometer, concluded in partnership with Expat Communication and Caisse des Français de l’Étranger (CFE).
Based on responses from more than 6,400 expatriates living in over 80 countries, the findings reveal a significant gap between having health insurance and feeling genuinely protected abroad.
Insufficient reimbursement is 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%.
The findings suggest that access to healthcare abroad cannot be measured simply by whether someone has an insurance policy. Affordability at the point of use, understanding what is covered and knowing how to navigate an unfamiliar healthcare system all influence whether expatriates feel able to seek care.
Healthcare costs remain difficult to navigate
The financial burden falls heavily on individuals: 71% of respondents fund their own health cover, while 56% pay more than €200 per month.
Despite this investment, many remain uncertain about what healthcare will cost. Almost six in ten respondents (59%) say they do not understand healthcare costs in their country of residence, and 19% have received an unexpected medical bill.
These findings underline the importance of giving internationally mobile people a clear picture of their overall financial exposure - not only the cost of their premium, but also likely out-of-pocket expenses, reimbursement levels and how they will pay for treatment. This is particularly important when expatriates select only certain benefits or rely on local solutions, which may leave gaps in protection both in their country of residence and when returning to their home country.
Solutions such as direct billing or virtual payment solutions can help reduce the need for patients to make significant upfront payments.
Fast appointments do not always create confidence
Although 83% of respondents can see a GP within three days and 79% can access a specialist within two weeks, this relatively fast access does not necessarily translate into confidence.
Almost four in ten (39%) believe access to healthcare is worse than in their home country, while 21% say they have felt medically at risk while living abroad.
The findings demonstrate that the quality of the expatriate healthcare experience depends on more than waiting times or the size of a provider network. People also need help identifying an appropriate medical professional, understanding the local system and accessing support in a language they understand.
Understanding of cover remains low
Complexity surrounding health cover is another 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 expressed a desire for clearer reimbursement information, wider access to direct billing and a named person they could reach when they needed guidance.
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.”
APRIL International supports internationally mobile people by providing access to a global medical network, provider guidance, teleconsultations and 24/7 multilingual assistance. Its digital services allow members to submit and track claims, while direct billing and solutions such as the Easy Pay Card can reduce the need to pay substantial eligible medical expenses upfront.
Mental-health provision remains a significant gap
The research also highlights a continuing gap in mental health support. Only 11% of respondents have access to psychological support, while 40% lack access despite potentially needing it. More than one in ten (12%) say their psychological wellbeing has deteriorated since moving abroad.
Relocation can involve isolation, cultural adjustment, language barriers and separation from familiar support networks. APRIL International believes that mental health provision should therefore be considered an important part of international healthcare protection – and that it must be accessible across borders, culturally appropriate and clearly explained to customers.
Isabelle 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.”
The 2026 Expat Health Barometer surveyed more than 6,400 expatriates living across over 80 countries. Respondents represented a mixed expatriate population, including employees, self-employed people, retirees and individuals paying for their own health cover. in partnership with Expat Communication and Caisse des Français de l’Étranger (CFE), the social security organisation for French citizens living abroad.
