You have a chronic condition.
You can still get covered abroad.
The median 65-year-old American manages at least one ongoing condition — high blood pressure, type 2 diabetes, statins, a cardiac history. The good news: most international carriers will insure you. The important news: the terms vary dramatically by condition and carrier, and two of the five major insurers are genuinely bad choices for certain conditions.
60-second version:
- ✓ Your hypertension and statins: most carriers handle these well under full medical underwriting.
- ✓ Your type 2 diabetes: coverable at Cigna and BCBS; complicated elsewhere; permanently excluded at AXA.
- → Your GLP-1 medications (Ozempic/Wegovy): no carrier has a public policy — assume out-of-pocket, but European prices are 70–85% lower than the US.
- ✗ Your cardiac history (recent stent or heart attack): the hardest scenario to insure. Use an impaired-risk broker, not a DIY quote tool.
Not managing any chronic conditions? The main insurance guide is the right starting point.
Published
This page is educational, not licensed insurance advice. Underwriting decisions are made individually — the carrier assessments here reflect general policy and community-verified patterns, not a guarantee of coverage for any specific applicant. Always disclose your full medical history when applying, and confirm terms directly with the insurer or a licensed broker before purchasing.
Moratorium underwriting is a trap for retirees on daily medications.
International insurers offer two underwriting approaches. One is designed for relatively healthy applicants who want to skip the paperwork. The other is the one that actually covers you.
The right choice for retirees with managed conditions
You disclose your full medical history upfront. The underwriter reviews each condition and tells you exactly what is and isn't covered. You may get a pre-existing condition explicitly covered, excluded with a time limit, or excluded permanently — but you know before you buy.
When you apply: always request FMU. If the insurer doesn't offer it, that's a signal.
Structurally useless if you're on daily medication
No medical forms — sounds convenient. The catch: any pre-existing condition is excluded for a 24-month continuous symptom-free, treatment-free, and medication-free period.
If you take daily metformin for type 2 diabetes, the 24-month clock never starts. The condition will never be covered under moratorium. Same for daily statins, antihypertensives, or any ongoing medication.
Allianz and AXA both offer moratorium — don't use it if you're on any daily maintenance medication.
What each carrier actually does with your condition.
Five conditions, five carriers. The verdict per cell — and where to look if you need to dig in.
Best options: Cigna (explicit underwriting review; can cover T2D; no age cap) and BCBS Global (waives waiting period if you had continuous US health insurance before enrolling — Medicare Parts A+B likely qualifies, confirm with broker).
Avoid AXA for T2D — it is permanently excluded under moratorium underwriting, and AXA's standard FMU position is also unfavorable for diabetes specifically.
How each carrier handles type 2 diabetes
Explicitly lists T2D as a condition it can cover after underwriting review. May accept with premium loading or partial exclusion. No age cap. Outpatient module required for ongoing Rx coverage.
If you had 6+ months of continuous US health insurance immediately before enrolling, the 6-month waiting period is waived — T2D covered from day one. Without prior coverage: 6-month wait. Hard stop at age 83.
Under FMU: underwriter may accept with special terms. Under moratorium: permanent exclusion (clock never starts on daily medication). Always choose FMU. New applicants capped at 75.
Standard 24-month waiting period. May be waived with creditable prior coverage (no gap exceeding 63 days). Chronic daily management is not well covered — IMG's model focuses on acute illness. New applicants capped at 74.
AXA explicitly lists T2D as permanently excluded under moratorium — not subject to a waiting period, but a flat permanent exclusion. FMU outcome for T2D is also unfavorable per AXA's public underwriting position. Do not rely on AXA as your primary insurer if you have T2D.
Controlled hypertension is the most commonly accepted pre-existing condition in international insurance. Under FMU, most carriers accept it with no additional exclusion — sometimes no loading, either. BCBS and Cigna lead here.
AXA caution: even if hypertension is "accepted" at underwriting, AXA's 5-year lookback means related conditions — a stroke, heart attack, or kidney damage linked to hypertension — may still be excluded. Read the underwriting decision carefully.
How each carrier handles controlled hypertension
Cigna explicitly lists hypertension as a condition it can cover. Likely accepted at underwriting — possibly with premium loading. No age cap; guaranteed renewal.
Explicitly listed as covered under the creditable coverage waiver. With continuous prior US insurance: covered from day one. Hard stop at 83.
Under FMU, Allianz explicitly states 70% of applicants are accepted with no additional exclusions. Hypertension is a commonly accepted condition. Moratorium path: excluded indefinitely if on daily medication.
Standard 24-month wait; waivable with creditable prior coverage. After the wait, hypertension-related claims should be covered. New applicants capped at 74.
5-year lookback. Hypertension itself may be accepted at FMU. However, AXA's underwriting may still exclude related conditions — stroke, heart attack, or kidney damage — as "arising from" the hypertension. Confirm exactly what the exclusion covers before buying.
The statin itself is rarely the underwriting problem. The real question is whether ongoing maintenance prescriptions are covered — not all international plans include outpatient pharmacy as a standard benefit.
One piece of good news: generic atorvastatin runs €5–12/month across most of Europe. Even without prescription coverage, the out-of-pocket cost is low enough that many retirees simply pay it.
How each carrier handles statins and outpatient Rx
Creditable coverage waiver applies to statins as a pre-existing condition. Outpatient pharmacy included. With prior continuous US coverage: covered from day one.
Chronic maintenance prescriptions are covered under Cigna's outpatient module (not the base plan). The module must be added at enrollment — confirm it's included before buying.
If underlying cardiovascular condition is accepted at FMU, statins should be covered as treatment for it. Moratorium path: excluded indefinitely if on daily Rx.
IMG's model covers acute illness, not chronic maintenance. Outpatient pharmacy is an add-on, but ongoing maintenance prescriptions are not reliably covered even with the add-on. Plan to pay out-of-pocket for statins — fortunately, generics are cheap in Europe.
If you've been taking statins for >5 years and the underlying condition (hypercholesterolemia, CAD) is pre-existing, AXA's 5-year lookback applies. Related cardiac events may still be excluded even if the statin prescription itself is accepted.
Ozempic, Wegovy, Mounjaro — no carrier has published a policy on international health insurance coverage for GLP-1 medications. The general principle: if T2D is covered AND you add an outpatient module AND the insurer's formulary includes the drug, it might be covered at Cigna or BCBS. Get that in writing before relying on it.
European out-of-pocket prices are dramatically lower than US list prices — in some cases startlingly so. Spain's retail Ozempic is ~€118/month; France's is ~€77/month. Compared to $900+/month in the US without insurance, this may change your planning entirely. See the drug pricing section below.
GLP-1 coverage by carrier (all unconfirmed — needs broker verification)
None of the five carriers has a public policy statement on GLP-1 drugs for international plans. The following reflects inferred coverage logic, not confirmed terms.
If T2D is covered and outpatient module is included, Ozempic prescribed for diabetes may be on the formulary. Ask for written confirmation of the drug formulary before enrolling.
Same logic as Cigna: creditable coverage waiver + outpatient pharmacy benefit may include GLP-1s. Needs written formulary confirmation before purchase.
IMG's acute-illness model doesn't cover ongoing maintenance Rx reliably. Allianz and AXA's pre-existing exclusion logic means GLP-1s are excluded if T2D is excluded (and T2D coverage is already uncertain at both). Assume out-of-pocket.
A stent placement or heart attack in the past 3–5 years is the toughest underwriting scenario in international health insurance. Across the carriers reviewed here, the consistent FMU outcome is a permanent cardiac exclusion — meaning future cardiac events won't be covered — but everything else (cancer, orthopedic injury, infection) is still insurable.
Two things that help: (1) time — carriers are more willing to reassess if it's been 10+ years since the cardiac event; (2) an impaired-risk broker, who works with underwriters on your behalf rather than sending you through a generic quote form. Pacific Prime and Expatriate Group specialize in this.
Post-stent underwriting across carriers
Across the five carriers reviewed here, the consistent FMU outcome for a recent stent is a permanent cardiac exclusion. The cells below reflect inferred outcomes — individual underwriting decisions vary.
Cigna's case-by-case underwriting may offer premium loading instead of permanent exclusion for some cardiac applicants. Other carriers default to permanent exclusion, but Cigna's approach is more flexible. Use a broker to get an indication quote.
The creditable coverage waiver removes waiting periods, but underwriters may still permanently exclude cardiac events for recent stent patients regardless. Individual underwriting decision required.
FMU path is required. Permanent cardiac exclusion is the likely outcome for recent stent under FMU; non-cardiac coverage should be obtainable.
Standard FMU review applies. Permanent cardiac exclusion is the expected outcome for a recent stent. New applicants capped at 74.
AXA's 5-year lookback and strict pre-existing approach make a permanent cardiac exclusion highly likely. Everything else (non-cardiac) remains insurable.
A permanent cardiac exclusion means cardiac events aren't covered — not that you're uninsurable. A broken hip, cancer diagnosis, or hospital infection would still be covered. The exclusion is narrow, not total.
Age caps: the plan you buy today needs to be one you can keep at 80.
International insurers impose two types of age limits: when they'll accept a new application, and when they'll stop renewing your policy. Both matter, and they're different numbers.
Important for long-term planning —
BCBS Global Solutions: the 83-year hard stop.
BCBS Global Solutions' maximum coverage age is 83 — no exceptions. A healthy 72-year-old enrolling today gets 11 years of coverage, maximum. There is no extension, no Senior Plan transition, and no way to convert to another carrier without new underwriting (which, at 82, may result in extensive exclusions). Factor this into any long-term plan.
The out-of-pocket numbers — especially for Ozempic.
Until you get written confirmation from your underwriter that your medications are covered, plan around out-of-pocket costs. For most maintenance medications abroad, the numbers are much lower than in the US — in some cases startlingly so.
Generic (30-day supply)
Metformin 500–1000mg
Estimated — based on European generic pricing norms. Prices not individually verified at pharmacy.
Generic (30-day supply)
Atorvastatin 20–40mg
Greece: medium confidence (regulatory ex-factory ~€3–4; retail markup estimated). Others: estimated.
Monthly injection pen
Ozempic / semaglutide
Spain, France: confirmed from official retail sources. ✓ = verified. Others: estimated from EU market data.
All prices reflect retail (private pay) — no public system benefit. Once you join a country's national health system (typically after converting to a long-term residency permit, 1–5 years depending on country), local drug pricing through the public formulary may be lower still.
Before you decide, compare at least two carriers.
For retirees with chronic conditions, the right insurer depends on your specific conditions, age, and whether you have prior creditable US coverage. Based on your condition, one of these three is likely the right fit: Cigna (chronic conditions, no age cap), BCBS (prior US coverage), or IMG (healthier retirees under 74). Get quotes from the ones that match your situation — the pre-existing context for each is below.
IMG Global
24-month wait on pre-existing; waivable with prior US coverage. Chronic daily management not well covered. New applicants capped at 74.
Cigna Global Best for chronic conditions
Can cover T2D and hypertension after underwriting review. No age cap — the only carrier with guaranteed renewal at any age. Outpatient module required for ongoing Rx.
BCBS Global Solutions Best if you have prior US coverage
Waives waiting period entirely with prior continuous US insurance. Strong for T2D and hypertension. Hard stop at age 83 — factor into long-term planning.
Allianz Care
Choose FMU — not moratorium. Hypertension commonly accepted with no exclusion. New applicants capped at 75; no renewal age limit.
AXA Global Healthcare
Permanent T2D exclusion under moratorium. 5-year lookback for FMU. Renewals to age 99. Not recommended for T2D or recent cardiac history — seek FMU guidance before applying.
Frequently Asked Questions
What does 'full medical underwriting' mean?
Does Medicare count as creditable coverage for BCBS's waiting period waiver?
If my condition is excluded, can I still get coverage for everything else?
What happens to my pre-existing exclusions at renewal?
What's an impaired-risk broker and when do I need one?
Can I buy coverage if I'm already abroad and uninsured?
Three steps, in this order.
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List every condition and every medication before contacting any insurer
You'll need to disclose them all. Getting this list together before you request a quote makes the process cleaner and prevents the kind of accidental non-disclosure that voids claims later.
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Request full medical underwriting on every application
Not moratorium. FMU only. If the insurer doesn't offer FMU, that's a signal. Lead with the question — it filters out the wrong choices early.
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Get at least two quotes — Cigna and either IMG or BCBS
Cigna's no-age-cap policy is a structural advantage for long-term retirees with chronic conditions. BCBS is worth quoting if you've had continuous US health insurance. Pricing varies more than you'd expect for similar coverage.
See typical costs by age →
Not sure which plan type you need?
The main insurance guide covers the decision framework — local plan vs. Worldwide Excluding USA vs. full worldwide coverage — and explains the six things worth checking before you sign any policy.
Back to the insurance overviewPrimary sources
- Cigna Global — retiree health insurance plans and underwriting overview
- Allianz Care — international health insurance with pre-existing conditions
- Allianz Care — full medical underwriting versus moratorium
- BCBS Global Solutions — Worldwide Premier plan (creditable coverage terms)
- VitalsToday — Ozempic pricing in Spain (official RRP ~€118)
- DoktorABC — Ozempic retail price in France (~€77)
- Pacific Prime — type 2 diabetes insurance guide for expats
- IMG (International Medical Group) — Global Medical Insurance plan overview