International Private Medical Insurance Compared (2026): Bupa Global vs Cigna vs Allianz Care vs Aetna

Published on: June 16, 2026

Quick answer: The question isn't whether a visa requires health cover, it's which plan to buy, what it costs at your age, and what it quietly excludes. International Private Medical Insurance (IPMI) is its own category; the four names you'll meet most are Bupa Global, Cigna Global, Allianz Care and Aetna International. Two levers move the price most: your age band and whether you include the United States (US cover roughly doubles the premium). In countries with strong local healthcare, a local plan plus a leaner international policy often beats premium-only cover.

If you're moving abroad, the question isn't whether a Golden Visa requires health cover, it's which plan you should actually buy, what it will cost at your age, and what it quietly excludes. That's a different question, and it's the one this guide answers. (For the visa-compliance side, see our guide on what your Golden Visa actually requires.)

International Private Medical Insurance (IPMI) is its own product category, separate from travel insurance and from local-country health plans. This is a 2026 comparison of the four names you'll meet most often, Bupa Global, Cigna Global, Allianz Care, and Aetna International, built around the two things that actually decide cost: your age and whether you include the United States.

First, don't confuse two different products

A lot of confusion (and a lot of overpaying) comes from mixing up two things that share the phrase "worldwide cover":

• Domestic PMI with a worldwide add-on, a home-country health policy with a travel extension, for residents who occasionally go abroad. Roughly £75–£300 per month depending on age and US inclusion.
• International Private Medical Insurance (IPMI), full health cover for people living abroad or moving between countries. Roughly £180–£950+ per month depending on age, region, and US inclusion.

If you're emigrating, retiring abroad, or chasing a residency visa, you want IPMI, not the add-on. The rest of this guide is about IPMI.

The four major providers at a glance

A few patterns worth knowing:

• Cigna Global is frequently the default for US expats thanks to US-based, English-language service and broad worldwide coverage, and it tends to keep covering you as you age, provided you remain an expat.
• Allianz Care has a reputation for taking on people with pre-existing and chronic conditions that other insurers surcharge heavily or decline. If you have an existing condition, get an Allianz quote.
• Bupa Global sits at the premium end, large network, high limits, priced accordingly.
• Aetna International is strong on global network reach and is common in corporate/employer schemes.

How the tiers actually work

Whatever the marketing names, IPMI plans are built in layers. You almost always start with a core (in-patient and hospital) and then add modules:

1. Core / in-patient, hospital stays, surgery, cancer treatment, intensive care. This is the non-negotiable layer; even budget plans include it.
2. Out-patient, GP and specialist visits, diagnostics, physiotherapy. A major cost driver; "hospital-only" plans are far cheaper because they omit this.
3. Dental & optical, usually a separate, optional add-on with its own limits.
4. Maternity, almost always subject to a waiting period (often 10–12 months) and only on higher tiers, so it must be arranged before you plan a pregnancy.
5. Medical evacuation & repatriation, flying you to adequate care, or home. Essential if you'll live somewhere with limited local facilities.
6. Mental health, wellness, telemedicine, increasingly standard on mid and upper tiers.

The practical rule: a lower tier isn't "worse cover" so much as "narrower cover." A budget hospital-only plan can be perfectly rational for a healthy person in a country with good cheap out-patient care, see the combo strategy below.

What it costs by age (2026)

Premiums are driven primarily by age band, region of cover, and US inclusion, then adjusted for tier, deductible, and any medical history. As broad 2026 IPMI ranges:

• Under 40: lower end of the band, roughly £180–£350+ per month for solid worldwide-excluding-US cover.
• 40–55: mid band, premiums climb steadily as claims risk rises.
• 60+: upper band, comprehensive cover can reach £700–£950+ per month, more with US cover.

These are illustrative ranges, not quotes, your number depends on the exact plan, deductible, region, and health declaration. Two levers move it most:

• Deductible / excess: accepting a higher annual excess can cut premiums substantially.
• Region of cover: "Worldwide excluding US" is dramatically cheaper than "Worldwide including US."

The single biggest cost lever: the United States

This is the most important number in the whole guide. Adding US cover increases premiums by roughly 80–115% across every major provider. American healthcare is so expensive that insurers price the risk accordingly.

So:

• If you won't live in or routinely travel to the US, choose "Worldwide excluding US" and save a large fraction of the premium.
• If you're a US expat who visits home regularly, you may need US cover, but compare carefully, because some retirees use US-based options (or short trip cover) rather than paying for full US inclusion year-round.

The smart-money strategy: local plan + international top-up

In countries with strong, affordable private healthcare, Spain, Portugal, Mexico, Thailand, Costa Rica, many expats don't buy a premium IPMI plan at all. Instead they combine:

• a local-country private plan for everyday GP, specialist, and out-patient care (cheap and high-quality locally), plus
• a leaner international policy for emergencies, serious treatment, and travel outside the country.

This combo typically saves 30–50% versus a premium-only international plan, while still protecting against the catastrophic costs. It works best where local private healthcare is genuinely good; it's the wrong call in countries with weak private systems or if you travel internationally a lot outside your base.

What's commonly excluded (read this before you buy)

Even comprehensive plans carry exclusions that surprise people:

• Pre-existing conditions, often excluded outright or surcharged, unless you go to a specialist like Allianz Care or disclose and get them underwritten. Never hide a condition; non-disclosure voids claims.
• Maternity without the waiting period, buy it before you need it.
• Chronic-condition limits, some plans cap or limit ongoing chronic care.
• Long-term / custodial care, IPMI covers treatment, not the daily assisted-living or nursing care of old age. (See our separate guide on the cost of growing old abroad, this gap catches many retirees.)
• Home-country cover is limited, top plans may include trips "home," but usually capped at a set period (e.g. 90 days), not unlimited.
• High-risk activities, experimental treatment, and certain pre-authorised procedures.

How to choose, in five steps

1. Map your geography. Which countries will you live in and travel to? Confirm each provider's network actually covers them, and decide if you truly need US inclusion.
2. Be honest about health. If you have any pre-existing condition, get an Allianz Care quote alongside the others and disclose everything.
3. Pick your tier by out-patient need. Healthy and in a country with cheap local care? A hospital-core plan plus a local policy may be ideal. Want everything in one plan? Go mid/upper tier.
4. Tune the deductible. A higher excess can cut the premium meaningfully if you can absorb small costs yourself.
5. Read the exclusions, not the brochure. Maternity waiting periods, chronic-care limits, and the long-term-care gap are where plans differ most.

Frequently asked questions

Bupa Global vs Cigna, which is better?
Neither is universally "better." Cigna Global is often favoured for English-language US-based service and high limits; Bupa Global for premium network access. The right one depends on your geography, budget, and health.

Why does adding US cover cost so much more?
US medical costs are far higher than elsewhere, so insurers raise premiums by roughly 80–115% to include the US. If you won't be there, exclude it and save substantially.

Can I get cover with a pre-existing condition?
Often yes, with underwriting. Allianz Care in particular has a reputation for accepting chronic-condition clients other insurers decline. Always disclose fully, concealment voids the policy.

Is local insurance plus an international top-up really cheaper?
In countries with strong private healthcare (Spain, Portugal, Mexico, Thailand, Costa Rica), yes, typically 30–50% cheaper than premium-only international cover, while still covering emergencies.

Does international medical insurance cover old-age care?
No. IPMI covers treatment, not long-term custodial or assisted-living care. That's a separate planning problem.

Cover the health gap before you move

Medical cover is one of those details that never appears on a property listing yet shapes whether life abroad is secure or fragile, and it sits right next to the visa requirement, the tax picture, and the long-term-care plan. JanusHermes lets you compare property and residency pathways across 50+ countries with the full cost-and-risk picture attached, and reach vetted local agents, explore listings and country intelligence on JanusHermes.

This article is general information for comparison purposes and is not insurance advice or an endorsement of any provider. Plans, prices, tiers, and exclusions change frequently and vary by individual; figures here are 2026 ranges, not quotes. Always read the full policy wording and confirm current terms directly with the insurer or a regulated broker before buying.

A note on the numbers: where no source is named, the market figures in this article (prices, yields, costs) are indicative estimates compiled from publicly available market data and industry reporting at the time of writing. Markets move and rules change, so treat them as a starting point and verify current figures with official sources before acting on them.