Last updated 19 October 2026.
If you spend the winter in Spain, work remotely from Lisbon for a few months a year or have just moved abroad for good, the question of health cover gets awkward fast. Travel insurance is built for trips. International health cover is built for living somewhere. Public healthcare at home is usually built for people who are actually at home. Spend the year between countries and it is easy to fall into the gap between all three, often without noticing until you need treatment. This guide explains what each type of cover is for, where the gaps usually are, how pre-existing conditions and residency rules change the picture, and when you are likely to need which. It ends with a decision table and two worked scenarios.
This is general information, not insurance, medical or legal advice. Every policy is different, and the policy wording decides what you are covered for. Official guidance quoted below was checked on 19 October 2026.
This piece sits in the Protect section. It pairs with Emergency cash when ISA and FSCS do not apply (the cash buffer for when something goes wrong) and Operating cash vs investment cash when you hold two currencies (keeping that buffer in the right currency).
Three kinds of cover, three different jobs
| Type | What it is built for | What it is not built for |
|---|---|---|
| Travel insurance | Emergencies on a trip away from where you live: emergency treatment, getting you home on medical grounds, and usually cancellation, baggage and similar travel costs | Living abroad. The UK Foreign, Commonwealth & Development Office (FCDO) says plainly: “Travel insurance is not intended for permanent residence abroad.” |
| International health cover (often called expatriate or international private medical insurance) | Ongoing medical care where you live, and sometimes in other countries within the policy’s area of cover | Travel costs such as cancelled flights or lost luggage. It is health insurance, not trip insurance |
| Public healthcare and reciprocal cards (the NHS, Medicare, provincial plans; the UK GHIC) | Care for people who are resident where the system is, and in some cases necessary state care on a visit to a partner country | Private treatment, repatriation, or anyone who has stopped being resident |
What travel insurance does and does not do
The FCDO’s guidance on foreign travel insurance (last updated 2 August 2024) gives a sense of what is at stake if you travel without the right cover. Its examples of the cost to you without insurance: a broken leg in Spain needing hospital treatment and possibly evacuation, £25,000 or more; a quad bike accident in Greece needing surgery and evacuation, £80,000 or more; a stomach bug or infection treated in a US hospital, £150,000 or more.
The same guidance lists what to check, and several items matter more if you are away for long stretches:
- Trip length. It warns that “many policies have a maximum trip length and/or an annual limit on how much time in total you can spend outside the UK”. An annual multi-trip policy that looks fine for holidays may not cover a three-month stay.
- Pre-existing conditions. You need to declare existing conditions, and pending treatment or tests, so you are covered if there are related complications. It says failing to declare something may invalidate the policy.
- Work. For long-stay policies it says to make sure the policy covers “specific activities and work (paid or unpaid) you may undertake”. Remote work on a laptop is worth asking about directly.
- Where you are. If FCDO advises against all travel or all but essential travel to a destination, your insurance may be invalidated.
If your life has moved abroad, the FCDO’s advice is to look at private medical insurance for expatriates or local cover instead, and to check “whether you could transfer medical cover if you re-locate to other countries in the future”.
What public cover does and does not do abroad
Public systems are generally tied to residence, not nationality, and they cover very little outside their own country. Some examples from official sources, as checked on 19 October 2026:
- UK: the NHS and the GHIC. The NHS says that if you move abroad permanently, “you’ll no longer automatically be entitled to medical treatment in the UK under normal NHS rules”, because it is “a residence-based healthcare system”. The UK Global Health Insurance Card lets UK residents get necessary state healthcare in the European Economic Area and some other countries, including Australia, on the same basis as a local resident. That can include treatment for long-term or pre-existing conditions. It does not cover private treatment, medical repatriation or mountain rescue, and the NHS says it “is not a replacement for travel insurance”. You are only entitled to a GHIC if you are ordinarily resident in the UK (or in some specific S1 or A1 situations).
- US: Medicare. Medicare’s own site says it “usually doesn’t cover health care while you’re traveling outside the U.S.”, with narrow exceptions. It adds that Medigap supplement policies may cover emergency care abroad, and that “travel insurance doesn’t necessarily include health insurance”.
- Canada: Ontario’s OHIP, as one example. To keep OHIP while outside Canada for more than seven months in any 12-month period, Ontario says you need a valid health card, Ontario as your primary home and at least 153 days in Ontario in each of the two 12-month periods before you leave, and you need to visit ServiceOntario before you go. Even then, emergency cover abroad under its Travellers Program is limited: up to CAD 50 a day for emergency outpatient care, and up to CAD 400 a day for intensive or operating-room inpatient care (CAD 200 for lower levels of care). It does not pay for conditions that are pre-existing, or for a transfer back to an Ontario hospital. Other provinces have their own rules.
Where the gaps usually are
- The long trip that outgrows the policy. A stay that runs past the policy’s maximum trip length, or a year in which total days abroad pass an annual limit.
- The move that nobody told the insurer about. Once you are living somewhere rather than visiting, travel insurance may no longer apply, and public cover at home may have lapsed too.
- The condition you did not declare. The FCDO warns that failing to declare an existing condition, or pending treatment or tests, may invalidate your travel insurance.
- Waiting periods at the new home. The NHS points out that while an S1 form is being registered in the new country, “it’s your responsibility to make sure you have appropriate healthcare cover”. Similar gaps can open while you register for any new public system.
- Getting home. Neither the GHIC nor Ontario’s Travellers Program pays for medical repatriation or transfer home. That is a travel insurance job.
Pre-existing conditions
For travel insurance in the UK, the FCA’s rules require firms to point you to a medical cover directory in certain cases: if they decline to quote or cancel a policy because of a medical condition, offer a policy with a medical condition exclusion that cannot be removed, or, from 1 January 2026, charge a medical condition premium of £200 or more. MoneyHelper runs one such directory, a shortlist of FCA-authorised specialist firms most likely to cover people with health conditions. It does not provide quotes, and it warns that depending on your age or condition, cover may still be very expensive or unavailable.
Health insurance treats existing conditions differently. MoneyHelper’s guide to private medical insurance (a UK guide, but the principle travels) says policies usually do not cover pre-existing conditions or chronic illnesses. Many health insurers offer a choice of underwriting. One UK insurer’s explanation, published on 22 September 2026, describes them like this: with full medical underwriting you disclose your history upfront and know your exclusions from day one; with moratorium underwriting you disclose nothing at the start, and a condition you had in the five years before cover started can become eligible only after two continuous years without symptoms, treatment, medication or advice. Terms vary by insurer, so read the wording of any policy you are offered.
If you have a condition that needs regular treatment, it is worth knowing that the UK GHIC can cover treatment for pre-existing conditions within state systems on a visit, while most private policies will not. That is one reason the cards and insurance work best together rather than as substitutes.
Residency rules can make insurance compulsory
Health cover is not always optional. The FCDO notes that “local law may require you to have medical insurance, including as part of a visa application”. A clear example is the EU’s short-stay visa rules. For travellers who need a Schengen visa, Article 15 of the EU Visa Code requires travel medical insurance covering repatriation for medical reasons, urgent medical attention, emergency hospital treatment and death, valid throughout the Schengen area for the whole stay, with minimum coverage of EUR 30,000. Many residence visas have their own insurance requirements, set country by country. Check the requirement with the consulate or immigration authority before you buy, because a policy that is fine for you may still not satisfy the visa.
Decision table: which cover fits which pattern
| Your pattern | Likely starting point | Check before you rely on it |
|---|---|---|
| Live at home, take trips of a few weeks | Travel insurance, plus a GHIC if you are UK resident and visiting a partner country | Pre-existing conditions declared; activities covered |
| Live at home, spend one or two months at a time abroad | Travel insurance with a long enough maximum trip length | Maximum trip length and annual days-abroad limit; whether remote work is covered |
| Split the year, still resident at home | Long-stay or single-trip travel insurance for each stay | Whether you still meet your home system’s residence rules (for example, Ontario’s seven-month and 153-day tests) |
| Moved abroad, settling in | Local public cover where you qualify, or international health cover, plus travel insurance for trips from your new home | Waiting periods while you register; visa insurance requirements; what happens to cover if you move again |
| Moving between countries with no settled base | International health cover with an area of cover that matches where you actually spend time | The area of cover; how claims are paid; pre-existing condition terms |
Two worked scenarios
Illustrative scenarios. The people and their plans are made up. The rules quoted are from the official sources listed.
Helen, a UK resident wintering in Spain
Helen lives in Bristol and spends about ten weeks in Valencia each winter. She has type 2 diabetes. She is ordinarily resident in the UK, so she can use a UK GHIC for necessary state healthcare in Spain on the same terms as a local resident. The NHS says that can include treatment or routine care for long-term or pre-existing conditions, though whether treatment is medically necessary is decided by the provider in Spain. That still leaves gaps the GHIC does not fill: private treatment, medical repatriation and anything a local resident would pay for. So she buys travel insurance too, and checks two things: that the policy’s maximum trip length covers ten weeks in one go, and that she has declared her diabetes. If an insurer declines her or quotes a medical condition premium of £200 or more, the FCA rules mean it must point her to a medical cover directory such as MoneyHelper’s.
Dev, an Ontario resident working remotely abroad
Dev lives in Ottawa and plans to spend eight months of the next year working remotely from Mexico City. Eight months is more than the seven-month threshold, so he can only keep OHIP if he has spent at least 153 days in Ontario in each of the previous two 12-month periods, keeps Ontario as his primary home and visits ServiceOntario before he leaves. Even if he keeps OHIP, its Travellers Program pays up to CAD 400 a day for intensive inpatient care abroad and nothing towards a transfer home, and Ontario itself recommends buying private health insurance before leaving. Whatever he buys, he would want to confirm that it covers both an eight-month stay and remote work. If Dev decides to stay in Mexico for good, the picture changes again: he would no longer be visiting, and he would need to look at cover built for living there.
Questions to ask before you buy
- What is the maximum length of a single trip, and is there an annual limit on days abroad?
- Does the policy cover me if I work, paid or unpaid, while I am away?
- How are my declared conditions treated, and is any exclusion permanent?
- Does it cover medical repatriation, and to which country?
- For health cover: what is the area of cover, and does it include the countries where I actually spend time?
- If I move again, can I keep or transfer the policy?
- Does it meet the insurance requirement for my visa, if there is one?
Whichever cover you choose, keep a cash buffer for excesses and costs you pay upfront before a claim is settled. Our guide to emergency cash when ISA and FSCS do not apply covers where to hold it.
FAQ
Is a GHIC enough on its own for a trip to Europe?
No. The NHS says the UK GHIC “is not a replacement for travel insurance”. It does not cover private treatment, medical repatriation or mountain rescue, and you may have to pay whatever a local resident would pay.
Can I use travel insurance if I have moved abroad?
Generally not for living there. The FCDO says travel insurance “is not intended for permanent residence abroad”. You can usually buy travel insurance for trips from your new home, but cover for day-to-day life needs to be local or international health cover.
What counts as moving abroad, rather than a long trip?
Each system has its own test. The NHS talks about moving abroad “on a permanent basis”. Ontario uses day counts and a primary-home test. Insurers have their own definitions in the policy wording. Check each one separately, because you can meet one and not another.
Will international health cover pay for an existing condition?
Often not, at least at first. Private health policies usually exclude pre-existing and chronic conditions. Some may cover a condition after a period without symptoms or treatment, depending on how the policy is underwritten. Ask before you buy.
Do I need special insurance for a Schengen visa?
If you need a Schengen short-stay visa, yes: the EU Visa Code requires travel medical insurance with at least EUR 30,000 of cover, including repatriation, valid across the Schengen area for the whole stay.
What this article is not
It is not insurance, medical, legal or immigration advice, and it does not recommend any insurer or policy. It does not cover cancellation, baggage or gadget cover, life insurance or income protection, and it only gives examples of public systems in the UK, the US and Ontario. Helen and Dev are fictional. The official rules quoted were checked on 19 October 2026 and can change, and the policy wording you are offered is what decides your cover.
Sources
- GOV.UK (FCDO): Foreign travel insurance (last updated 2 August 2024). Cost examples (£25,000+, £80,000+, £150,000+); maximum trip length and annual limits; declaring conditions; long-stay cover and work; “Travel insurance is not intended for permanent residence abroad”; local law and visas; transferring cover. Last checked 19 October 2026.
- NHS: Get healthcare cover abroad with a UK GHIC or UK EHIC (last reviewed 12 December 2023). What the card covers and does not cover; countries; “not a replacement for travel insurance”; eligibility. Last checked 19 October 2026.
- NHS: Planning your healthcare when living abroad. Residence-based entitlement; S1 scheme; responsibility for cover while an S1 is registered. Last checked 19 October 2026.
- Medicare.gov: Travel outside the U.S. Medicare usually does not cover care abroad; Medigap may cover emergency care; travel insurance does not necessarily include health insurance. Last checked 19 October 2026.
- Ontario: OHIP coverage while outside Canada (updated 16 January 2026). Seven-month absence rule; 153-day test; Travellers Program limits of CAD 50, CAD 400 and CAD 200 a day; pre-existing conditions not covered; no transfer home. Last checked 19 October 2026.
- EUR-Lex: Regulation (EC) No 810/2009 (Visa Code), consolidated text, Article 15. Travel medical insurance for Schengen visas; minimum coverage EUR 30,000. Last checked 19 October 2026.
- FCA Handbook: ICOBS 6A.4 Travel insurance and medical conditions (last updated 26 June 2026). Circumstances that require signposting, including a medical condition premium of £200 or more (rule effective 1 January 2026). Last checked 19 October 2026.
- MoneyHelper: Travel insurance directory. Specialist FCA-authorised firms; no quotes; cover may still be expensive or unavailable. Last checked 19 October 2026.
- MoneyHelper: What is private health insurance? Pre-existing conditions and chronic illnesses usually not covered. Last checked 19 October 2026.
- Aviva: What is medical underwriting? (published 22 September 2026). Full medical and moratorium underwriting; five-year look-back and two-year clear period under moratorium. Last checked 19 October 2026.
- Bankrolled: Emergency cash when ISA and FSCS do not apply.
- Bankrolled: Operating cash vs investment cash when you hold two currencies.
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