Insure everything or just the really expensive stuff?

If you would happily pay a 5,000-baht medical bill yourself but would hate to see 500,000 baht disappear from your savings, somewhere between those two numbers is the amount of healthcare you actually want to insure.

Some expats would rather pay routine costs themselves and keep insurance for treatment that could do serious damage to their finances. Others would rather pay more in premiums and have consultations, scans, medication and hospital care covered as far as possible.

Would you insure this?

MedPark currently lists an echocardiogram at 4,200 baht and coronary calcium scoring at 5,200 baht. Its spinal MRI screening starts at 15,000 baht, while a current colonoscopy package is 23,100 baht.

For many expats, those are amounts they could pay without much difficulty. If you see a doctor only occasionally, paying them yourself may feel preferable to buying broader outpatient cover simply so every smaller expense can be claimed back.

That balance changes when smaller bills become regular. Frequent specialist visits, medication and diagnostics can make broader cover more worthwhile.

Now keep raising the number

Bangkok Hospital currently publishes a 225,000-baht package for laparoscopic appendectomy. Bangkok Heart Hospital lists coronary angiography with PCI at roughly 299,000 to 322,000 baht, while published coronary artery bypass packages start above 1.1 million baht.

These are listed hospital package prices, and additional treatment can push the final bill higher. A 20,000-baht bill may still feel manageable. Once costs move into the hundreds of thousands, paying them yourself starts to have a much bigger impact on savings.

At more than 1 million baht, the issue is no longer just whether you can pay, but what losing that money would mean afterwards.

Self-insured or simply uninsured?

Many long-term expats choose high deductibles, skip outpatient cover or keep savings aside for medical costs. That can be a deliberate strategy, but it is different from simply going without insurance.

Self-insurance only works if the money is actually there when needed, and if it is money you are prepared to spend on healthcare rather than the same savings earmarked for retirement, family support or everything else.

A medical reserve also has to survive more than one big bill. Spending 500,000 baht from a 3-million-baht fund leaves less available for whatever comes next.

One big bill is not the whole problem

The strongest case for self-funding is often built around a single event: decide how large a hospital bill you could absorb, keep that amount available and insure anything beyond it. Healthcare does not always arrive so neatly.

Cancer is currently the biggest driver of insurers' medical claim costs globally, according to WTW's 2026 Global Medical Trends research, and serious conditions can involve diagnostics, treatment, follow-up care and further treatment over a long period.

Someone with substantial savings may reasonably keep more of that risk themselves. The same bill will feel very different to someone with a large portfolio than to someone relying mainly on a fixed pension, so the limit is what their finances could withstand over time, not simply what they could pay once.

A deductible puts a number on it

If you are comfortable paying the smaller part yourself but want protection once the bill becomes painful, insurance already has a mechanism for that: the deductible. 

A higher deductible means accepting more of the initial cost yourself before insurance begins paying eligible claims, generally in exchange for a lower premium. A lower deductible shifts more of that cost to the insurer but usually costs more to maintain.

Cigna Global currently allows deductible choices from zero up to US$10,000 on its core international health plans, alongside different cost-sharing options. That lets policyholders decide how much expense they want to retain instead of treating the choice as fully insured or completely self-funded.

And what about everyday healthcare?

Cigna's International Outpatient option for its Silver, Gold and Platinum plans can add cover for consultations, prescribed medication, diagnostics and rehabilitation, while Close Care has its own outpatient and wellness option.

Someone who rarely needs those services may look at the extra premium and decide to pay as they go. Someone seeing specialists regularly may reach the opposite conclusion because repeated smaller bills are exactly the expenses they want to make predictable. Neither approach requires insuring absolutely everything.

Name your number

Saying you only want insurance for "the expensive stuff" still leaves one decision: what counts as expensive? Is it 100,000 baht, 300,000 baht, 500,000 baht or 1 million baht? And would that number still work if another substantial bill arrived next year?

Explore Cigna Global's plans and compare how different deductibles, cost-sharing levels and outpatient options change what you keep paying yourself and what you hand over to the insurer.

If you pay smaller medical bills yourself, what is the biggest bill you would still be comfortable covering before you would want insurance to take over?

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