One of the biggest questions facing expats in Thailand, particularly retirees, is what to do about medical insurance.
Only a couple of visa options have a mandatory health insurance requirement — the OA Visa being one of them. Entering on a 90-day O Visa and doing your retirement visa extension inside Thailand allows you to avoid this mandatory insurance. However, you’ll still want some coverage.
Most people don’t consider self-funding as an option, but it may be a better choice than paying an annual or monthly premium.
It’s not an easy decision. Healthcare in Thailand is excellent and relatively affordable compared to the West, but medical costs can still add up if you’re hit with something serious. Meanwhile, insurance premiums skyrocket with age and pre-existing conditions.
So what’s the smarter choice? Let’s unpack the pros and cons of both options and look at some real numbers to help you decide.
The Rising Cost of Health Insurance with Age
If you’re retiring in Thailand at 60 or 65, you’ll quickly notice that private health insurance isn’t cheap.
There isn’t a universal age at which private health insurance becomes unavailable, as each provider sets its own limits. Some companies impose a maximum entry age, often ranging from 65 to 80, while others allow new policies at any age. For instance, certain insurers may stop accepting applicants around 75, whereas providers like Cigna and Bupa impose no upper age restriction.
The reality is, though, that premiums rise sharply with age, and many insurers will exclude pre-existing conditions (which, by retirement age, many people have).
Even if you do qualify, the coverage limits can be underwhelming. A plan that costs $4,000–$6,000 a year might only cover up to $100,000 per year — and that may not include every scenario, especially long-term or age-related illnesses.
When Health Insurance Becomes Unavailable
At some point, private insurance may no longer be an option.
A policy may become prohibitively expensive, and the policy might have low maximum benefits or exclude most age-related illnesses.
Many expats eventually find themselves paying thousands each year for a policy that no longer provides meaningful protection — or dropping cover altogether when premiums exceed their budget.
The Case for Self-Funding
There was a time when I never considered this an option. I was so conditioned to thinking I always needed insurance that I hadn’t looked beyond it. Yet, many expats successfully choose to self-fund.
Self-funding simply means setting aside your own money to pay for healthcare as and when you need it.
This approach is becoming increasingly popular among retirees in Thailand, mainly because Thai healthcare is much cheaper than in the West, and you don’t have to rely solely on private hospitals.
Private vs Government Hospitals
Most expats assume you must go to a private hospital like Bumrungrad or Bangkok Hospital. These are excellent, and while not quite as expensive as Western-style hospitals, they certainly aren't cheap.
However, what many don’t realise is that you can use government hospitals as a paying patient — and even book a private room, depending on the hospital.
The doctors are often the same ones who work at private hospitals, but at a fraction of the cost. Naturally, waiting times for surgeries can be longer, and beds may not always be immediately available. For routine care, though — things like blood tests, heart check-ups, or flu treatment — you can use a standard private hospital (not one of the big-name chains) and still pay very reasonable prices.
Here’s a quick example: a friend of mine’s son had a leg operation at a government hospital in Bangkok, and the surgeon was none other than one famous for performing surgery on the King.
Here’s a comparison of a few costs. for private vs government hospitals:
| Treatment / Service | Private Hospital (฿) | Government Hospital (฿) |
|---|---|---|
| MRI Scan | 20,000 – 40,000 | 8,000 – 10,000 |
| Blood Test Panel | 3,000 – 6,000 | 1,000 – 1,500 |
| Overnight Stay (Private Room) | 4,000 – 8,000 | 1,200 – 2,500 |
| Knee Surgery | 190,000 – 340,000 | 80,000 – 150,000 |
| Cataract Surgery (per eye) | 60,000 – 90,000 | 15,000 – 30,000 |
If you live outside Bangkok, Pattaya, or the islands, prices will be lower.
Building a Self-Funding Pot
If you retire at 65 and start with a self-funding pot of $20,000 (≈฿730,000), then save ฿10,000/month into that fund, you’ll have around ฿1.95 million after 10 years (excluding interest).
That’s a solid buffer for most medical situations, especially if you’re using local or government hospitals.
Of course, this doesn’t mean you should avoid insurance altogether; some people choose low-cost inpatient-only cover to protect against catastrophic bills, while self-funding everything else.
Domestic Insurance
A more affordable alternative to high-end international insurance is a domestic Thai policy, which can cost roughly half the price of a plan like Cigna Platinum and is widely available to expats.
These policies typically only cover treatment within Thailand, so they wouldn’t protect you if you return home or travel abroad, though travel insurance can fill that gap.
Domestic plans may come with tighter budget controls, limits on treatment types, and restrictions on which hospitals you can use, so it’s important to read the fine print carefully.
That said, they remain a viable option, especially as part of a hybrid strategy, combining self-funding for routine care with domestic coverage for inpatient or unexpected expenses.
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The “Go Home” Option
Another factor worth considering: many expats still have access to healthcare in their home country.
If you’re from the UK, you may be able to return and use the NHS if you become seriously ill — though there are rules about residency and re-qualification periods.
Still, for some, this is the fallback plan: manage routine care in Thailand, but return home for major or long-term treatments like cancer or surgery.
Comparing Costs: Insurance vs Self-Funding
The table below illustrates a 10-year comparison for someone starting at age 60 in Thailand.
The private insurance costs are based on a Cigna Platinum plan, which covers inpatient treatment, cancer care, mental health, and more. Premiums are assumed to rise 5% per year, reflecting the typical escalation for older expats.
Self-funding assumes an initial pot of $20,000 (≈฿730,000) with monthly contributions of ฿10,000. Over 10 years, the pot grows steadily, showing how much can be accumulated to cover routine or moderate healthcare costs in Thailand.
This side-by-side view highlights a key point: while insurance provides complete coverage for high-cost treatments, its cumulative cost can be much higher than building a self-funding pot, giving readers a clear sense of the trade-offs between the two approaches.
| Year | Age | Annual Insurance Premium (฿) | Cumulative Insurance Paid (฿) | Annual Self-Funding Pot (฿) | Self-Funding Pot (Cumulative) (฿) |
|---|---|---|---|---|---|
| 0 | 60 | 360,000 | 360,000 | 120,000 | 730,000 |
| 1 | 61 | 378,000 | 738,000 | 120,000 | 850,000 |
| 2 | 62 | 396,900 | 1,134,900 | 120,000 | 970,000 |
| 3 | 63 | 416,745 | 1,551,645 | 120,000 | 1,090,000 |
| 4 | 64 | 437,582 | 1,989,227 | 120,000 | 1,210,000 |
| 5 | 65 | 459,461 | 2,448,688 | 120,000 | 1,330,000 |
| 6 | 66 | 482,434 | 2,931,122 | 120,000 | 1,450,000 |
| 7 | 67 | 506,556 | 3,437,678 | 120,000 | 1,570,000 |
| 8 | 68 | 531,884 | 3,969,562 | 120,000 | 1,690,000 |
| 9 | 69 | 558,478 | 4,528,040 | 120,000 | 1,810,000 |
| 10 | 70 | 586,402 | 5,114,442 | 120,000 | 1,930,000 |
Observations:
- Insurance cost escalates quickly: Over 10 years, cumulative premiums exceed ฿5 million, whereas the self-funding pot reaches ฿1.93 million with modest monthly contributions.
- Self-funding growth is predictable: You know exactly how much you have, without risk of premium hikes or exclusions.
- Insurance provides full coverage for expensive treatments (cancer, mental health, private rooms), but comes at a very high cost, especially for older retirees.
- Self-funding plus partial insurance: Some expats use a smaller, inpatient-only policy to cover catastrophic events and self-fund routine care.
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The Gamble
Ultimately, it’s a gamble whichever route you choose. Paying for comprehensive private insurance means peace of mind, but if you stay healthy, you may end up spending a significant sum for little tangible benefit.
On the other hand, self-funding allows you to build a nest egg that could be left to your children or partner, rather than handed to an insurance company.
The risk is that a serious illness — say a severe infection requiring two to four weeks in hospital, extensive treatment, and ongoing outpatient care — could quickly deplete a large portion of your self-funded pot.
This is where your lifestyle and personal risk tolerance come into play. Consider your diet, alcohol consumption, exercise habits, and family medical history when deciding how comfortable you are carrying that financial risk.
The Middle-Ground Approach
Many expats use a hybrid strategy:
- Buy inpatient-only or catastrophic cover for major accidents or emergencies.
- Self-fund outpatient care and checkups.
- Use government hospitals if you are on a lower budget.
- Maintain a dedicated savings buffer for healthcare.
- This provides peace of mind without draining your budget.
Final Thoughts
There’s no one-size-fits-all answer.
If you’re younger, in good health, and can afford a solid policy, insurance can make sense — especially for peace of mind and emergencies.
But for older retirees, or those priced out of comprehensive plans, self-funding (or a hybrid model) can be a sensible and sustainable way to manage healthcare in Thailand.
The key is to plan ahead:
- Research hospital options in your area
- Build and regularly top up a medical fund
- Get quotes for both local and global insurance
- Keep a realistic plan for emergencies and serious illness
For most expats, Thailand offers excellent healthcare at a fraction of Western prices, and with the right strategy, you can stay healthy and financially secure through your retirement years.
+ Get a Private Medical Insurance Quote
Last Updated on
JamesE says
Nov 02, 2025 at 8:04 pm
Kenneth says
Nov 02, 2025 at 10:51 pm
Simon says
I ask because I did and it adds a huge amount to the total cost, despite it being for only a fraction of the coverage amount?
Is it worth just paying for any Outpatient stuff oneself, in people's experience?
Nov 01, 2025 at 4:38 pm
TheThailandLife says
Nov 02, 2025 at 10:37 pm
Andreas says
Right now and for the last 10 years I've always had very good international health insurance, being 65 now I can see in years to come that an international healthcare policy will become very expensive and possibly prohibitively expensive. I've used it in Thailand a few times over the years at Bumrungrad and Bangkok hospital, I thought the costs were surprising high and really mounted up so I was very happy to be covered. Going forward, my question is. Can anyone pay to use the goverment hospitals or do you need to have some sort of resident visa ?
Nov 03, 2025 at 7:32 pm
TheThailandLife says
Nov 03, 2025 at 8:05 pm
Simon says
They come with no Outpatient treatment included, although you need this (and the Inpatient) to get the upgrade from the 90-day Non-O to the One-Year visa, so the Outpatient segement needs to be an added benefit that increases the price.
So, I would guess from your answer that you never had the need for it.
Otherwise, yes I think I may drop that at some point, and self-fund that part.
Thanks for your answer, and I have been enjoying your recent articles as well, by the way, as ever.
Nov 03, 2025 at 8:07 pm
Mike says
Oct 28, 2025 at 2:15 pm
Mike Baker says
I could fly business class to the UK, have the procedure and it would still be cheaper.
Care may be good here, but they do see you as a cash cow. Any foreigner in an accident seems to be immediately taken to the most expensive hospital and I do wonder if the 1st responders (who I believe are independant?) are on a hefty commission.
Oct 29, 2025 at 8:44 am
TheThailandLife says
Oct 29, 2025 at 5:37 pm
JamesE says
Oct 29, 2025 at 5:16 pm
Jeff says
Those rates are the same for me and for my Thai wife. I'm not being gouged because I'm a farang.
Peter's article is great when comparing private vs government facilities and services, and sometimes I choose the latter route if it's not routine, or it if the wait to be scheduled isn't a factor.
Oct 30, 2025 at 5:38 am
JamesE says
I think this is true everywhere but, particularly coming from American "healthcare", people have been trained not to ask what things will cost. In the US, when I ask about prices in advance the response I get is "We don't know." They are not lying. Here, as with your experience, the final price I see has always been within a few hundred ฿ of what they told me up front. Fortunately, I haven't needed any truly emergency care and have always been able to get an estimate upfront.
Oct 30, 2025 at 6:50 am
Jeff says
As for fellow Americans who don't ask what it costs upfront? That's their fault.
Oct 30, 2025 at 8:35 pm
SimonC says
I found out I accidentally had 30,000 baht coverage and went to Bangrungrad. Well, that only covered an x-ray and a 5,000 doctor consult which was just me telling I fell and dr telling em to get an x-ray. They quoted 500,000 for the operation. Absolute rip off. And the drs were so rude once they realised my insurance coverage was limited. They rused pain medication. The older dr even scolded younger drs for trying to help me get transferred to another hospital.
In the end, they pushed my bed out on the side of street and I climbed into a taxi yelling in pain.
After a couple of days, I then went to Lerdsin public hospital and they were absolutely amazing. Ended up costing 48,000 baht - not 500,000 baht! And the drs were incredible.
So I went from 'i really need to get health insurance' to 'Oh wow, it's so cheap, maybe I don't'.
I think you're absolutely spot on Peter. You can do it yourself but you just have to be organised and automate a set amount into a specific account each month for health and emergencies.
Oct 28, 2025 at 1:59 pm
TheThailandLife says
Oct 28, 2025 at 8:44 pm
Mike Baker says
The 1st company I looked at seemed to offer cover that was too good to be true. Due diligence revealed they were based offshore in some unfamiliar territory, were not subject to any oversight or regulations, were trading in the UK illegally (not registered with regulators), had a very strange ownership model (each customer was a partner and as such liable for the company debts) and to me looked like a ponzi scheme in its purest form.
The 2nd company, a well know name based in Thailand, provided what I considered very low cover rates for the premiums, had multiple exclusions (including anything they considered pre-existing that was not even known about!) and a requirement for a self funded prostate PSA test and examination and a medical eye test (not just a sight test) to obtain cover for those items. Noting that the incidence of PSA false positives and negatives are known to be as high as 75%, I felt this exercise to be truly onerous and worthless. In addition, the premium increases were horrendous to the point that self funding from zero would be cheaper after about 3 years after age 70.
I keep and regularly add to my own reserve fund.
PS you forgot the 4th option very popular nowadays. GO FUND ME (because I won't take personal responsibility).
Oct 28, 2025 at 9:25 am
TheThailandLife says
Oct 28, 2025 at 8:50 pm
JamesE says
In the end their underwriters decided they didn't want me as a customer and refused my application with no explanation at all.
I dropped my Medicare in the US and am using what I was paying them each month to shore up my emergency fund. My goal is to be able to cover two major incidents in a year should that ever become necessary.
But for anybody's decision it comes down to the risk you want to assume. Many people would just love to have the bill sent to insurance and not worry about anything. They also would have to have significantly more resources available than I do. Others might be at the opposite end of that spectrum. But, as your chart shows, the cost crossover happens at year 3.
For US citizens there is currently an additional political risk as Medicare is consistently raising its premiums and - if you use Medicare Advantage Insurance - coverage limits are dropping resulting in increased out-of-pocket costs. The current administration has also shown itself willing to cut benefits without regard to the effects those cuts would have on its citizens.
All-in-all, the self-funding decision was basically made for me.
Oct 23, 2025 at 8:25 am
TheThailandLife says
Oct 23, 2025 at 5:23 pm
Kenneth t Sands says
Nov 01, 2025 at 9:36 am