A Comprehensive Guide To Philippines Health Insurance For Expats

However, healthcare in the Philippines is an even higher level of complicated. There are vastly different levels of quality, some medical facilities are equivalent or better than expats would receive in most Western countries. While some rural clinics feel like a throwback to witch doctors and shamans. 

Step-by-Step Guide To Apply For PhilHealth

Moving to the Philippines as an American expat comes with a unique set of challenges. One of them is ensuring you can access quality healthcare while living in the country.

How you protect your health will depend on your age, pre-existing medical conditions, where you live in the Philippines, and your budget. 

This guide is written specifically to help expats understand their medical insurance options and make an informed decision on handling their health insurance in the Philippines.

I have a separate guide with a complete breakdown of how the Philippine Healthcare System works, so check that article out for all the details.

To keep things brief here, the key points are:

• Tiered System: The Philippines has a mixed healthcare system with both a private and public medical system
• Public vs. Private: Public healthcare (PhilHealth) is more affordable but faces resource challenges, while private healthcare offers better services at a higher cost.
• Healthcare Quality: The country is recognized as a medical tourism destination, ranking 24th globally. The overall healthcare quality ranks 96th globally, but disparities exist between urban and rural areas and between public and private.
• Universal Healthcare: All citizens are covered by PhilHealth. Foreigners can pay to join, but PhilHealth has limitations on coverage.
• Healthcare Is Cheap Here: Expats can join PhilHealth for as low as 15,000 PHP / $270 USD annually or access better hospitals and doctors with private health insurance for as low as $550 yearly.

Your most crucial healthcare decision is to rely on a cheaper government-sponsored hospital or a more expensive private healthcare facility.

The two systems have fundamental differences in cost, care, and coverage. Additionally, there are even more differences between rural and city healthcare options, so your choice may rely on where you call home in the Philippines. 

The Department of Health (DOH) governs the public care system in the Philippines. The Philippine Health Insurance Corporation (PhilHealth) is the national health insurance program.

Former President Rodrigo Duterte signed the 2019 Universal Healthcare Bill, known as the “UHB,” granting 100% of the country’s citizens basic healthcare, regardless of employment or ability to pay.

The good news for expats is that the healthcare reforms have continued to include foreigners with valid ACR cards or retired expats with a Special Resident Retiree’s Visa.

Citizens of other countries working and/or residing in the Philippines – foreign citizens with valid working permits and/or Aliens Certificate of Registrations (ACRs) working and or residing in the Philippines – PhilHealth Section 5b6rule 1, Title 3 of the revised IRR of the Republic Act 7875

The public healthcare facilities are primarily based on government-funded hospitals and provide subsidized health services to public health insurance members. Since PhilHealth covers 100% of the country’s citizens, these government-run hospitals often experience high patient volumes, resulting in crowded conditions.

Locals rely on public Rural Health Units (RHU) and Barangay Health Centers for primary care services, but these public healthcare clinics are often poorly staffed and equipped. Most areas outside of Manila don’t have enough public doctors and hospitals.

The resulting quality of care drops noticeably even further between healthcare facilities in rural areas and hospitals in large cities.

Some notable government hospitals in the Philippines include:

• Cebu City Medical Center
• Philippine General Hospital (PGH)
• Jose R. Reyes Memorial Medical Center
• San Lazaro Hospital

Private insurance is a better fit for the needs of most expats. Expats demand better service, comfort, and access to better-equipped facilities. With a private policy, expats can choose their preferred doctor or hospital and often have shorter wait times for appointments and procedures.

Most private hospitals are in major cities like Quezon City, Taguig City, Makati City, Cebu City, and Davao City. These hospitals also tend to be more expensive than public ones. Having private health insurance can significantly offset these costs.

Prominent private hospitals in the Philippines include:

• Makati Medical Center
• St. Luke’s Medical Center
• Asian Hospital and Medical Center
• The Medical City

INSIDER TIP: Using PhilHealth In Private Hospitals- Did you know that PhilHealth isn’t just for government hospitals? You can still use PhilHealth for private hospitals for covered hospitalization, treatments, and minor procedures.

However, not every hospital is a PhilHealth member. Before admission or treatment, confirm with the hospital staff to ensure the medical facility is PhilHealth-accredited to maximize your benefits.

Your choice of public or private medical system dictates the kind of Philippine health insurance you need.

PhilHealth is a government-mandated insurance program responsible for providing basic health coverage under the Universal Health Care (UHC) system for Filipinos. PhilHealth is funded through:

• Government subsidies at the local and national level
• Company payroll deductions and employee contributions
• Voluntary member contributions

PhilHealth offers different membership categories and benefits, depending on the individual’s income and contribution. Currently, there are 8 types of PhilHealth members: Overseas Filipino Workers (OFWs), Senior citizens, Lifetime members, Sponsored members, Indigent members, and the three categories most expats fall into

• Formal economy members – employed expats working for Philippine companies
• Informal economy members – self-employed expats, naturalized Filipinos, foreign retirees, and foreigners in the Philippines who voluntarily or individually pay annual premiums to join PhilHealth.
• Qualified dependents – Spouses married to Filipino citizens or children under 21 years of age who are unmarried and unemployed

Enrollment in PhilHealth is only mandatory for foreign nationals employed in the Philippines. If you work for a local company, you pay into the public system through your employer’s payroll deductions.

Unemployed or retired expatriates have the option, but not the obligation, to purchase PhilHealth coverage under the Informal Economy Member category, provided they have legal residency status.

While PhilHealth is the only place to go for public insurance, private health insurance is provided by various insurance companies. Private insurers offer a wide range of plans that cater to individuals’ specific needs and preferences. Private insurance often provides more comprehensive coverage than public health insurance, including access to a broader network of healthcare providers, more in-patient treatment coverage, and additional benefits such as dental and optical coverage.

Local employers often provide private health insurance coverage as part of their expat benefits package on top of the mandatory PhilHealth contribution. The downside is that foreign employees can’t choose their preferred insurance company.

Foreigners not employed or sponsored by a company can choose a policy from the best Philippine private insurance company that fits their needs and budget.

Average cost for a 65-year-old male with no pre-existing conditions:

• HMO Plan with a 1,500,000 PHP benefit limit is about 45,000 Philippine Pesos per year (roughly $815 USD).
• Global Medical Plan with a $1,000,000 USD policy limit is about $3,200 USD annually.

Another health insurance option for foreign nationals is travel or international health insurance. These types of coverage are suitable for expats living part-time in their home country and the Philippines.

Travel insurance typically covers medical emergency expenses, trip cancellation, lost baggage, and other travel-related incidents. It’s usually purchased per trip and can provide coverage for a specific duration, ranging from a few days to a year.

However, travel insurance with emergency medical coverage is NOT enough for most full-time expats. Travel health insurance does not cover preventative care, limits trips to 6 months or less, and includes a requirement to maintain health insurance in your home country.

A proper global health plan covers expats living and working abroad long-term. It offers more comprehensive coverage, including routine check-ups, pre-existing conditions (depending on the policy), and access to healthcare providers in different countries.

This type of insurance provides more flexibility for foreigners who may need to travel back to their home country for medical services or seek treatment in other countries.

As foreigners, we don’t get free healthcare, but the cost of public insurance is cheap by US standards. The minimum contribution for foreigners to a PhilHealth ID card is:

• Employed Expats – 4% of gross salary
• Expat Retirees on an SRR Visa – $300 / 15,000 PHP per year
• Foreign Nationals with an ACR-I-Card – $335 / 17,000 PHP per year

For less than $1 per day, expats get primary care coverage, including fully covered preventative check-ups, health screening and assessment, laboratory, and prescribed medicines, which members can avail of through the “Konsulta” (Filipino translation to the word “consult”) program (formerly called Tsekap, a playful translation to the word “check-up”).

INSIDER TIP: No Medical Requirements– Unlike most private insurance companies, PhilHealth does not require individuals to undergo a health checkup or fill out a medical questionnaire before joining. Expats with preexisting conditions will not be denied coverage.

Depending on the cost of treatment, PhilHealth’s fixed co-pay typically covers 20% to 30% of your medical bills. However, the actual amount will vary significantly depending on the type of treatment and the hospital you choose.

The variance is because PhilHealth pays the hospital for each medical condition based on a set price list. Regardless of what the hospital charges you, Phil Health will only pay a fixed amount for the treatment.

The good news is you have some control over your portion of the cost. Different hospitals will have different rates, especially when comparing government hospitals to private facilities. 

Shop around and find a lower-cost hospital, and you pay less. Choose an expensive private hospital, and you will be stuck with additional medical expenses to pay.

Here is an example comparing the cost (including room, doctor’s fees, and services) of the same procedure at several hospitals. The prices range from 35,000 PHP / $630 USD to 150,000 PHP / $2702 USD. 

Depending solely on PhilHealth may not be enough for most foreigners residing in the country. Although it offers decent health coverage, it has limitations and exclusions that could expose expats to significant medical expenses.

PhilHealth’s main limitation is the fixed benefit amount. PhilHealth only subsidizes a portion of the treatment, not the full cost.

Look at the chart in the previous section showing the prices for C-sections. The fixed case rate PhilHealth covers for a Cesarean is 19,000 PHP. This benefit only covers between 13% to 54% of the actual treatment cost.

Additionally, foreigners don’t get all the PhilHealth benefits. A 2017 rule change excluded foreigners from accessing the most expensive medical treatments, including prostate cancer, heart bypass, hip replacements, and other serious but costly health issues.

Here’s an overview of what PhilHealth covers and what it doesn’t.

INSIDER TIP: Age Restrictions- While most health insurance companies will deny coverage to older expats or raise the premiums for any expats over 65 years old, PhilHealth has no age restrictions to enroll. Even if you’re a hundred years old, PhilHealth will provide you with insurance coverage.

To contrast, private medical plans do not have specific exclusions for foreigners. Private health plans can also include vaccinations, vision care, dental benefits, and mental health, giving you greater peace of mind and overall well-being.

Foreigners in the Philippines should obtain additional private health insurance coverage to fill these gaps.

My article comparing the top private insurance for foreigners in the Philippines can help you choose the best option.

Expats should not consider PhilHealth as “health insurance.” PhilHealth is a government-subsidized co-pay. PhilHealth pays a fixed amount (case rate) based on your specific treatment that covers about 30% of your medical bills, not the total cost.

You must pay the remaining 70% gap out of your wallet if you don’t have additional private insurance.

Here are some examples of the fixed amount PhilHealth pays for common illnesses and medical conditions.

INSIDER TIP: PhilHealth Expat Exclusions- Another reason expats should not rely solely on PhilHealth for coverage is that non-Filipinos cannot use PhilHealth’s Z benefit package. This package covers the most expensive catastrophic illnesses, such as acute lymphocytic leukemia, early breast cancer, prostate cancer, and kidney transplants.

Additionally, foreigners cannot get room and board coverage for hospitalization (referred to by PhilHealth as “confinement,” a weird term, right?). Also excluded are special privileges (prenatal and maternity care) and for women about to give birth (WATGB).

Private health insurance premiums are more expensive than PhilHealth, but they act more like health insurance plans that Americans and other expats are accustomed to. Private health plans offer a more comprehensive range of coverage and can be tailor-made to suit the unique requirements of expats living abroad.

Depending on the plan, private health insurance may cover inpatient treatment, medical tests, prescription drugs, or alternative treatments such as acupuncture and chiropractic care. Some coverage even includes medical evacuation to another Southeast Asian country (Singapore, Thailand, Malaysia, etc.) with better-equipped modern hospitals if necessary.

Private insurance lets you choose the provider and specialist of your preference. Most plans have a network of affiliated service providers you can choose from, and some even offer the convenience of a telemedicine website or phone app. Depending on the plan, you may also be entitled to cashless hospitalization or reimbursement for medical costs.

Additionally, private health plans give you access to private clinics and hospitals, including the five JCI accredited hospitals in the Philippines:

Expats may find the cost of healthcare in the Philippines cheaper than in their own country and think it is better to go without private insurance and pay for healthcare costs out of their retirement savings or emergency fund.

Either because of age, costs, or a misunderstanding of how health insurance works, many older expats decide to self-insure.

Expats feel self-insuring in the Philippines has lower upfront costs and more freedom and control over healthcare decisions. However, self-insurance poses significant financial risks. You may save a few thousand dollars in the short term for minor injuries or even moderate medical issues.

The biggest risk is the volatile nature of healthcare. You don’t plan on getting into a car accident. You don’t schedule heart attacks.

If you get hit with an unexpected medical emergency or major illness, your out-of-pocket hospital bills can quickly blow through a meager $2,000 emergency fund. Your total medical expenses can easily outweigh the short-term savings of not paying insurance premiums.

I pay for most of my medical bills out-of-pocket rather than claiming insurance. The cost of medical care outside the United States is shockingly cheap. Here are some examples of medical treatments I paid out-of-pocket around the world.

• Knee MRI: $200 (Philippines) vs. $2000 (US)
• Platelet-Rich Injection Treatments: $100 (Mexico) vs. $700 (US)
• DEXA Bone Density Scan: $25 (Colombia) vs. $250 (US)

However, I still maintain an international health plan to cover catastrophic medical issues.

Sure, paying for a broken bone out of savings is fine, but paying for injuries from a simple accident or an unexpected brain hemorrhage would be financially devastating.

Here are real-world examples of claims paid for expats injured overseas. 

Need more reasons why living in the Philippines without private insurance is not an option?

GoFundMe is full of expats who have had to resort to digital fundraising because they didn’t have adequate health insurance.

INSIDER TIP: Unpaid Hospital Bills- While the government has past laws preventing public hospitals from physically preventing you from leaving, private hospitals can still detain you for unpaid bills unless you have private insurance that agrees to pay on your behalf.

Having adequate health insurance can save you from bankruptcy if you need access to specialized treatments, expensive emergency evacuation, or medical reparation.

Expats are drawn to the beaches and islands of the Philippines, but those 7,500+ islands make even an uncomplicated health condition like a hernia become a life-threatening medical emergency. Private insurance companies often offer additional benefits, such as access to medical evacuation and repatriation services.

Need to be airlifted from a remote province to the helipad at St. Luke’s Medical Center? The average cost of a helicopter ambulance is over $30,000 USD. What if you need a life flight to the UK? Does a $90,000 emergency flight to Europe seem cheap?

INSIDER TIP: Paying For Public and Private Insurance- PhilHealth is cheap at less than $1 per day. Additionally, while health insurance provided by private companies has the best benefits, many expats have both a cheap PhilHealth plan and a more comprehensive HMO or PPO international insurance policy. Enrolling with PhilHealth is still recommended because PhilHealth is always considered the “primary insurer.”

Primary insurer means a hospital will initially bill the “PhilHealth portion” and then send the remaining bill to your private insurance company. If you do not have PhilHealth coverage, you must pay out-of-pocket for the PhilHealth portion of the medical expenses.

At $300 annually, PhilHealth provides an affordable entry point for Philippine health insurance. However, expats must understand that public coverage is very limited. PhilHealth is a complement, not a standalone healthcare solution solution.

I highly recommend all expats supplement PhilHealth membership with a private healthcare plan that bridges the gaps, and includes inpatient care, major illnesses, and medical evacuation coverage that PhilHealth misses.