75: Healthcare systems in Europe: What Americans need to know

You’ve just moved to Europe, settled into your new apartment… and then you get sick. Now what? Do you need insurance? How do you see a doctor? And is it going to cost a fortune?

In this episode, we’re breaking down what Americans need to know about healthcare systems in Europe. We’ll compare the U.S. healthcare system to what you’ll find abroad, walk through public vs. private healthcare options, and look at the real costs of doctor visits, medications, and insurance in top expat destinations like Spain, France, Germany, and more.

You’ll learn:

• Why many Americans are relieved to leave the U.S. healthcare system behind
• How healthcare costs compare across countries
• When (and why) expats might still want private insurance
• What steps to take before you move abroad

If the idea of free and quality healthcare sounds too good to be true, you'll want to give this episode a listen. 

🎧 Plus, take the “Which European City Should You Move To?” quiz to start planning your move, and DM me on Instagram @jordan.giberson with your healthcare questions.

👉Take the free quiz: Which European city should you move to? 🤔

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Website: jordangiberson.com
Instagram: @jordan.giberson

Transcript

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Just because it's a lower cost does not mean that it's quality healthcare. So keep that in mind, as you're thinking about moving abroad. And then I also think one of the big pluses about Europe and our conversation about healthcare in general is that the fear of medical debt disappears. Hey, my name is Jordan Giberson. I'm a Texas girl living and thriving in London. The best thing I've ever done? Moving abroad, hands down. And I'm passionate about helping others do the same. Are you curious about finding a job abroad? You're in the right place, friend. I'll teach you the tried and true secrets of how to make moving abroad a reality for you and how to live a fulfilling life once you get there. We'll cover topics like choosing the best visa for you, how to get a job offer in another country, how to get over your fear of moving abroad, and how to live a life you love once you get there, this is The Move Abroad Podcast. Hello, and welcome to another episode of the Move Abroad podcast. Before we get started with today's episode, I wanted to ask you, do you know exactly where you want to move abroad to if you're still trying to figure out exactly which European City is the best fit for you? I have a free quiz. It's at Jordangiberson.com/quiz so you can find out your perfect European destination abroad. So if you go to Jordangiberson.com/quiz, or you can click on the link that's at the bottom of the podcast description. Then you can go take that quiz to find out your perfect European match. So with that behind us, we'll go ahead and get started with today's episode, which is about healthcare systems, so healthcare systems around Europe. What expats really need to know, let's say you've just moved to Europe, you've settled into your new apartment or your new home abroad, and then boom, you get sick. Do you need insurance? How do you see a doctor? What does the process look like and is it going to cost you an arm and a leg? In today's episode, we're going to be talking about the biggest differences between US healthcare and healthcare in other European countries, and then what expats really need to know about public versus private healthcare. And again, expats just really means a person that's moved abroad to a different country that's not their own. And then we'll also be talking about the cost breakdowns for things like doctor's visits, medication, and private insurance, and how that compares to the United States. So let's talk about the healthcare puzzle that we have to navigate as Americans moving abroad to Europe. So the 1st thing that I really wanted to talk about is the U.S healthcare system. And how it compares to the rest of the world. And we're going to be specifically focused on Europe, so we'll talk about the U.S healthcare system and why expats might be really excited to leave it behind. The 1st thing is that insurance is really expensive and there are high deductibles and copays that you're expected to pay. Even if you have an employer based coverage. You do have huge limitations on the freedom within that. A lot of things aren't covered by insurance or like I said, you might have really high deductibles where you pay a certain amount before insurance will start covering things, and you might have copays as well. In the U.S you also might have a lot of surprise medical bills, even if you're insured. Another thing with the U.S healthcare system is that there are a lot of surprise medical bills. Even if you are insured, you might be slapped with a bill that you really weren't expecting, and it might not be just a hundred dollars or$200, it might be thousands depending on what type of care you had. Honestly digging into U.S healthcare can be such a rabbit hole. These were just a couple of the findings that I looked into whenever I was looking into healthcare in the U.S. I found that roughly 41% of Americans, or more than 100 million people carry medical debt. So a 100 million Americans have medical debt, and that is 41% of all Americans that are in the U.S have medical debt. I thought that that was crazy. I also saw that in 2021, the average hospital stay cost an average of$13,200, which I also found incredibly insane that you're just expected to pay$13,000 if you need to go to the hospital, which is not what you really wanna be thinking about. Whenever you need to go to the hospital for something that's serious, you're not thinking about the cost. You're thinking, I need care ASAP, but you will be slept with a massive bill. So some ways that the healthcare is different in European countries is that many countries offer free or low cost public healthcare, which is really quality healthcare as well, and we'll get into that in a little bit. You also won't be hit with surprise medical bills that are astronomical like you would be in the U.S it's very clear how much you'll be paying, and a lot of times it's public healthcare, so you won't be paying anything. So that is a little bit on the U.S healthcare system, and this is how healthcare abroad in European countries is different. First of all, many European countries offer free or low cost public healthcare, and the public healthcare is really high quality as well. We'll get into some of the healthcare system performance rankings in a little bit, but the healthcare in Europe is really great. You also won't be hit with surprise medical bills like you might be in the U.S. Where it's not just,$50 or a hundred dollars, it might be more than that. So you won't be hit with these massive surprise medical bills and medications in European countries are often much cheaper, like a whole lot cheaper. And we'll get into some of the costs in a little bit. Private insurance is available, but is usually optional. It's really not necessary, but some people like to get private healthcare and if you're working for a company, they might be paying for it, but in a lot of countries it's really not necessary, but it is an option. But even if you do pay for private insurance and you are paying for out of pocket, it is significantly cheaper than it would be in the U.S by literally thousands. So is the healthcare even good in Europe compared to the U.S? While the U.S spends significantly more per capita on healthcare than most European countries, it is consistently lagging behind in overall health outcomes and access to care with the U.S ranking last in a recent comparison of 11 developed countries. So if we're looking at the healthcare system performance ratings across this study, there were different countries that I was comparing with, Australia, Canada, France, Germany, Netherlands, New Zealand, Switzerland, Sweden, UK, and then the U.S. So if we're just looking at the European countries, France, Germany, Netherlands, Sweden, Switzerland, and UK. Some of those countries that I just listed are non-European countries, but a lot of these are popular European countries that people would want to move to, like France, Germany, Netherlands, Switzerland, Sweden, and United Kingdom. And in a comparison with all of these countries that also included Australia, Canada, and New Zealand, the US was ranked last, so all of these countries ranked above the US. France ranked above the U.S, Germany ranked above the U.S. Then the Netherlands ranked above the U.S, Switzerland ranked above the U.S. Sweden ranked above the U.S and the United Kingdom ranked above the U.S. I feel like a lot of times in the United States, we feel like we have really quality healthcare. We have some of the best doctors in the world, and while that is true, we do have great healthcare and there are amazing doctors. There are amazing hospitals, and I'm not saying that the U.S has terrible healthcare, but I just wanted to tell you that actually in Europe, the healthcare is really great. It's very high quality because a lot of times we might think that we're paying a lot, but you're getting what you pay for, so you have to pay a lot in the U.S, but you're having some of the best doctors while actually that's not true necessarily. There are really great doctors, really great hospitals in European countries, and they have public healthcare. You can pay for private healthcare like we've talked about, but it's not really necessary and it's also much cheaper. And we'll get into some of the costs in a little bit, but I just wanted to drive it home that the U.S was actually ranked last amongst all of these countries in this comparison of healthcare system performance, and I just wanted to share that the healthcare is really great in Europe, even though you're not paying a whole lot for it, or you're not paying anything for it, it is included in just living there in general. So now that we've established some of the differences between the U.S healthcare system and the healthcare system in Europe, I wanted to dig into some of the costs between what healthcare would look like in the U.S versus what you might be able to expect in Europe. Now let's talk about our home, the United States. If you are an American from the United States. So in the U.S there is no universal healthcare, so it's no public healthcare. Those universal and public healthcare mean the same thing. Do ex-pats need private insurance? You are required unless you are covered by your employer to pay for private insurance. So it is something that you do really need to have in the U.S, what is the private insurance cost per month? Normally it's between 400 to$800 for an individual and you can expect upwards of$1,500, for your family if you're paying for a family per month. So 400, 800 individual 1500 plus for a family. A doctor's visit without insurance might be a 100 to 300 depending on what you're getting. And that's before insurance. And then for prescription, some meds are 10 times to a 100 times more expensive than in Europe. It depends what the medication is. Obviously this is going to vary across different medications and across different countries as well. But some medications are legitimately 10 times more expensive or a 100 times more expensive than in Europe. So good old United States, loves to charge us a lot for our prescription medications. Continuing with our cost differences in the U.S and what some of the United States healthcare costs are. For health insurance, you might have an employer sponsored plan and you're still going to be paying a 100 to$400 a month in premiums depending on how many times you're going to the doctor. So for a private marketplace plan, you might be paying 400 to$800 a month for an individual and 1500 for a family. Like we mentioned. I just find that crazy that you would be expected to pay that out of pocket just of your own accord if you wanted to pay for insurance in 2024, the average annual premium for a single coverage in the U.S was around$8,951. So almost$9,000 while family coverage was an average of 25,500, basically. So if you're thinking about how much you're taking out of your pocket every single year, I mean that is a decent chunk of money,$9,000. Every year that you're paying for your own coverage. If you decide that you need to do that and you're paying for your own private healthcare, like let's say that you decide to be an entrepreneur and you just really wanna give that a go, you're tired of the 9 to 5 and you wanna be a freelancer, or you really want to, start a business, then you can be expecting to pay 400 to 800 a month out of pocket. And like I said, the average is$9,000 a year that you'll be expected to pay for private insurance and then also for family, the average is 25,500. You'll also have really high deductibles. Many plans have high deductibles, meaning that you pay for a lot before insurance even kicks in. In 2024, the average deductible for an individual was$1,787, and that's for employer provided coverage. That's the average is$1700 that you can be expected to pay out of pocket before insurance even kicks in. Now we've talked about the health insurance. Let's talk about the doctor's visits and hospital costs. Primary care visits can be an average of a hundred to$300 without insurance. Specialist visits are 200 to$500 without insurance, and ER visits can be 1500 to$3,000 for minor cases. And it could be up to$10,000 if it's really serious. I found on a research study that the average cost of a hospital stay in the U.S is around$13,200 for an average stay of 4.6 days with a per day cost averaging 2,800. So every day that you need to stay in the hospital, you need to go to the hospital. For emergency, you're gonna be paying 2,800 and the average stay, if you need to stay longer, depending on what the injury or issue is that you need to go to the hospital for, you might be paying$13,000 so you need to be saving up for all those healthcare costs in the U.S unfortunately. And then just kind of a more detailed breakdown of all those costs. I mean, the average per day hospital cost is 2,800. The average length of hospital stay is 4.6 days. Like we said, the cost of hospital stay on average is 3,200, and then the average cost of an overnight stay might be like 11,000 for example. So that's the hospital stays and then talking about prescription medication. Do we have the infamous U.S drug prices. Insulin, for example, is 300 to$600 per vial in the U.S versus$10 to 30 in Europe. So hopefully you don't need insulin. Or maybe you'll wanna move to Europe because you do need to pay for insulin, and you're like, well, I might as well move to Europe because it's 10 to$30 for a vial of insulin versus in the U.S 300 to 600, which is crazy. And then an EpiPen, for example, is$600 in the U.S while in Europe it's gonna be 60 to a 100 instead of 600. And then birth control is another great example. I mean, a lot of women have to take birth control for several years, every single month. And the average cost of birth control is 20 to$50 a month in the U.S and is often free or less than$10 in Europe. So that's a little bit smaller of a price difference. 20 to$50 a month in the U.S versus 10 in Europe. I mean, that's not necessarily gonna break the bank like paying for insulin or an EpiPen would, but it's still just kind of highlighting some of the different drug price differences in Europe compared to the U.S where the prices like we said earlier in the episode can be from 10 times higher to a 100 times higher, which is crazy. So I've been slamming the U.S for the healthcare costs in the past few minutes, but let's talk about the healthcare, what that looks like across Europe. Whether you need public healthcare, whether it's provided, whether you need insurance. What the insurance cost is compared to the U.S you can get a really good picture, doctor's visit costs and prescription medications that you can get a really good feel for some of the price differences and what that would look like across Europe. So one of the first ones that I looked at, which is the United Kingdom, we have public healthcare, it is free. And do expats need private insurance? It's not required, but some ex-pats prefer to have private insurance just to have faster access to doctors. I have private insurance through my company. If I didn't have insurance through my company, I still would probably pay for it because it's only$50 to$150, depending on the coverage and what you're looking for. But it's really not that expensive per month. So I would be paying that out of pocket just so I have the option to see a doctor. Even if you don't have insurance, a lot of times you can pay to see a doctor for, maybe like$200 out of pocket and you say, oh, well, maybe I'll just do that instead of having insurance, and that's fine as well. So my point is that it's just so much cheaper in general to pay for private insurance to see a private doctor, even if you don't have insurance, or if you wanna get insurance per month, it's 50 to 150 versus, 400 to 800 in the U.S. Doctor's cost visit is free in the United Kingdom because there's public healthcare and prescription medications. Most prescriptions are capped at$13, and I can vouch for this being the truth. I legitimately picked up a prescription probably 2 hours ago, 3 hours ago now, and I paid, I think 11 pounds. So I mean that's what probably$14 or something like that. So I mean that was including tax as well. So really the prescription medications are not expensive in the United Kingdom. Okay. Jumping into France, there is also a public system that reimburses up to 70% of your costs. You are not required to get public insurance, but you can, get private coverage if you like to at an extra cost. And the cost is$50 to$200, which is still significantly lower than the U.S of 400, 800. And then a doctor's visit might be up to$30. And a lot of times there's a 70% reimbursement for that as well. And then the prescription medication, very low cost, often under$10. Jumping into Spain there is free or very low cost. Public healthcare, you are not required to get private insurance, but private speeds up wait times if you prefer to do that. The private insurance cost is 50 to$200, and then a doctor's visit might be up to$50. Prescription medication is 50 to 80% cheaper than the U.S so go to Spain. The Netherlands has mandatory private insurance system, so you do have public healthcare, and yes, the residents, including ex-pats, must get insurance. So you do need to get insurance in the Netherlands, but it's also about$120, and it is government subsidized. And then a doctor's visit might be$50. And then really the prescription medication is affordable with insurance, which you will get in the Netherlands. But again, it is a very low cost for insurance of,$120 or so, and it's also government subsidized. In Portugal there is a public system, that is very low cost. You are not required to get private insurance. And then if you do want to get private insurance, it's 50 to 150. So we're seeing that as being the typical average of 50 to, 150 to$200 per month if you chose to do it. But again, there is public healthcare in all of these countries, so you don't even need to get private insurance. But if you do decide it is so much lower, the cost of a doctor might be 40 to$60. And the medication is 60 to 80% cheaper than the U.S. Now, jumping into Germany as our last example, they do have a public healthcare system that is excellent as we would expect with Germany because Germans are on top of things. Expats can choose public or private insurance depending on what they want. It is more expensive in Germany, it's 110 to$500 per month on average, but again, that is still so much cheaper than the U.S and you are not required to get private healthcare if you don't want to. Again, the public system is really excellent in Germany, so it's probably not necessary, but it is an option if you want to pay for it. The cost for a doctor's visit is$30 and there is a very low cost, with insurance cost for prescription medications. So again, across Europe, you don't really need to worry about the cost of prescriptions. You don't really need to worry about the cost of private insurance. It also gives you more freedom to choose whatever job you want and not need to be employed by a company to pay for your healthcare like you do in the U.S. You can say, I wanna be an entrepreneur, I wanna build my own business. I wanna be a freelancer. I want to take off of work for a little bit, and you don't have to worry about paying astronomical prices for insurance. You can just say, I don't even need it, because all these countries have public healthcare. Or you can say, I'm gonna get private insurance, but instead of paying 400, 800, you're paying 50 to$200 per month. So I've just been throwing all these little stats in and numbers at you, but why does this matter for expats? Why does this matter for you as an American thinking about moving abroad to Europe? Americans moving abroad rarely need private insurance unless they want faster access to care. A lot of expats are shocked at how much cheaper healthcare is abroad, even with private insurance on top of the cost, which is free because it's public healthcare, which means it's for the whole public. But if you want private insurance, it's so much cheaper. And like I talked about in the beginning, just because it's cheaper, it does not mean that it is not quality. Like I had said in the beginning or towards the beginning of the episode, the U.S ranked last, and all of those countries that are in developed countries in Europe, France, Germany, Netherlands, Switzerland, Sweden, UK, all of those countries ranked higher in quality healthcare than the U.S so rest assured you will be taken care of in Europe. Just because it's a lower cost does not mean that it's quality healthcare. So keep that in mind, as you're thinking about moving abroad to Europe. And then I also think one of the big pluses about Europe and our conversation about healthcare in general is that the fear of medical debt disappears. Whenever you move to a country with a solid public healthcare system, you don't need to worry about going into crazy debt. You don't need to worry about, am I going to get cancer and I'm gonna like, go into debt and go bankrupt. Am I going to, have medical issues? Are my parents gonna start having medical issues where I'm gonna have to pay that out of pocket? That doesn't have to be something that you save up and have an emergency fund for all of your medical bills because you don't have to worry about that in Europe, which is such a beautiful thing, to not have to have that stressor on top of all the other stressors that we have in life. Talking about medical debt. Medical debt is a significant factor for bankruptcies in the United States with studies indicating that over 60% of bankruptcies are at least partially due to medical bills. So again, in Europe it's quality healthcare and you don't have to worry about going bankrupt. 60% of bankruptcies are at least partially due to medical bills, so it's so nice to have that. I guess just peace and knowing that you don't have to worry about going into debt because of all the medical expenses that you might have in the future. And then I also just wanted to cover just understanding the cost and what you really need to know with public healthcare. So why do some expats get private healthcare? Public healthcare is really great, but you can have long wait times for specialists and elective procedures. So if you do want to get elective procedures, which means that you choose to get the procedure, it's not really necessary for your health, but you just want to get it for yourself. Or if you want shorter wait times, then you can pay. But again, it's like 50 to$200 versus 400 to 800 per month if you chose to do that. And if you are employed. A lot of companies do provide you with public healthcare if you wanted that, but again, it's not necessary. And if you're not getting elective procedures and you're not worried about the longer wait times, and again, if it's really important, they're gonna prioritize you. If it's a less important thing, yes, you might have longer wait times to get an appointment. Private insurance also gives you faster access to specialists, to potential English speaking doctors and to private hospitals if that's something that's important to you. And another reason why expats get private insurance is that some visas require private health insurance. That is something that is important to consider. So Portugal's D7 visa, Spain's non lucrative Visa, for example. You will probably need to provide your own private health insurance, most of the time you're going to need to pay for private health insurance whenever you have a visa that does not lead to permanent residency. It's gonna be more of the temporary visas. Like if you are getting a digital nomad visa for example, it's quite easy to get the visa. You just need to prove that you make a certain amount of income per month, but you will be required to pay for private health insurance. But again, it's not gonna kill you in the cost compared to the U.S, which I've talked about probably too many times. But, you might be paying 50 to$200 per month instead of paying, a crazy amount like in the U.S 400 to 800. And that's just for you alone. It's 1200 plus if you're paying for a family. And then just different cost considerations that expats should really know about and expat again is just that would be you if you're moving abroad to another country. Doctor's visits are shockingly cheap compared to the U.S. Many medications are subsidized or capped at a low price, and emergency care is often free or a fraction of the U.S cost. And then just some things to think about whenever you're preparing for moving abroad. I say to research if your visa requires private insurance and how much that will be for the country that you're moving to. But again, it shouldn't kill you. It should be 50 to 200 or so. Check which medications you take and their availability abroad, just to kind of see how much you'd be paying out of pockets to understand what that looks like and if they have the specific medication that you're looking for.'cause different countries might have slightly different medications, but they should have all the medications that you would need. They are developed countries. They'll have what you need in healthcare. And again, it's very quality healthcare like we've talked about. And then learn how to register for public healthcare. Once you qualify, like once you get there, you'll have to register and probably get a public healthcare number and register at your local doctors and things like that so that you are prepared if and when you get sick so that you're not, you're not sick and feeling miserable and then stressing over what to do and how to handle things. And you feel terrible, but then you're like, I need a doctor, but I don't know what to do. Like you don't really wanna be in that situation. So I'd say to prepare for that whenever you first move there. So those are some things to prepare before moving abroad. So in wrapping us up, what do expats love about healthcare abroad in Europe? Imagine ever worrying about a medical bill again, especially if you're a person that's had a lot of medical issues in the past. Can you imagine living a life where you don't have to worry about your medical bills or especially as you're getting older and you're considering how your health might be changing over time? Imagine not needing to worry if you're going to go in debt, not needing to worry if you have enough savings to cover if you or your spouse, has any medical issues. Just having that peace of mind I think is just so reassuring and it gives you peace, I think. And the picture paying just$50 instead of$500 for a doctor's visit, for example. Think about getting affordable care without it being tied to a job where you can say, I really wanna quit my job. I'm miserable here. And you don't need to worry about, oh my healthcare I don't wanna have to pay that out of pocket. Or thinking, I wanna be an entrepreneur. And I've always wanted to pursue that, but my healthcare is tying me down where I feel like I need to stick with my 9 to 5 job because they're paying for my health insurance, which is really required in the U.S. Or, I really wanna be a freelancer and you want to do that, just have that freedom where you're not tied to that 9 to 5 job and thinking about not even needing to pay for healthcare at all because it's provided for you. Or you pay for private insurance, which again is so much cheaper. This is the reality for millions of expats in Europe. It's not a perfect system, I will say, I mean, with any healthcare system it's not perfect, but for so many, it's so much better than the U.S. So if you were considering moving abroad to Europe, I mean, healthcare I think is very quality. I've been living here for several years. I have in my personal experience, I have needed to go to the hospital a few times. I have needed to go to the doctors. I have needed to pay for prescriptions, and I can say there's not surprise medical bills ever. I've never had a surprise medical bill come in the mail. I had to go to the hospital and I have several tests be done to me, that would've been at least$2,000 in the U.S, like minimum. And I paid$0 after needing to go to the hospital and having an EKG. My blood taken. I had a CT scan. I think I had one more test. Maybe I didn't. This was I think this was in 2022 and maybe that was it. EKG, blood test. I feel like there was one more thing that they did, but regardless, I paid$0, I paid nothing. And in the U.S that would've like a CT scan and paying for all that being at the hospital, that would've cost at least$2,000. So just knowing that I didn't have to pay that out of pocket, which I could not have afforded at the time. Knowing that you don't have to go into debt knowing that you and your family and your children, if you have children now or if you want children in the future will be taken care of and you won't need to worry about saving up a bunch of money or what if someone gets really, really ill. And you need to have consistent medical attention to deal with some ongoing health issue. You don't wanna have that kind of in the back of your mind. So I just think that in Europe you can have the peace of mind knowing that it's quality healthcare. There are really great doctors. It's ranked higher than the healthcare in Europe is ranked higher than in the U.S and knowing that you'll be taken care of and not need to pay tons of money out of pocket and not need to worry about those expenses. So, that is it for me for today's episode. I hope that this helped you have a bit of clarity with the healthcare system in Europe and what that would look like versus in the U.S just to give you some peace of mind that it is quality healthcare and that you won't have to be worrying about breaking the bank in Europe. And again, if you are thinking about moving abroad to Europe and don't know exactly where you want to move abroad to, or you have a couple places that you're trying to decide between, or you just want reassurance that you are picking the best European destination for you. I have a free quiz on my website. It's at Jordangiberson.com/quiz, or the quiz is actually linked at the bottom of the podcast description, which will probably be a lot easier. If you click on the link. It'll take you right to the quiz and you can get it started immediately. And then, you'll get to see your results afterwards to figure out where your perfect European destination is that matches you with. Perfectly with where you should move abroad to. So anyways, thank you again so much for listening to another episode of the Move Abroad podcast. I will catch you here again next week, same time, same place. I'll catch you then.