In 2019, I spent three days at Samitivej Hospital for appendicitis. Total bill: ฿187,000 — roughly €4,800. My insurance at the time — a "basic" plan at €80/month — reimbursed €1,400 after the deductible and coverage cap. I paid the rest out of pocket. That's the moment I truly understood what "properly insured" actually means.
This guide doesn't list 12 insurers. It compares the four that genuinely deserve your attention as an expat in Thailand, using real-world criteria: do they pay the hospital directly (or do you front the cash and wait for reimbursement?), what does an actual claim look like, and how restrictive are the exclusions.
One thing up front, to be honest with you: I use Pacific Cross and I'm genuinely happy with it. But I don't believe for a second in a "best for everyone" insurance. The right policy depends on your age, your budget, your home country, how long you're staying, and your health. I'll explain my choice first, then how to find yours — because it won't necessarily be the same.
Transparency: the CheckDi link below is an affiliate link. It doesn't change your price — the broker is paid a commission by insurers on signed contracts. I mention it because I can't stand it when sites don't.
What actually matters in expat health insurance
Most people compare prices. That's a mistake. Here's what you should be comparing first:
- Direct billing vs. reimbursement. The best insurers pay the hospital directly. The bad ones make you front the entire amount and wait 30–60 days for reimbursement. In an emergency, that difference is massive.
- Hospital agreements in Thailand. Bumrungrad, Samitivej, Bangkok Hospital — make sure your insurer has direct agreements with these specific facilities.
- Medical evacuation. An emergency medevac to France costs €50,000–100,000. This is non-negotiable in your policy.
- Annual coverage cap. Minimum €500,000. Anything below that and you're underinsured for any serious condition.
Pacific Cross — what I've been using since 2020
The only weak spot: if you travel frequently to Europe or the US, the base plan's out-of-Asia coverage is limited. You'd need the "Worldwide" plan at around €210/month.
Cigna Global — the best pick if you travel a lot
AXA and Allianz — why I don't recommend them
I'm grouping these two together because my verdict is the same for both: they're solid insurers on their home turf (France, Germany), but their expat products just aren't optimized for Asia.
In practice: no direct billing agreements with Thai private hospitals in many cases, customer support that doesn't know the local facilities, and a higher price tag than Pacific Cross for inferior coverage in a Thailand context. If you already have a relationship with AXA and want continuity, fair enough — but don't default to these insurers just because the name rings a bell.
What budget to expect based on your age
| Age bracket | Realistic monthly budget | My recommendation |
|---|---|---|
| Under 40 | €130 to €200/month | Pacific Cross Essential |
| 40 to 50 | €200 to €320/month | Pacific Cross or Cigna depending on mobility |
| 50 to 60 | €320 to €500/month | Cigna or custom quote |
| 60 and over | €500/month and up | Custom quote, compare several |
Practical tip: Sign up before you turn 35 if you can. Premiums jump with every age bracket, and a policy taken out young with a clean claims history will always cost less at 50 than a brand-new policy taken out at 50. It's just math.
The real advice: compare for YOUR profile
I just told you I use Pacific Cross and I'm happy with it. That's true. But I'm not going to pretend my choice is automatically yours. The perfect cover for me — 40, healthy, based in Thailand year-round, paid in euros — isn't necessarily the best for you.
What changes everything from one expat to the next:
- Age. At 30 and at 58, it's not the same insurers or the same caps that make sense.
- Budget. Between a €130 plan and a €450 one, the right trade-off depends on how much you can absorb out of pocket if something goes wrong.
- Home country. A French, Belgian or British expat won't have the same repatriation options or the same tax treatment on these policies.
- Length of stay. Six months a year or settled for good — that points you toward short-term cover or a proper long-term expat contract.
- Health. A pre-existing condition can get a pathology excluded with one insurer and not another. That's exactly where comparing becomes vital.
The problem is that requesting a quote insurer by insurer takes hours, and each one obviously pushes its own product. That's why I recommend going through a broker that puts the offers in competition for you. In Thailand, I point people to CheckDi: they compare several health insurers at once based on your exact profile (age, budget, nationality, needs), and the service is free for you — they're paid by the insurers, like brokers everywhere.
In practice: you fill in your profile once, you get several comparable offers side by side, and you decide without anyone twisting your arm. Even if you end up like me with Pacific Cross, at least you'll know why.
My honest advice: start by comparing, not by choosing. See what your profile turns up before you sign anything — including before you take my word on Pacific Cross.