International health insurance for freelancers: Your 2026 guide

As a freelancer, there’s a good chance you’re used to complicated rules around tax, pensions, accounting, and much more. And wherever you’re living, healthcare is just another thing to add to this list.

This is hard enough in your home country. But for expats, it’s even tougher. This is because there’s a whole range of questions you need to answer first. How do freelancers get health insurance? What policy do you need? What coverage should you take? How does this interact with your visa?

In truth, the answer can be very different depending on where you’re moving to and from. Here, we explain how health insurance works for expat freelancers around the world. For a broader overview of how cover works globally, see our definitive guide to international health insurance.

Why international health insurance matters for expat freelancers

In many countries, health insurance is a non-negotiable requirement – even for permanent residents. But as a self-employed expat, there are several reasons why it’s particularly important for you:

• Healthcare: The first reason is the most obvious. Without health insurance, you risk needing emergency healthcare and not being able to afford it. At its worst, this can result in high out-of-pocket costs or being denied treatment.
• Visa requirements: As an expat living abroad, you will likely require health insurance as a condition of your visa. In this case, an international health insurance policy can be the best way to meet these requirements. We've covered the specifics of this in our guide for visa applicants.
• Employer contributions: In some countries, employers are required to offer private healthcare insurance. As a freelancer, you unfortunately don’t qualify for this – a challenge shared by the unemployed and other groups without an employer plan. In practice, this makes it more likely that you’ll have to buy a long-term private policy that covers all your healthcare needs.

Therefore, most self-employed expats will need some form of health insurance. But what does that include?

How do freelancers get health insurance: comparing the main options

For expats and digital nomads, there are several different types of health insurance you need to consider. The same logic also applies to other groups going abroad, such as students:

• Travel insurance: This is designed for vacations, work projects, or other self-contained trips. It focuses on emergency and acute treatment – and is only valid on a per-trip basis. Therefore, it isn’t suitable for expats or freelancers, unless you’re only staying short-term. In fact, many visas explicitly rule out travel insurance as an option.
• International insurance: This is any insurance policy designed for expats. It aims to provide health coverage for those moving abroad either permanently or for more than a few months. Many expats will take out international health insurance policies to qualify for a visa. Then, they can transition to domestic public or private insurance after they’ve arrived.
• Domestic private insurance: This is the standard private insurance used by citizens and long-term residents in a country. Long-term expats can use these policies alongside (or instead of) public healthcare policies.
• Domestic public healthcare: Many countries also offer public healthcare coverage. This is particularly the case in the European Union (EU) and European Economic Area (EEA) countries. Generally, freelancers or expats will qualify for this after a certain period living in the country. In some cases, it is even a requirement.

What international health insurance do you need around the world?

Getting the right health insurance policy for your situation isn’t straightforward. To get it right, there are several key questions you need to understand the answers to:

• How do freelancers get health insurance?
• What health insurance is required for your visa?
• When do you need to secure the policy?
• How long should it be valid for?
• Can you transition to public healthcare coverage? And when?
• Are public or private health insurance policies tax-deductible?

In truth, the answers to this will differ depending on the country you’re traveling to and where you’ve come from. Therefore, it’s helpful to discuss requirements in key locations around the world:

United States

In the United States, there’s no single, dedicated visa for freelancers. Instead, one of these three options is most likely to apply:

• O-1A/O-1B: For individuals with extraordinary ability in business, science, arts, or athletics. Allows self-employment with a US-based agent or sponsor.
• EB-1A/EB-2 NIW: These are green card routes for those with extraordinary ability or national interest. It bypasses the need to be sponsored by an organization. These are permanent residency, not visas.
• E-2 Treaty Investor: Technically for business investment, but used by some self-employed individuals. Very limited freelancing scope.

In practice, the second and third options on the list aren’t really designed for freelancers. This makes the O-1A/O-1B visa the most common route.

The United States does not require private health insurance as a condition of these visas. Nonetheless, the cost of healthcare in the US means it is virtually essential to be covered.

In the US, there is no universal public healthcare system. Therefore, private health insurance for expat freelancers is similar to that of local residents. The main difference is you won’t receive any employer-sponsored health insurance, which many in the US rely on.

On the bright side, however, private insurance premiums are tax-deductible in the US. This applies to premiums for yourself, a spouse, and dependents. If you're insuring children too, our guide to international health insurance for families covers what to look for.

Germany

In Germany, freelancers are known as ‘Freiberufler’ or ‘Selbstständiger’. There are two main visa routes for expat freelancers to enter the country:

• Freelancer Visa (‘Freiberufler Visa’): The primary route for self-employed professionals (writers, artists, engineers, consultants, IT, etc.)
• Opportunity Card (‘Chancenkarte’): A points-based visa for job/work-seeking, including exploratory self-employment. This isn’t a full freelancer visa, but it can be a stepping stone to one.

Germany has a two-part healthcare system. Most citizens and long-term residents are covered under the public healthcare system. This is known as GKV (‘gesetzliche Krankenversicherung’). Otherwise, employees who earn over €77,400 a year can opt for private insurance (‘private Krankenversicherung’ or ‘PKV’) – though there is no minimum for freelancers.

For expats, however, PKV remains the default setting. Germany requires all visa applicants to have private health insurance when they apply. The policy must offer the equivalent coverage as Germany’s public GKV system.

The healthcare insurance also needs to be valid before you apply for the visa. Generally, this means you’ll need to purchase a policy before making the application.

Most self-employed expats in Germany will need indefinite private health insurance. This is because most non-working expats do not qualify for public healthcare coverage. The main exception is if you’ve historically made social security contributions in an EU country. In this case, you may opt in to GKV, making your private insurance requirements redundant.

In Germany, public healthcare (via GKV) is tax-deductible as ‘special expenses’ (‘Sonderausgaben’). Private contributions (via PKV) are only tax-deductible up to the equivalent GKV rate.

France

France has two main routes for expat freelancers looking to gain a visa:

• Long-Stay Visa (VLS-TS) (‘Visa de Long Séjour valant Titre de Séjour’): This is the default visa for non-EU/EEA nationals planning to stay in France for between 90 days and a year.
• Talent Passport (‘Passeport talent’): A four-year talent passport for entrepreneurs, investors, and independent professionals. It aims to award entry to those with a compelling project or established expertise.

Like most European countries, France requires you to have valid health insurance when you apply for your visa. The policy must offer the same level of coverage as the French public healthcare system. This is known as PUMA (‘Protection Universelle Maladie’).

In France, you can apply for public healthcare coverage after just three months’ residence in the country. If you register as self-employed in France, this becomes a legal requirement. When you qualify for PUMA coverage, any private health insurance you have is redundant and can be canceled.

In practice, this means many freelancers only need short-term health insurance policies when they apply for the visa. However, even with public coverage, you will likely still require a top-up insurance policy (‘mutuelle’), as PUMA does not cover 100% of costs.

However, French lawmakers are currently reforming this law to ensure that non-EU nationals must contribute a ‘minimum healthcare contribution’ to qualify for PUMA coverage. At the time of writing, this law does not apply, but could be introduced as early as this year.

Generally, social security and top-up insurance contributions are tax-deductible in France.

Spain

Spain also has two main visa routes for self-employed expats looking to relocate. Broadly, these depend on whether you expect most of your income to come from inside or outside of Spain:

• Self-employment visa (‘Autónomo Visa’): This is the traditional route for non-EU nationals wishing to live and work in Spain as self-employed. Generally, this is better suited to those looking to register as a freelancer in Spain and stay long-term.
• Digital Nomad Visa (‘Visado de nómada digital’): For remote workers and freelancers working primarily for clients outside Spain. This is a recent addition to the Spanish system and is now one of the most popular routes of entry for international freelancers. To be registered under this visa, at least 80% of your income must be derived from outside of Spain.

In principle, the situation here is similar to in France. If you’re registering permanently, you’ll generally do so as an Autónomo. In this case, you must contribute to the country’s public healthcare system (‘Seguridad Social’).

If you’re registered as a digital nomad, you’ll likely need full-time private insurance. It must cover your full visa period and be active when you apply.

In Spain, public social security contributions are fully tax-deductible. However, private contributions are only partially deductible. By default, Autónomos can deduct up to €500 a year per insured person. In some cases, such as disabilities, this can be higher at €1,500 a year.

United Kingdom

In the United Kingdom, the situation is different from other countries on this list. That is because public healthcare coverage is the default setting for most people in the country. This is done through the National Health Service or ‘NHS’.

Regardless of the visa you’re applying for, the situation is effectively the same. The majority of visa applicants will have to buy access to the NHS up-front as a pre-condition of their visa being accepted. This is known as the ‘Immigration Health Surcharge’ (IHS). In 2026, the rate is £1,035 per year for most visa applications. If you’re applying for a multi-year visa, you’ll have to pay the IHS up-front for all years.

If you’re staying in the UK for less than six months, you do not need to pay the IHS. Instead, you will simply be charged up-front for any health-related needs you have while you are here. You may choose to purchase private health insurance to cover this, but there is no requirement to do so.

How can freelancers choose the right international health insurance policy?

As a freelancer, getting the right international health insurance policy is not straightforward. To get it right, you need to thoroughly check the details. Then, take the time to understand their implications for your budget and healthcare coverage.

Here are some tips to help you ask the right questions:

Check your visa requirements

In Europe, you’ll almost certainly require private healthcare for your visa to be accepted. Elsewhere, the situation may be more flexible. Either way, you should check the requirements before choosing the policy.

Check the cancellation terms

In some cases, you will qualify for public healthcare coverage shortly after arriving. Nonetheless, you will still need international healthcare insurance when you apply for the visa. In this case, the policy would become redundant shortly after. If this applies to you, you should ensure the policy has flexible cancellation policies so you don’t get stuck paying for something you don’t need.

What coverage do you need?

You should also consider what type of coverage you need in the short and long term. This could apply to opticians, dental/orthodontic care, or chronic conditions. In particular, international health insurance for pre-existing conditions can be expensive – this is especially relevant for older freelancers and seniors. So it’s important to understand what these implications are before you start looking.

Extra coverage generally comes with higher premiums. But it’s often worth it if you’re likely to need the treatment. Otherwise, you may prefer a lower up-front premium, though this risks higher out-of-pocket expenses in the long run.

Consider co-pays or deductibles

Co-pays or deductibles can help bring down your premium in the short term. But it can be a false economy. These additional costs can easily add up if you find yourself needing a particular type of treatment a lot. You should also be aware that co-pays and deductibles are not allowed for most visas in the Schengen area. If you’re considering going down this route, tread carefully and check the details thoroughly.

Decide whether to register as self-employed

In some cases, expat freelancers can live in a country without registering there as self-employed. This is essentially the ‘digital nomad’ route. Here, freelancers remain registered with their country of origin for tax purposes. If you’re staying in the country temporarily, this can offer a smoother transition.

But in practice, if you’re moving permanently, you’ll almost certainly end up registering in your country of residence sooner or later. In many European countries, this is the only way to access public healthcare entitlements. You should check what self-employed health insurance options are available. If necessary, consult a tax expert or lawyer to better understand the implications for your situation.

Feather: expert health insurance for expats

“They made everything very straightforward and I had no problem when it came to dealing with claims and bills. Once I started working it was very easy to switch my insurance from expat to public health insurance. Everything was so smooth and stress-free. I am forever grateful I went with Feather, I had the best experience.”

— Amanda, Feather customer (via Google)

At Feather, we understand how daunting healthcare can be when you first move abroad. If you get it wrong, there’s a real risk of huge bills or rejected visas.

We know this, because Feather was founded by expats like you. We thought there should be a better way for expats like you to understand and find the right insurance policy for your situation. So, we created it.

That’s why we offer a range of flexible international healthcare policies. Crucially, these are designed specifically for expats. This means our coverage is designed with European visa requirements in mind – so you don’t have to worry about your policy getting accepted. And if you’re confused about your visa situation, you can rely on our friendly English-speaking support team to explain the details.