Published On: January 24th, 2024Categories: Healthcare, InsuranceTags: , , , , , , ,

2024 Guide to Moving Abroad With a Disability or Pre-Existing Condition

2024 Guide to Moving Abroad With a Disability or Pre-Existing Condition

Moving abroad with a disability or pre-existing condition comes with challenges. What countries allow me to move there? Can I use the healthcare system? Is accessibility acceptable and reliable? Can I still receive my U.S. government benefits—such as social security, SSDI, or VA benefits—if I leave the U.S. for good?

It’s tough to discover how another country will accommodate your needs before you actually arrive there. To that end, Expatsi reached out to fellow expats to ask how their countries accommodate people with mobility issues or diagnoses like autism. Here’s what we found out:

Why don’t other countries adapt for disabled people like the U.S?

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The U.S. is somewhat of a pioneer in the level of accommodations for its disabled residents, thanks to the Americans with Disabilities Act (ADA). Signed by President George H.W. Bush in 1990, the ADA created the first comprehensive civil rights law for people with disabilities. It established standards like curb ramps, wheelchair lifts on buses, and adding lift access to public buildings.

Other countries followed the United States’ lead and passed disability rights laws, improving access for disabled people in their cities. However, in less populated parts of those countries, accessibility issues often remain, as they believe retrofitting an entire country to be cost-prohibitive. Also, some benefits are reserved for their citizens or tourists, because they may discriminate against disabled expats.

Italy illustrates how these efforts towards accessibility can produce mixed results. Global mobility expert Damien O’Farrell says that bustling urban centers have wheelchair access ramps throughout, but it’s common to find vehicles blocking those ramps. O’Farrell says the Roman subway system offers accessibility options, but “elevators and escalators in these stations are notorious for being frequently out of service,” forcing users to find less convenient transportation.

Ecuador has also made strides in becoming more accessible in its big cities. Andre Robles from Voyagers Travel reports that Quito and Guayaquil expanded sidewalks and updated buses to better accommodate wheelchair users, though adaptations still lag behind for the deaf and blind. Ecuador’s Ministry of Tourism site helps visitor find accessible hotels and entertainment, while the CONADIS council continues advocating for disability equality across the country.

Accessibility and acceptance are growing

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Disabled expats tend to find better accessibility options when traveling in more modernized areas abroad. Laura from A Piece of Travel describes accessibility options in Panama City, Panama:

“Accessibility is best in newer areas where the sidewalks tend to be in better shape and drop-down curbs are more present. There are many hotel chains in Panama…and those typically offer the best accessibility features. The metro and MetroBus in Panama City are accessible, though their immediate sidewalks can be challenging. Large chains and buildings in newer areas often offer accessible entrances.”

Hunter Schultz, author of the Expat Health Guide, confirms Laura’s thoughts about Panama’s capital. He adds that mobility challenges can escalate outside Panama City, due to inconsistencies in pavement and building construction standards. Children with autism can access special social programs for assistance, however, and Panamanians are normally very caring and helpful. Hunter’s best advice for people with disabilities: “Come and try living here for three to six months. See if it fits you and you fit it.” He also recommends checking out expat Facebook groups for your chosen cities before booking the scouting trip.

Expats also see this dichotomy of accessibility in Japan. Matt Heron, a Canadian entrepreneur living in Japan, says most urban places feature a number of accommodations: ramps, elevators, textured paths, and Braille for the visually impaired. Commuters often wait patiently while disabled riders get assistance on trains and buses—”a positive upgrade from what I remember seeing in Canada,” he says. Alex Evans from Southeast Travel Guide recommends using cable cars for additional options; be sure to confirm their wheelchair accessibility in advance. However, the rest of Japan hasn’t upgraded its infrastructure for older structures, often leaving narrow stairs as the only access point.

Turkey has some of the same issues as these countries. An Istanbul resident since 2019, expat Kimberly McCauley explains that most Turkish buildings are too old to add elevators, though sliding chairs inside stairwells are becoming more prominent in these structures. She describes the harrowing experience of watching blind people traverse chaotic crosswalks between speeding cars.

Reddit expats have been quick to share their experiences with us. One expat on Reddit’s r/expat forum describes their experience in Ireland: “Accessibility is not great, but [it’s] better than most European countries. [There’s] less stigma, easier paperwork, but [poor] healthcare and lack of public transport.”

More industrialized cities should be easier to navigate than smaller towns. A Piece of Travel says that American brands abroad will often incorporate the ADA standards seen in the U.S.; consider using these familiar hotels and stores while testing out a new country. At the very least, frequenting these businesses can help build confidence while experiencing life in a new country.

Are there any countries where a disabled person can or can’t move?

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In most cases, disabled people can move wherever abled people can. Kristine Thorndyke of TEFLHero confirms that there’s no visa barrier there for disabilities. Panama is the same. Countries with universal healthcare will still extend coverage, though waiting periods and supplemental insurance may apply. In countries like Germany, where health insurance is mandatory, you’ll find private insurers to fill in gaps on preexisting conditions. Others, like Costa Rica, extend healthcare coverage for all at one nominal rate. Brazil covers medical costs for all residents for free.

A few countries may dig a little deeper into your medical background. As with Medicare in the U.S., citizens pay into the health system their whole working lives; these countries may discriminate if you’re going to cost the system more money than it’s comfortable with. Many Americans have autism or raise children with autism, so discrimination against people with autism is a more common concern.  

The UK, Canada, New Zealand, and Australia may decline your residency if your autism treatment costs rise above a certain threshold. Canada has the highest threshold: so long as your autism-related treatment costs less than $25,000 per year, it won’t disqualify your residency visa on its own. New Zealand recently increased its medical cost threshold to $81,000 over a five-year period, while also removing HIV/AIDS from its list of serious conditions. Practically speaking, this should mainly prohibit expats with the only most severe physical or mental limitations.

In short, just because one country denies you residency for medical reasons, another country may not.

Can I get health insurance abroad?

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This is a very complex question, so we’ll simplify it as best we can.

Generally, you can get health insurance, but the specifics on how to qualify vary between countries. Many countries have some form of universal healthcare that you can participate in; expats often supplement these universal schemes with private health insurance for faster service or to cover preexisting conditions. Some countries may require an upfront fee to access the universal system. The National Health Service (NHS) in UK covers your medical care, provided you pay an “immigration health surcharge” of £1,035 a year. 

Expat healthcare planner

Let’s use Spain as an example of how you might get coverage abroad. Spain considers healthcare to be a constitutional right, but not all expats can access SNS, their universal health scheme. As a resident in Spain, you’ll only get access to public healthcare if you contribute to social security (generally when you work in Spain) or, in some cases, once you qualify for permanent residency (PR) after five years. So, most expats in Spain need to purchase private health insurance. Alison Johnson from Moving to Spain says insurers DKV and ASISA recently began covering clients with preexisting conditions, including disabilities. You could get insurance through one of them until you qualify for SNS, or longer if necessary. You can get a quote from them now to see how your premiums might look.

Spain may have other benefits for you, too. According to Johnson, Spanish immigration can classify disabled people as dependents in Spain. Therefore, most visas are achievable, so long as you can financially support yourself and any dependents and get qualifying private health insurance. In addition, she said that in many cases, Spain doesn’t tax a client’s U.S. military disability pension. Remember that expat tax laws can be complex, so check out our guide to expat taxes or consult an expat tax professional.

Other countries can still be slow to update their approach to healthcare. One U.S. expat living in Germany describes that system as “just so inflexible and they want everything done organically….I was here through COVID, and even the COVID vaccine roll-out was a solid 6 months behind the U.S.” This passive approach, according to the Reddit user, summarizes the German health’s system philosophy of maintaining a slow, measured approach to treatment.

Can I still receive social security or SSDI if I leave the U.S.?

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American citizens can still receive social security payments or SSDI benefits once they leave the U.S. There are a couple of stipulations you’ll have to follow to get paid:

  • Alert the Social Security Administration (SSA) that you’re leaving the country.
  • Set up direct deposit for social security payments. You can get direct deposit at banks in any of these countries.
  • The SSA sends a questionnaire every 1-2 years to confirm that you still qualify for payment. You can find details here, starting at page 21.
  • Be aware SSA cannot pay you any social security benefits in these countries: Afghanistan, Azerbaijan, Belarus, Cuba, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine, Uzbekistan, Vietnam.

The official SSA website has more information on how this process works.

What are the best countries for disabled people to immigrate to?

Shutterstock Wheelchair Dance Catalonia Spain jpg

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Details on which countries welcome disabled expats can be murky and subject to change over time. It’s important to note that no country is 100 percent accessible for disabled expats, according to accessibility consultant Svetlana Kouznetsova. We’ll continue to watch for new countries deciding to welcome people with disabilities with open arms. As of January 2024, here are our top countries for disabled expats:

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Co-founder at Expatsi | + posts

Brett Andrews is an expat influencer and co-founder of Expatsi, a company that's helped thousands of expats on their moving abroad journeys. Brett and his partner Jen developed the Expatsi Test to recommend countries to move to, based on factors like budget, visa type, spoken languages, healthcare rankings, and more. In a former life, he worked as a software developer, IT support specialist, and college educator. When he's not working, Brett loves watching comic book movies and reading unusual books.

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bed49dc5d4263d6d37b46cb09574d411?s=150&d=mp&r=g
Co-founder at Expatsi | + posts

Brett Andrews is an expat influencer and co-founder of Expatsi, a company that's helped thousands of expats on their moving abroad journeys. Brett and his partner Jen developed the Expatsi Test to recommend countries to move to, based on factors like budget, visa type, spoken languages, healthcare rankings, and more. In a former life, he worked as a software developer, IT support specialist, and college educator. When he's not working, Brett loves watching comic book movies and reading unusual books.