According to recent data from the Employee Benefit Research Institute (EBRI), many U.S. retirees are falling short in their health care budget planning by six-figure sums.

And though Medicare may cover a lot, it doesn’t cover everything, meaning retirees still need a good deal of savings set aside for health care costs.

Indeed, the EBRI’s findings suggest that individuals on lower-cost Medicare Advantage plans will need savings from $60,000 to $125,000 to cover additional health care costs while individuals with Medigap or traditional Medicare will need from $120,000 to $250,000. For couples, additional health care costs range from an estimated $135,000 to $405,000.

In more extreme cases, such as particularly high prescription drug expenditures, the EBRI model finds a couple will need to have saved as much as $469,000 to adequately cover their health care costs in retirement.

For some, those amounts are simply unattainable. Little wonder then that one of the chief motivators for many North Americans seeking a better life overseas is unaffordable health care costs at home.

The good news is, in a host of overseas havens first-rate medical facilities, English-speaking doctors, and exceptionally high standards of care are the norm.

Let’s take a look at some of the best options…

Mexico

Mexico’s health care system provides both public (comprised of both a social security system and a public-services system) and private options, and the treatments are high-quality and affordable.

You can find at least one hospital in every mid-sized and large city, and many Mexican doctors will have trained in the U.S., Europe, or Canada and speak English fluently. The country’s best hospitals are found in the capital, Mexico City, and in Guadalajara, Monterrey, Puerto Vallarta, and Cancún.

Many of Mexico’s private facilities cater extensively to international patients, accept most global insurance plans, and are familiar with coordinating billing for American expats.

For most expats, Mexican health care is so affordable that they opt to pay out of pocket for basic medical needs and only return to the United States should serious health problems occur.

Mexico’s national health care program, the Instituto Mexicano de Seguro Social (IMSS), is available to retired expats for a small annual fee. To join the system you must have a valid visa and provide medical tests. There are also some limitations based on pre-existing conditions. Public services are more limited and offered in Spanish but can provide an affordable safety net for long-term expats on a budget.

Thailand

Thailand is a highly sought-after medical tourism destination, attracting people from around the world with its affordable, excellent quality care and many English-speaking care providers. Medical procedures in Thailand can cost anywhere from 20% to 80% less than they do in the U.S.

Thailand is home to more than 1,000 public and private hospitals including 62 Joint Commission International (JCI)–accredited hospitals, the fourth-highest number of JCI-accredited hospitals in the world.

To access private health care facilities, most expats maintain private insurance. Some of the country’s best facilities are found in the capital, Bangkok, and in Chiang Mai, Phuket, Pattaya, and Hua Hin.

For those working in Thailand, the Thai social security program is an affordable option for health insurance coverage inside a network of both public and private hospitals. It covers most standard medical expenses including hospitalization, doctor visits, and prescribed medicines, and the fees run about $20 per month.

Hospital fees are strictly structured in Thailand so there’s no fear of unscrupulous doctors or pharmacists charging more than they should.

Spain

Spain has both a private and public health care system. The public system, La Sistema Nacional de Salud (SNS), is taxpayer-funded, administered under the country’s Ministry of Health, and used by around 90% of the population.

Services covered by the program include emergency hospital visits, doctor consultations, and in-patient and out-patient care. Expats from EU countries have the right to medical treatment in Spain thanks to European-wide reciprocity agreements but different rules apply for those coming from non-EU countries including the U.S.

Retired expats need to take out private health insurance—proof of which is a requirement for a residence visa—at least initially, to access Spain’s public health care system. Monthly premiums typically range from €100 to €300 but will depend upon a range of factors including pre-existing conditions and your age.

Spain also operates a government pay-in plan—the Convenio Especial—under which, after a year as a resident in Spain, you can pay a monthly fee (€60 for under-65s rising to €157 for those 65 and over) to gain access to the national health system.

For minor ailments, knowledgeable staff in local pharmacies can provide good advice and recommend remedies—some of which would require prescriptions back home.

Panama

Panama has a three-tier health care system comprising public hospitals, social security institutions (which you gain access to by being employed), and private facilities.

Most expats opt for private facilities which offer English-speaking staff, high standards of care, and affordability—particularly in comparison to the U.S.—by means of Panama’s inexpensive insurance policies.

It’s important to note that while health care in Panama is a good deal cheaper than in the U.S., local health insurers often impose waiting periods for pre-existing conditions. Coverage under international or expat health plans depends on factors such as age, medical condition, and the insurer’s policies and can result in higher premiums or exclusions for certain conditions.

Most of Panama’s best hospitals are concentrated in the capital, Panama City. Punta Pacifica Hospital is well-regarded and affiliated with Johns Hopkins Medicine International. It offers a wide range of specialists, English-speaking staff, and almost luxury-level facilities.

Other popular expat options are Paitilla Hospital, Hospital Nacional, and Santa Fe Hospital where you’ll find U.S.-trained doctors well-versed in all manner of prescriptions and ailments.

Outside of Panama City, Chitré, the capital of the Panamanian province Herrera, which is located in the northeast of the Azuero Peninsula some four hours from Panama City, stands out for its health care offerings.

Portugal

Portugal is home to one of Europe’s most impressive health care systems. Public health care is available to legal residents who are registered with their local medical center and is essentially free.

The country’s national health care system, the Serviço Nacional de Saúde (SNS), guarantees all basic health care needs are covered including most specialist consultations, GP visits, and hospital treatments.

That said, it’s important to note that wait times in the public system can be considerable. Most expats supplement the public program with insurance that allows them to visit private facilities.

As in many European countries, public hospitals are normally better equipped for emergency situations than private hospitals. On the whole, the Portuguese hospital network offers well-equipped, modern facilities staffed by a good number of English-speaking doctors, particularly in the bigger cities. Some of the best hospitals are found in the capital, Lisbon, in Porto, and in the country’s Algarve region.

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