How Do US Healthcare Costs Compare to Europe?

Private health insurance in Spain costs €60-100/month with no copays and no deductibles, compared to $600-1,200+/month for a US marketplace plan in 2026 — a savings of $6,000-13,000+ per year. Portugal's private plans start at €30/month, and the Netherlands' mandatory system averages €100-150/month with comprehensive coverage.

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For a lot of Americans considering a move abroad, healthcare is the thing that tips the conversation from "maybe someday" to "let's actually do this." Healthcare is one of the top drivers of the current wave — our analysis of why Americans are leaving in 2026 covers the full picture.

It's not hard to see why. The U.S. spends more per person on healthcare than any other developed country in the world — at least 40% more than the next closest — yet Americans have shorter life expectancies, higher rates of preventable death, and more than one in four report skipping medical care because of cost. And in 2026, it just got worse.

The enhanced premium tax credits that subsidized ACA marketplace plans expired on December 31, 2025. An estimated 20+ million Americans who were receiving subsidies are now seeing premiums jump by an average of 114%, according to KFF analysis. The average benchmark premium is projected to nearly double — from roughly $888/year to $1,904/year. The Urban Institute estimates that 4.8 million additional people could lose coverage entirely.

Meanwhile, in the three countries where our platform helps Americans relocate, healthcare looks like this: Spain's private insurance starts at roughly $75/month with no co-pays. Portugal's public system is available to residents at minimal cost. The Netherlands has a mandatory, regulated system averaging €100-€150/month with some of the shortest wait times and highest satisfaction rates in Europe.

This isn't a theoretical comparison. It's the difference between staying in a system that's actively getting more expensive and moving to one that's designed differently from the ground up.

How Do European Healthcare Systems Actually Work?

The biggest conceptual shift for Americans is understanding that in Europe, healthcare access isn't tied to your employer. Every legal resident has access to care — the mechanisms just differ by country.

Spain operates a dual system. The public healthcare system (Sistema Nacional de Salud) is funded through taxes and social security contributions. Once you're registered as a resident and contributing to Spanish social security — which happens automatically when you register as an autónomo or through your employer — you're covered. There are no premiums, no deductibles, and no co-pays for most services through the public system. Wait times for specialists can be long in some regions, which is why many expats also carry private insurance. Private coverage in Spain is remarkably affordable by American standards — comprehensive plans from providers like Sanitas or DKV start around €60-€80/month for individuals, covering specialist visits, diagnostics, and hospital care with no co-pays and very short wait times.

Portugal also has a public national health service (Serviço Nacional de Saúde, or SNS) available to all legal residents. Registration happens after you receive your residence permit and obtain a user number from your local health center. Public care is either free or involves small co-pays (called taxas moderadoras) — typically €4-€5 for a GP visit. Hospital emergency visits are around €15-€18. As with Spain, many expats supplement with private insurance for faster access and English-speaking providers. Private premiums in Portugal start around €30-€60/month for basic coverage, scaling higher for comprehensive plans.

The Netherlands takes a different approach. Health insurance is mandatory for every resident, and you must purchase a basic package (basiszorgverzekering) from one of several regulated private insurers. The government sets what must be covered — GP visits, hospital care, prescription drugs, mental health, maternity — and insurers compete on price and service. Premiums average €100-€150/month per adult. There's a mandatory annual deductible (eigen risico) of €385 in 2026. Children under 18 are covered free. Income-based subsidies (zorgtoeslag) are available for lower earners. The Dutch system is consistently rated among the best in Europe for quality, access, and patient satisfaction.

What Does Healthcare Actually Cost in Each Country?

Here's what a healthy 35-year-old remote worker would pay in each country, compared to the U.S.:

United States (2026, without ACA subsidies): Monthly premium: $600-$1,200+ for a marketplace plan (wide variation by state, age, and tier). Annual deductible: $1,500-$8,000+ depending on plan. Co-pays and coinsurance on top of that. A single unexpected ER visit with imaging and labs can easily cost $2,000-$5,000 out of pocket even with insurance.

Spain: Public system: €0 (covered through social security contributions, which you're already paying as a resident). Private insurance: €60-€100/month for comprehensive coverage. No co-pays on most private plans. No deductible. Annual total: roughly €720-€1,200 for private coverage — about $800-$1,300 per year. For a detailed breakdown of Spanish insurers, pricing, and the dual public-private strategy most expats use, see our guide to health insurance in Spain.

Portugal: Public system: Minimal co-pays (€4-€5 per GP visit). Private insurance: €30-€80/month for supplemental coverage. Annual total: roughly €400-€1,000 for private supplemental coverage — about $440-$1,100 per year.

The Netherlands: Mandatory insurance: €100-€150/month. Annual deductible: €385. Children free. Annual total: roughly €1,585-€2,185 — about $1,700-$2,400 per year. This is the most expensive of the three European options but still dramatically less than most U.S. plans, and the coverage is comprehensive with no surprise billing.

For a family of four, the U.S. cost gap widens further. A family marketplace plan without subsidies can easily run $1,800-$2,500/month in 2026. In Spain, adding family members to private coverage typically costs €150-€300/month total. In the Netherlands, children under 18 are free, so you'd add one adult premium.

What Does European Health Insurance Cover?

Americans are accustomed to fighting with insurance companies about what's covered. European systems work differently.

In all three countries, the following are standard for residents: GP and specialist visits, hospital stays and surgery, prescription medications (often at reduced or no cost), maternity care, mental health services, emergency care, preventive screenings, and laboratory and diagnostic testing.

Spain's private plans also commonly include dental care, physiotherapy, and optical — services that are typically separate (and expensive) add-ons in the U.S. The Netherlands mandates mental healthcare, maternity, and physical therapy in the basic package. Portugal's public system covers rehabilitation and palliative care.

Dental coverage varies most across the three countries. Spain's private plans often include basic dental. In the Netherlands, dental is not included in the basic package for adults (it's covered for children under 18) and requires supplemental insurance. Portugal's public dental care has long wait times, and most expats use private dental services.

How Much Do Prescription Drugs Cost in Europe?

The cost of prescription medication is another area where the difference is stark. The U.S. has some of the highest drug prices in the world, driven by pharmaceutical company pricing practices, pharmacy benefit manager markups, and a fragmented negotiation system.

In all three European countries, prescription drugs are regulated and subsidized. Common medications that cost hundreds of dollars per month in the U.S. — blood pressure medication, cholesterol drugs, insulin, thyroid medication — typically cost €5-€20 per month or less in Spain, Portugal, and the Netherlands, often fully covered by insurance.

If you're currently spending significant money on prescriptions in the U.S., the savings from European pharmaceutical pricing alone can be substantial.

What Happens to Your US Health Insurance When You Move Abroad?

Moving abroad raises practical questions about U.S. health insurance:

ACA marketplace plans: You can drop your marketplace plan when you establish foreign residency. Moving abroad qualifies as a qualifying life event. You are not penalized for being uninsured while living outside the U.S.

Employer coverage: If your employer allows you to keep U.S. health insurance while working remotely abroad, it may not cover you for care received in Europe (check the plan's international coverage terms). Many remote workers drop employer coverage and rely on their European country's system plus local private insurance.

Medicare: If you're over 65 or approaching Medicare eligibility, note that Medicare generally does not cover care received outside the U.S. You'll need to maintain your European country's healthcare coverage. You can still keep Medicare Part A (hospital insurance) premium-free if you've earned enough U.S. work credits, which can be useful for visits back to the U.S.

Travel insurance is not health insurance. Every European visa program explicitly requires health insurance valid in the destination country — travel insurance and international nomad policies (SafetyWing, World Nomads) are generally not accepted for visa applications. You need local coverage.

Are Pre-Existing Conditions Covered in Europe?

In the U.S., the ACA prevents denial based on pre-existing conditions for marketplace plans, but it doesn't prevent high premiums. In Europe:

Spain: Private insurers can exclude or limit coverage for pre-existing conditions, but the public system covers everything for residents regardless of medical history. Many expats rely on the public system for chronic condition management and use private insurance for routine care.

Portugal: The public SNS covers all residents regardless of pre-existing conditions. Private insurers may impose waiting periods or exclusions for specific conditions.

The Netherlands: The basic health insurance package is legally required to accept all applicants regardless of pre-existing conditions, at the same community-rated premium. Insurers cannot deny you or charge more based on your health status. This is the most protective system of the three for people with existing health conditions.

Is European Healthcare Actually Good?

A common American concern: "Is the healthcare actually good?"

The short answer is yes — and in many measurable ways, better than the U.S. system.

KFF's international comparison data shows that the U.S. underperforms peer nations on life expectancy, infant mortality, and preventable deaths despite spending far more per capita. More than 25% of Americans report skipping care due to cost — a figure that's dramatically lower in countries with universal or mandatory coverage.

The Netherlands is consistently ranked among the top 3 healthcare systems in Europe by the Euro Health Consumer Index. Spain ranks highly for life expectancy and specialist care quality. Portugal's system has improved substantially in recent years and provides solid primary care coverage.

You may experience longer wait times for non-urgent specialist appointments in public systems (especially Spain and Portugal) compared to the U.S. — but you won't receive a $47,000 bill for an appendectomy either.

The Bottom Line for 2026

The ACA subsidy expiration makes this comparison more stark than it's been in years. For millions of Americans, particularly self-employed workers, freelancers, and early retirees who don't qualify for employer coverage, 2026 healthcare costs in the U.S. represent a significant financial burden that simply doesn't exist in most of Europe.

Healthcare alone doesn't justify an international move. But for Americans who are already considering relocation for work, lifestyle, or family reasons, the healthcare math removes one of the biggest practical obstacles. You're not trading quality for affordability — you're getting both.

If healthcare costs are part of your decision, see how the three most accessible European visa programs compare in our Spain vs. Portugal vs. Netherlands guide. Want to find out which European visa you qualify for? Our free eligibility assessment takes about 5 minutes.

Ready to prepare your documents? Our platform generates your complete visa application package — pre-filled forms, cover letters, and a step-by-step checklist. Start your free assessment →

Frequently Asked Questions

How much does health insurance cost in Spain for Americans?

Private health insurance in Spain costs €60-100/month for comprehensive coverage with no copays and no deductibles. The public system is free once you're a registered resident contributing to Spanish social security. Most American expats carry both for maximum flexibility.

Can I keep my US health insurance if I move to Europe?

You can, but it usually doesn't make sense. Most US plans don't cover care received abroad, and you'll need local insurance for your visa anyway. You can drop ACA marketplace plans penalty-free when you establish foreign residency. Medicare Part A can be kept premium-free for visits back to the US.

Does European health insurance cover pre-existing conditions?

Yes, through the public systems in all three countries. The Netherlands goes furthest — private insurers are legally required to accept all applicants at the same premium regardless of health status. In Spain and Portugal, the public healthcare system covers all residents regardless of medical history.

Is travel insurance accepted for European visa applications?

No. Every European visa program requires health insurance valid in the destination country. Travel insurance and international nomad policies like SafetyWing or World Nomads are generally not accepted. You need a local or EU-recognized health insurance plan.

How much do prescription drugs cost in Europe compared to the US?

Common medications that cost hundreds of dollars per month in the US — like insulin, blood pressure medication, and cholesterol drugs — typically cost €5-20/month or less in Spain, Portugal, and the Netherlands. European governments regulate pharmaceutical pricing and subsidize most prescriptions.

What about dental care in Europe?

Spain's private insurance plans often include basic dental coverage at no extra cost. In the Netherlands, adult dental requires supplemental insurance (children under 18 are covered). Portugal's public dental has long wait times, so most expats use affordable private dental services.

Sources referenced in this article:

• KFF (Kaiser Family Foundation): ACA subsidy expiration analysis, international health system comparison (2025)
• Urban Institute: Coverage loss projections (2025-2026)
• Commonwealth Fund: International health system rankings
• Expat Focus: International Healthcare Update (January 2026)
• World Population Review: Health care costs by country (2026)
• William Russell: International health insurance costs (2026)
• Get Golden Visa: Top 10 healthcare systems for expats (January 2026)
• Investment Visa: Healthcare in Europe for expats (October 2025)
• Peterson-KFF Health System Tracker: U.S. vs. peer nation comparison (September 2025)