27 August 2026 · Cogotec, Bangkok
Almost everyone starts with travel insurance, because it is cheap and it is what you bought for holidays. It works for a while. The problem is that it is designed around an assumption that stops being true about six months in: that you have a home country you are going back to.
Travel insurance versus international health insurance
Travel insurance is emergency-led and trip-shaped. It gets you stabilised and, in the serious cases, repatriated. It commonly caps how long a single trip can be, excludes pre-existing conditions outright, and does not cover routine or ongoing care.
International private medical insurance is an annually renewable health plan. It has a defined area of cover, high annual limits, and — once you are accepted — covers chronic conditions that develop while you are insured. It does not assume you are going home.
The dangerous middle is the person who has been abroad for two years on annually rebought travel cover. Each renewal quietly resets what counts as pre-existing, so the condition that developed in year one becomes the exclusion in year two. That is a structural trap, not bad luck.
Residence, when you don't really have one
Insurers price on a country of residence. Nomads reasonably ask what to put. Two things make it simpler than it looks:
First, your declared residence does not have to be your nationality, and several insurers are entirely comfortable with people who move — it is a normal case, not an exotic one. Second, what matters more than the label is that it is honest and that your area of cover genuinely matches where you spend time. A policy declared in one country while you live in another is the kind of thing that holds up fine until a large claim, and then does not.
The USA is the specific lever. "Worldwide excluding USA" is materially cheaper than worldwide, and for many nomads it is the right call. But excluding it and then spending six weeks there is not a saving, it is an uninsured six weeks.
The four things to check before price
1. Area of cover. Where you are actually insured, including the USA question and any regional exclusions.
2. Home-country cover. How many days a year you are covered when you go back. Often limited, sometimes zero. If you spend a month at home each year, this is not a detail.
3. Evacuation and repatriation. If you spend time somewhere with thin local healthcare, evacuation is the part of the policy that actually matters. Check whether it moves you to the nearest adequate facility or to a country of your choosing — they are very different products.
4. Pre-existing conditions. Excluded, loaded, or moratorium — insurers treat your history very differently, and it is the largest single cause of declined claims. Disclose fully. An underwriting outcome that looks generous at the quote stage is sometimes the one that pays nothing on the condition you have.
What it costs
Age, area of cover and configuration drive the price far more than lifestyle does. As a reference point: a live comparison on 26 August 2026 for a 40-year-old British national resident in Thailand returned premiums from $117 to $852 a month across 26 plans from 13 insurers — the full run is here.
That is a resident persona, not a nomad one, and we are labelling it that way rather than dressing it up as a nomad range we have not measured. A genuinely mobile person will usually price higher, because the area of cover is wider. The useful number is the one from your own brief.
Claims from wherever you happen to be
The practical difference between plans shows up at admission, in a country you do not know, in a language you may not read. What you want is direct settlement — the insurer dealing with the hospital — rather than paying up front and reclaiming across a timezone gap.
This is what Nomi, our assistant, is actually for: policy questions answered from your insurer's own wording, at 3am, wherever you are, with a person in Bangkok to escalate to when the answer needs judgment rather than retrieval.
Where to start
Run a live comparison with your own age and area of cover, or talk to us if your situation is genuinely mobile and you want it looked at properly. Cogotec is an international insurance consultancy based in Bangkok, working across a network covering 140 countries.
Premiums are indicative until underwritten and vary with medical history and final configuration. General information, not personal advice.