39 year old US expat – insurance options?

Hi all – thanks in advance for any help!!

Question up front:

What are my options, especially to cover me in the US in the case of serious illness? Am I correct that I cannot get a high-deductible plan to cover me only in the US as a US citizen residing abroad? Should I apply for a super high-deductible expat insurance plan? Do I have any options at all?


I’m 39 years old and I am an American citizen. I moved to Europe in 2023. I’d rather not say which country to keep this as confidential as possible.

I have national health insurance from my new country, but in this country the public hospitals aren’t very good (even if you ask locals).

I have a local job with a very small employer that doesn’t offer private health insurance, so that’s not an option.

I’m fairly financially successful (low 7 figures net worth and $80-100K annual income) and for this reason, I can cover routine / minor health care out of pocket (cash) at local clinics.

Why do I want private insurance? I want catastrophic care, care for a hospital stay, cancer, major surgery. If I become seriously ill, or require major surgery, I’ll definitely want to go back to the US for care.

My health:

Unfortunately, I was denied by two expat health insurance companies, GeoBlue and Cigna due to pre-existing conditions.

I’m a 39 year old man, I’m 180cm (5’11”) and 80kg (about 180 lbs) with 7% body fat. I’m very active. I have normal blood pressure, no diabetes, no heart conditions etc.

My pre-existing conditions are pretty typical for a 39 year old man except for those outlined further below: shoulder tendinitis, back pain / with a disc bulge shown on MRI, irritable bowel syndrome (this is not a serious disease – it’s not IBD, Crohn’s disease – it requires no medication), and plantar fasciitis.

Atypical pre-existing conditions:

I had 2 colonoscopies to rule out anything serious due to my GI complaints, and during the first of them, the doctor found a 1cm polyp. I had a follow-up colonoscopy 3 years later that was totally clean, no findings. However, I have a family history of colorectal cancer, so I can imagine maybe this was seen as high risk by GeoBlue and Cigna.

The other thing that may have killed my health insurance applications: I got flagged as a potential auto-immune disease patient this year when investigating some hip pain (again, I’m very active and I probably overdid it), but it was totally bogus. I was applying for health insurance at this time. I had an MRI of my hip and the radiologist was an idiot and referred me to rheumatology. Since then, 3 different orthopedists have told me the radiologist read the MRI wrong. I also saw a rheumatologist and an immunologist and both said “no auto-immune disease – monitor just in case”.