BANGKOK, Thailand – Expats in Thailand face a harsh reality when they become care-dependent, as home country insurance systems provide no support.
German, Austrian, and Swiss nursing care insurance pays nothing in Thailand, leaving decades of contributions worthless. This rule is not new, but it consistently catches expats off guard.
What the German nursing care insurance provides in Thailand
The answer is short: nothing. According to § 34 para. 1 no. 1 SGB XI, all benefit claims from German nursing care insurance are suspended as long as an insured person resides permanently in a third country such as Thailand. It does not matter how many decades and at what level contributions were paid.
Since January 2026, a new regulation applies for temporary stays abroad: during a visit to Thailand of up to eight weeks, care allowance continues to be paid—previously it was six weeks. This change only affects people whose residence remains in Germany and who only visit Thailand temporarily.
Austria and Switzerland: the same basic rule
Austrian care allowance under the Federal Care Allowance Act is tied to residence in Austria. Anyone living permanently in Thailand loses the entitlement. Switzerland also does not provide an exportable helplessness compensation for residents outside the EU and EEA.
Those who formally keep their residence in Germany, Austria, or Switzerland but actually live in Thailand operate in a legal gray zone. Care funds can retroactively demand repayment of benefits if the actual center of life was moved abroad.
“Anyone in this situation should clarify the constellation with a specialized lawyer—before the care case occurs.”
What care in Thailand actually costs
This is the crucial difference to Europe: care in Thailand is significantly cheaper—and often significantly more personal. A private caregiver who comes for several hours daily or lives in the household costs between 500 and 800 euros per month. In Germany, the same care intensity would cost 3,000 to 5,000 euros.
The staff ratio in well-managed care facilities in Thailand is remarkable. Some houses geared toward German-speaking residents report ratios of three caregivers per resident—a standard structurally unattainable in German facilities.
Care at home or senior residence
Most expats in Thailand live in their own apartment or house, often with a Thai partner. As long as this constellation works, home care through a hired caregiver is the most obvious and cheapest solution. Important: the person must have basic nursing training—not every helpful person is suitable for medically demanding situations.
For those without a partner, living alone with progressive care needs, or with specific medical requirements—such as dementia or after a stroke—a senior residence is the more realistic option. Known regions for such facilities include Phuket, Koh Samui, Pattaya, and the outskirts of Chiang Mai.
What makes a good facility
Three points are decisive: first, medical connection to a nearby private hospital; second, care continuity—facilities with a long-standing core team offer more reliable care; third, cost transparency—reputable houses list all services and additional costs in writing before a contract is signed.
One underestimated aspect: visitability by relatives. Bangkok, Phuket, and Pattaya are reachable from European airports directly or with one stopover. A facility in a remote province may be cheaper, but if children or siblings can only come once a year, accessibility weighs heavily.
Power of attorney and will: what applies in Thailand
A German or Austrian power of attorney has no automatic legal effect in Thailand. To ensure that a specific person can make decisions in a care case, an additional document valid in Thailand is needed—either a notarized power of attorney under Thai law or one certified through the relevant consulate.
A will under German or Austrian law regulates the estate in the home country. For assets in Thailand—bank accounts, condominiums, vehicles—a separate will under Thai law is required. Specialized legal advice in Thailand helps to cleanly separate and secure both areas.
Private supplementary care insurance: is it worth it?
For those without private supplementary care insurance living in Thailand, the offer for persons over 65 with a residence outside the EU is thin. International health insurers like Cigna Global or April International sometimes offer care components—but at premiums that are substantial in old age and quickly make the comparison with self-financing in Thailand unattractive.
Those who are young enough and have not yet given up their residence should regulate the topic before emigrating—not afterward. A private supplementary care insurance taken out with a German residence before age 65 can possibly be maintained even if the center of life moves abroad.
What needs to be clarified now
Anyone living in Thailand who has not yet made provisions should address three things: first, clarify the care insurance status—is the claim already suspended, or is there formally still a residence in the home country? Second, have a power of attorney and will drawn up under Thai law. Third, inform themselves about one or two care facilities in their own region—not to move in immediately, but to be prepared in an emergency.
The good news: those who become care-dependent in Thailand are not helpless. The care provision on site is far better than many expect—and significantly cheaper than in Europe. What is missing is the state support from home. One must replace that oneself—with planning before the emergency occurs.