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The notion that healthcare outside the U.S. could be good as well as cheap is a foreign one to many Americans.

Expat Kathleen Peddicord frequently hears from such skeptics as founder of Live and Invest Overseas, a site for people curious about living abroad. Actual expats like her, however, tell of good-quality care at a fraction of the U.S. price.

Treatment for a motorbike accident in Panama cost her $20. Emergency dental surgery that might cost $10,000 or more in the U.S. was $4,500 in Paris.

In many countries, medications that would require a prescription in the States are available directly from licensed pharmacies at low prices, thanks to government subsidies or regulation.

“The healthcare in a lot of places around the world is very good, as good as in the United States,” said Peddicord, who currently divides her time between Paris and Panama. “Some places, it is better.”

Among reasons to move

Low-cost, quality healthcare usually isn’t the main reason people move abroad, said expat and Mexico resident Don Murray, who writes for rival site International Living. But reduced medical expenses are part of the lower living costs that prompt many Americans to relocate, he said.

About nine million Americans who aren’t in the military live outside the U.S., according to State Department estimates. That’s increased considerably from its 1999 estimate of three to six million.

The number could rise in coming years as millions more Americans barrel toward retirement without enough income to maintain their standard of living at home.

Healthcare is a particular concern for Americans who want to retire before age 65, when Medicare kicks in. Currently, early retirees can buy coverage through the Affordable Care Act, but it’s not always truly affordable and its future is uncertain.

Some who would otherwise retire plan to keep working, rather than risk being uninsured. But a move abroad could be an option for those intrepid enough to try it.

Cheaper healthcare also may appeal to gig economy workers who aren’t tied to stateside jobs. Freelance science writer Erica Rex, for example, recently wrote an opinion column for The New York Times about moving to the United Kingdom and then France after her 2009 cancer diagnosis.

“Moving to Europe was a choice weighed against other, grimmer options for healthcare, which included the strong possibility of being bankrupted by cancer treatment and winding up at the mercy of New York State’s welfare system,” she wrote.

Quality abroad varies

Not all expat havens have great healthcare systems. Belize, for example, encourages immigration by exempting retirees from most income taxes. But many expats there cross the border to Mexico for healthcare, Peddicord said.

France, on the other hand, is known for its excellent healthcare system. International Living and Live and Invest Overseas give the country top marks, along with Mexico, Ecuador and Malaysia.

International Living praises Thailand and Costa Rica as well, while Live and Invest Overseas said Portugal, Italy and Malta have admirable healthcare.

With any country, quality can vary, especially in sparsely populated areas. Murray and his wife, Diane, left their first retirement destination, a small town in Ecuador, after encountering broken equipment and few doctors.

They’re much happier with the care near their Yucatan Peninsula home, where next-day appointments are the norm, and doctors are typically trained in the U.S. or Europe, he said.

“It’s like in the U.S. — if you live in Possum Belly, Alabama, and they don’t have a hospital and the nearest one is an hour and a half away, the healthcare isn’t going to be the same” as in a major city, Murray said.

Options for coverage

Expats may be able to qualify for a country’s public healthcare system if they become residents. Otherwise, there’s typically a private system in which people can pay out of pocket and get reimbursed if they have private health insurance.

Peddicord and her husband, Lief Simon, who are in their 50s, have an international health insurance policy that covers them whether they’re traveling or at home in France or Panama. The annual cost is about $3,000 for both of them, she said. ‘

Murray, 69, said he and his wife pay about $80 each month for Mexico’s public health system, but use private doctors and pay out of pocket for most care (including $8 for a recent hospital visit to treat an eye infection).

“My personal budget no longer contains a line for healthcare expenses,” Murray said. “They are so inconsequential there is no need.”

This column was provided to the Associated Press by the personal finance website NerdWallet. Liz Weston is a columnist at NerdWallet, a certified financial planner and author of Your Credit Score. Email: lweston@nerdwallet.com.

—AP