How does health insurance work for expats in the Philippines?

Doctor visits and tests in the Philippines are cheap enough that many people pay for everyday care in cash. The layers that matter are the expensive ones: a hospital stay, a serious illness, and getting moved somewhere for care.

Yes, by choice. The Universal Health Care Act automatically covers every Filipino citizen and does not mention foreigners. The rule written for foreigners is a PhilHealth circular from 2017 (Circular 2017-0003). It lets SRRV holders and other foreigners with a valid ACR I-Card enroll voluntarily. Foreigners employed in the Philippines are covered through their employer instead.

• SRRV holders register through the Philippine Retirement Authority (PRA), using their SRRV or PRA ID.
• Other foreigners register at the nearest PhilHealth office with their ACR I-Card and the registration form for foreign nationals.
• Under that circular the premium is PHP 15,000 a year for PRA retirees and PHP 17,000 a year for other foreigners, payable quarterly, twice a year or yearly. We could find no newer rate for foreigners, so confirm the current amount when you register.
• You must have paid at least 3 months of premiums in the 6 months before a hospital admission to use the benefits.
• A foreign spouse cannot be covered as a dependent of a Filipino member. You enroll as your own member.
• At age 60, after 120 monthly contributions, a foreign member can become a lifetime member and stop paying.

PhilHealth does not reimburse care received outside the Philippines, and the free coverage for Filipino senior citizens does not extend to foreigners.

PhilHealth pays a fixed amount, called a case rate, for each diagnosis or procedure. The hospital deducts it from your bill when you are discharged, and you pay the rest.

In a basic or ward bed at an accredited hospital, covered services should come with no extra charge. Most expats choose a private room at a private hospital, and there the case rate usually covers only part of the bill. Treat PhilHealth as a discount on a hospital stay, not as full insurance.

In Medicare's own words, in most situations it will not pay for care or supplies you get outside the United States. The few exceptions are for emergencies while you are in or traveling through the US. None of them covers someone living in the Philippines, and Medicare drug plans do not cover medicines bought abroad.

Some Medigap policies include limited emergency cover abroad. Check your own policy's terms rather than assuming.

Medicare still matters as the layer for care back in the United States. If you stop paying Part B while abroad and sign up again later, Medicare can charge a late enrollment penalty for as long as you have it. Check Medicare's rules before you decide.

A health maintenance organization, or HMO, is a prepaid plan: you pay a fixed fee, and it covers set services at hospitals and clinics in its network, within the plan's limits. HMOs are common through Philippine employers and are regulated by the Insurance Commission.

For older expats the catch is age. Many HMOs limit new enrollment for older applicants or charge them much more. In 2023 the Insurance Commission said pricing based on genuine risk is not unfair discrimination, so expect age to matter. If you are under 60 and want lower premiums, a local HMO is worth comparing. Read the yearly limit and the exclusions for existing conditions carefully.

An international plan is private health insurance built for people living outside their home country. It pays for private hospitals in the Philippines and, depending on the plan, in other countries too. Many include medical evacuation. It costs more than PhilHealth or an HMO, but it is often the only full hospital cover open to older applicants.

The US State Department advises Americans retiring abroad to get coverage that includes medical evacuation, and the US Embassy in Manila notes that an evacuation can easily cost US$10,000 or more. When comparing plans, check the evacuation cover, the yearly and lifetime limits, whether existing conditions are excluded, and whether US care is included.

Many private hospitals ask for a deposit or payment upfront before a planned admission. Keep a card with room on it, or cash you can reach quickly, and check whether your insurer can send a guarantee of payment to the hospital directly.

Emergencies are different. Philippine law (Republic Act 10932, 2017) bars hospitals from asking for a deposit or any advance payment before giving basic emergency care in an emergency or serious case. Staff who break it face fines and jail, and a hospital whose policy breaks it can lose its license.

• Assuming Medicare or a US employer plan works in the Philippines.
• Joining PhilHealth and treating it as full cover for a private hospital.
• Waiting until your 60s to look for private cover, when the choices are fewer and pricier.
• Buying a plan without medical evacuation, or without reading its limits.
• Having no quick way to pay a hospital deposit for a planned admission.