Americans chase – From biologic medication to emergency hospital visits, rising U.S. medical costs are pushing Americans to countries with universal health care. Stories from patients in France and Spain show how lower prices and stricter food and safety rules abroad are reshap
On a severe asthma day, Hilary Hodge remembers doing the math. In the United States, her biologic medication for a chronic, worsening condition would have cost her $36,000 a year. A few years later, after she moved to Angers, France, the same treatment was 12 times cheaper—$3,000 a year.
For Hodge, the decision wasn’t about abandoning medicine. It was about being able to afford it, especially after her inhaler stopped working. She had severe allergic asthma and by age 32. her respiratory condition worsened to the point that her inhaler no longer provided relief. Her chronic condition became “a big struggle,” she said.
Hodge qualified for a biologic while living in Chicago, but the injectable medication was highly expensive at the time. In 2012, she saw hope in biologic medication—then faced the cost while living in the U.S.
In 2017, she and her husband decided on a temporary move to France. They planned to stay only for a few years, partly to be closer to his friends and family. But they got pregnant with their son and bought their own house. “It just sort of all of a sudden turned a lot more permanent. I guess we’re here,” Hodge said. “But honestly, health care is a big part of why.”.
Her experience echoes what many Americans say they fear. Nearly half of American adults worry about affording medication or health-related expenses. according to a 2025 survey by the West Health-Gallup Center for Healthcare in America. The survey found this level of concern is the highest since the study began in 2021.
Hodge’s case shows how cost can shape not only treatment decisions, but daily peace of mind. Along with her asthma, she experiences adrenal crises, a life-threatening medical emergency caused by a severe deficiency of cortisol. She has had three crises in the past few years and didn’t feel worried about affording treatment at the hospital.
“In the States, as you know, you kind of do the math,” she said. “You’re like. ‘Do I want to pay a $500 deductible to go to the hospital?’ For a lot of people. that can be a really dangerous question. an equation. Like, how sick do I have to get to go pay that $500 deductible?. Here, I just never even think about it.”.
The stakes are heightened by the scale of U.S. spending. Americans spend the most on health care of any country in the world. In 2025, a family health insurance plan averaged at $26,993—a 6% increase from 2024. An unexpected medical emergency or costly diagnosis, such as cancer, can leave people thousands of dollars in debt.
“It wasn’t the quality of health care that was the issue for Hodge; it was the price,” she said. “It’s just not something that would ever happen here for a lot of different reasons. When I just think about what’s best for my child and me. just purely from the point of view of health care. it’s a better place.”.
Health care isn’t the only factor pushing Americans overseas, but it’s often the trigger. The same West Health-Gallup Center survey underscores how deeply medical costs weigh on day-to-day life, even before a crisis hits.
For others, the move is tied to broader changes that can’t be separated from healthcare choices. Leah Mark moved to Mallorca, Spain, from Indiana in June. Her well-being. she said. is influenced by European Union rules on food. including bans on many additives. preservatives and other chemicals. She also said even some American food products are banned from being imported into Europe.
Mark finds the food “incredible” and “much more affordable.”
She started thinking about moving during a harsh winter and considered warmer destinations in the United States like Florida. But, she said, “Everywhere in the United States right now, I’m bumping up against the same issues – the toxic culture, the food, the increasing political unrest.”
The urgency rose in January 2025 after a shooting at a grocery store not far from her that killed two people. “I stopped feeling safe as a single woman in the United States,” she said.
Mark came across The Lux Nomads on social media. The relocation service is run by two expatriates themselves, Michelle Garabito and Paul Nelson. With their help, she began the process of moving abroad under a digital nomad visa. Now she travels throughout the E.U. with Mallorca as her home base.
“I’m so glad that I did it,” Mark said. “It was really hard, like just emotionally saying goodbye to that stuff, and I do miss some things over here, but I will say, the quality of life that was added is so much more valuable and important to me.”
In the background of these individual decisions is a growing set of options overseas—and an equally growing belief among Americans that a better deal exists elsewhere. In a recent American Expats Survey by The Harris Poll. 38% of the 6. 358 respondents cited cheaper. better health care as a reason for considering expatriation.
Michelle Garabito, of The Lux Nomads, said many of her clients are leaving the United States for health reasons. “We’re seeing a lot of families with small children also coming through the pipeline. and then we’re seeing a lot of retirees who are just ready to go and live a better retired life with universal health care right by the beach and having a beautiful home for half the cost and what they’re spending in the U.S.”.
The emotional logic shows up clearly in Hodge’s description of what changes when the price tag stops driving every medical decision. But the practical process also matters. Moving abroad is a major endeavor. It comes with legal paperwork, logistics, and missing friends and family back home.
A monthlong trial run can help people decide whether a big move is worth it. especially if they have never lived outside the United States. “I always advise to just do one month of living in countries around Europe. specifically because of the regulations. ” Garabito said. “Go eat out every single day and go walk in walkable cities and just see how you feel.”.
Legal residency can be slow. Foreigners often need a valid visa to access public health care systems in other countries, and the process can take months.
A starting point for many people. Garabito said. is obtaining digital nomad visas or nonlucrative visas for nonworking people like retirees. To apply, however, people also need private health insurance. “Getting your residency card can take a few months. ” Garabito said. and once someone becomes a legal temporary resident. paying into Social Security enrolls them in the country’s public health care system.
Overall, the timeline from visa approval to accessing health care takes three to six months.
In certain countries, digital nomad visas can lead to longer-term relocation. Garabito said digital nomad visas are stepping stones into more permanent relocation in countries including Portugal, Spain and Greece. In Spain, people can apply for permanent residency after five years of living there, and for citizenship after 10 years.
The full shift isn’t always immediate, and it isn’t always easy. But for Americans weighing cost, coverage and daily safety, the math is increasingly part of the conversation.
For Mark, the trade-off has brought a new kind of stability. “I’m not just saying it to say it,” she said. “I’m so much happier, so much more at peace.”
U.S. healthcare costs universal health care Americans abroad medical debt asthma treatment biologic medication France Spain Greece digital nomad visa nonlucrative visa West Health-Gallup Center The Harris Poll