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- By Wei Landgraf
Best Private Health Insurance for Sint Maarten Retirees (2026)
Private international health insurance is what most of my clients use to fill the gap between SZV (the local system) and Medicare (which doesn’t cover SXM). The market is real, the choices are limited, and the underwriting matters more than the brochures suggest.
I’m not a licensed insurance broker. The framework below is what I see working for my retired clients. For actual quotes and binding coverage, work with a broker who specializes in Caribbean expats.
Key Takeaways
- Typical premium for ages 60–70 with $1,000 deductible: $2,800–$5,000/year per person.
- Ages 70–75: $4,500–$8,000/year per person.
- Ages 75+: premiums climb steeply; some carriers stop accepting new applicants at 75 or 80.
- Pre-existing conditions are typically excluded for the first 12–24 months or excluded permanently. Disclose everything during underwriting.
- Top international carriers working in SXM: Cigna Global, Allianz Care, IMG Global, GeoBlue, William Russell, APRIL International. Local Sint Maarten carriers exist but with narrower coverage.
- Medevac is usually a separate policy. Don't assume international health includes air ambulance back to the US.
What to look for in a plan
Coverage area. Global vs regional
For most North American retirees, including US is the right answer. You’re going home for kids’ weddings, occasional specialist visits, and emergencies. Without US coverage, those become out-of-pocket.
- Worldwide excluding US: cheaper, often 30–40% less than worldwide-including-US.
- Worldwide including US: essential if you ever plan to travel to the US for elective procedures, second opinions, or family visits with healthcare access.
Annual maximum benefit
A complex cardiac surgery in Miami can hit $300K–$500K. A 30-day ICU stay can exceed $500K. Don’t undersize this.
- Minimum I'd consider: $1,000,000/year per person.
- Better: $2,000,000–$5,000,000/year.
- Top tier: unlimited annual / lifetime.
Inpatient vs outpatient coverage
- Inpatient-only plans are cheaper but won't cover GP visits, specialists, prescriptions, diagnostics. Useful only as a SZV supplement.
- Comprehensive (in + outpatient) is what most retirees buy. Confirm prescription drugs are covered (some plans exclude pharmacy).
- Maternity, mental health, dental, vision are typically optional add-ons. Most retirees skip maternity (obviously). Dental and vision add 20-30% to premium for relatively limited benefit.
Deductible structure
- Lower deductible ($500–$1,000): higher premium, lower out-of-pocket on claims. Good for retirees with chronic conditions who'll claim regularly.
- Higher deductible ($2,500–$5,000): lower premium, you self-insure for routine care. Good for healthier retirees who plan to use SZV for routine and private only for catastrophic.
Pre-existing conditions
- Underwritten plans (most plans for individuals): you disclose conditions at application; insurer either excludes them, surcharges, or denies. Hypertension, type 2 diabetes, knee/hip arthritis, mild depression. Common retiree conditions that often get excluded for 12–24 months or permanently.
- Moratorium plans: any condition you had in the prior 5 years is excluded until you go 24 months without symptoms or treatment for it. Then it's reinstated. Common in UK-origin plans (William Russell, BUPA International).
- Group / employer plans: less restrictive but rarely available to retirees.
Renewability
- Guaranteed renewable. The insurer must renew you regardless of claims history (typically until age 99 or 100 with some carriers).
- Conditional renewable. Insurer can decline at renewal based on claims experience or geography.
Carriers that work in Sint Maarten
- Allianz Care. One of the largest expat health insurers globally. Strong network, robust evacuation included on some plans.
- APRIL International. Good Caribbean network, French-side friendly.
- Cigna Global. Wide network, claim service generally well-rated. US-inclusive plans are competitive.
- GeoBlue. Blue Cross Blue Shield's expat arm. Strong for US-American expats wanting BCBS network access in the US.
- IMG Global. Good mid-tier pricing.
- William Russell. UK-origin, moratorium-style underwriting, good for retirees with manageable pre-existings.
- Local SXM carriers. Massy United, Guardian Group, etc. Often used as supplements to SZV, less robust for international care.
A licensed expat insurance broker can bring quotes from 5–10 carriers and structure side-by-side comparisons. Use a broker. Self-shopping is exhausting and often results in suboptimal coverage.
Premium examples (rough 2026 ranges)
For a comprehensive worldwide-including-US plan, $1M annual maximum, $1,000 deductible, healthy applicant:
| AGE | ANNUAL PREMIUM PER PERSON |
|---|---|
| 50–55 | $2,000–$3,500 |
| 55–60 | $2,500–$4,000 |
| 60–65 | $2,800–$4,800 |
| 65–70 | $3,500–$5,800 |
| 70–75 | $5,000–$8,000 |
| 75–80 | $7,500–$12,000+ |
| 80+ | Often $12,000+ or hard to get |
Add 30–50% for couples vs single. Subtract ~30% for worldwide-excluding-US.
These are rough. Real quotes depend on health, gender, exact coverage choices.
Combining SZV and private. The typical retiree stack
- SZV (mandatory). Handles routine GP, prescriptions, emergency at SMMC. NAF 200–500/month.
- Private international plan. Handles US care, specialist care abroad, complex care. $3,500–$5,500/year per person.
- Medevac plan. Handles air ambulance specifically. $300–$700/year for a couple.
- Medicare Part B (US clients) kept active. Handles US care if back home. ~$2,200/year.
Total annual health spend for a 65-year-old US couple: roughly $11,000–$16,000.
This sounds high. It’s actually similar to or less than what they’d pay at home, where Medicare premiums + Medigap + out-of-pocket easily run $8,000+/year per person.
When private doesn't pay off
Three scenarios where retirees can run lighter:
- Snowbirds maintaining home-country coverage. Don't need a full international plan. Buy travel medical for SXM trips.
- Very low-asset retirees willing to rely on SZV and accept slower care for complex cases. Risky but financially defensible.
- Retirees with strong family support and savings willing to self-insure the $500K-and-below band. Rare but possible.
If you’re Canadian and want a retirement community where you’ll know neighbors quickly, Pelican Key punches above its weight.
Common questions
Can I get a plan with a pre-existing condition?
Yes, often with that condition excluded. Some moratorium plans reinstate after 24 months symptom-free. Disclose during underwriting; don’t hide.
Can I switch carriers later?
Yes, but each switch re-underwrites. Conditions you developed under Carrier A become “pre-existings” for Carrier B. Switching after 70 is risky.
Do these plans cover dental and vision?
Optional add-ons typically. Many retirees self-insure dental at SXM cash prices ($70 cleanings, $600 crowns) and skip vision coverage.
Will they cover me back in the US permanently?
Some plans require a primary residence outside the US to maintain. If you move back to the US, the plan often terminates. Read the policy carefully.
Can I use the plan in Curaçao or the Netherlands for referred care?
Yes, generally. International plans are designed for cross-border use.
What about Canadian retirees?
The carrier list is largely the same. Canadian-origin alternatives include Manulife World Travel and TuGo, but these are typically travel-medical, not full residency-based health insurance. Most Canadian retirees in SXM use the same global insurers as Americans.
How do I pay claims?
Most plans operate on a direct-billing basis at network providers (you show your card, insurer pays the hospital). For non-network or out-of-network providers, you pay first and submit for reimbursement.
What to do next
01
Get three quotes from a Caribbean-expat-specialist broker. Don’t shop direct.
02
Decide US-inclusive vs not. US-inclusive is the right answer for most North American retirees.
03
Be honest in underwriting. Disclose every chronic condition and every medication.
04
Stack with SZV and medevac. SZV · Medevac.
05
Lock the policy before you turn 70. Premiums and underwriting get worse fast after that.