Healthcare for Expatriates in Palau: A Complete Guide

Published on March 10, 2026 and written by Cyril Jarnias

Moving to Palau sounds dreamy: turquoise lagoons, jungle-covered islands, laid-back vibe. But for an expat, health considerations can’t be summed up by a lagoon view. Between a healthcare system designed primarily for a small island population, costly medical evacuations, and sometimes confusing insurance, it’s best to arrive prepared.

Understanding the Palauan healthcare system as an expat

Palau’s healthcare system is a mix of public facilities and private clinics. It is designed for a population of about 18,000, scattered across a dozen inhabited islands, with a high concentration (around 70%) in Koror State.

The Ministry of Health and Human Services (MHHS) plays a central role. It oversees the Belau National Hospital, public health services (prevention, environmental health, mental health, epidemiology, oral health) and a network of community health centers on the outer islands.

For an expat, this means two essential things: access to basic care is real and generally effective, but as soon as complex conditions or serious emergencies arise, limitations quickly become apparent and evacuation abroad becomes a very likely scenario.

Belau National Hospital: the backbone of the system

The Belau National Hospital, located in Koror (Meyuns), is the national and main referral hospital. It is an acute-care hospital with about 80–100 beds (some documents mention 65–75 beds depending on the period), originally built with American financial support and designed to meet modern standards.

It includes:

Important feature for a diving country: the hospital has a hyperbaric chamber to treat decompression sickness, which is strategic for expats who are diving enthusiasts or work in the industry.

For most expats living in Koror or on Babeldaob, the hospital is accessible within two hours of travel. This is largely sufficient for routine consultations, minor injuries, common infections, uncomplicated births. Problems start when the condition requires specialized surgery, prolonged heavy intensive care, or complex treatments (interventional cardiology, advanced oncology, complex orthopedics, etc.).

Community Health Centers: territory coverage, limited capacities

Outside Koror, access to the Belau National Hospital can be difficult. This is where the network of ten Community Health Centers (CHCs), spread across different states to provide local care, comes in:

These centers provide general medicine consultations, maternal and child health follow-up, vaccinations, management of the most common chronic diseases, some minor procedures, and stabilization of emergencies before transfer.

Private clinics: more comfortable alternatives, but limited in number

Alongside the public sector, a few private clinics have developed, mainly in Koror. According to sources, there are three to five private medical clinics, a private dental center, and an independent private pharmacy. They offer:

– General medicine and quick consultations

– Minor surgeries and treatment of minor injuries

– Pediatric consultations

– Diving medical exams, occupational medicine

– Dental care (check-ups, cavities, extractions, dental X-rays)

– Optical care and eyeglass prescriptions

– Wellness services

However, the cost is higher, and the general rule remains the same: immediate payment required, most often in cash or by credit card.

A system generally effective for routine care, fragile for complex cases

On paper, Palauan authorities aim for universal health coverage. Citizens and legal residents are entitled to public care, mostly subsidized. Wait times are even reported to be shorter than in large countries for many procedures.

But the structural reality remains that of a country with 18,000 inhabitants, isolated in the middle of the Pacific, with limited resources and a shortage of specialists. Officially, just over 80% of adults report having health insurance, and more than half have had a recent annual medical exam. Yet, about 14% say they have forgone care in the past year due to financial or transportation constraints.

For an expat, it’s therefore important to distinguish what the local system handles well — routine care, prevention, simple emergencies — and what will eventually require leaving the country.

Health insurance: the cornerstone for expats

In Palau, healthcare is not free for foreigners. Even in the public sector, a non-citizen pays for care, sometimes at rates significant by local standards. Add to this a much heavier factor: the near-impossibility of treating certain serious conditions on-site, making medical evacuations to the region (Philippines, Taiwan, Guam) or to Hawaii frequent. These evacuations easily cost tens of thousands of dollars.

Without appropriate coverage, an expat therefore faces a dual risk: financial and health-related. Hence the importance of understanding the options well: local insurance versus international coverage.

Palauan-side health financing: useful to know, but largely inaccessible to foreigners

For citizens and legal residents, the country has set up an original system, the National Healthcare Fund, established by the 2010 funding law. It consists of:

– A national health insurance (National Health Insurance), which covers hospitalizations and partially funds care sent abroad

– Individual Medical Savings Accounts (MSA) for outpatient care, check-ups, certain medications or private insurance premiums

Each employee and their employer contribute 2.5% of the salary. Seniors (from 60–65 years depending on the scheme) benefit from public coverage of their contributions. The fund reportedly covers about 95% of the population and funds hundreds of medical referrals abroad each year.

Local or international insurance: what to choose concretely in Palau?

For a new resident, the question often arises: should you get local insurance or international health insurance?

Local Palauan insurance, like the “Palau Preferred Plan” offered by NetCare, are designed for residents. They offer coverage with no deductible for many services, an annual and lifetime maximum, defined copayments (e.g., a fee for 90 days of certain medications), and a clear referral mechanism to partner care centers in the Philippines or Taiwan.

A key point: to be covered outside Palau, a prior referral from an approved doctor, validated by the insurer, is required. Without this procedure, no coverage abroad. Care received from non-partner providers outside Palau, the Philippines, and Taiwan is generally not reimbursed. The insurance also includes specific limits per type of condition, e.g., for chronic orthopedic conditions (cap of $5,000 per contract period).

From an expat’s perspective, these local plans have several weaknesses:

– Restricted geographical coverage (Palau + a few targeted partner countries)

– No coverage for prolonged stays outside Palau beyond a certain number of consecutive days

– Little to no coverage if you return to your home country for treatment

– Numerous exclusions (dental care except accidents, fertility treatments, certain paramedical procedures, etc.)

– Rigid referral procedures for care abroad

Conversely, international health insurance (IPMI – International Private Medical Insurance) is designed for expats and globalized lifestyles. It offers:

– Worldwide or regional coverage (e.g., worldwide excluding the US, or worldwide including the US)

– The possibility of being treated in many countries, even in your home country, without changing contracts

– High reimbursement ceilings (often over a million dollars per year)

– Medical evacuation and repatriation included as standard

– Freedom to choose doctors and hospitals within a large international private network

– Service in multiple languages, with 24/7 emergency assistance

– Modular options (hospitalization only, + outpatient, + maternity, + dental, etc.)

In return, premiums are significantly higher than for simple local insurance. But in Palau, where a single serious medical event can ruin a budget, this extra cost must be compared to the real risk.

Five pillars for evaluating insurance when living in Palau

A useful framework for comparing offers involves examining five essential aspects:

In Palau, the “Medical Evacuation” pillar is non-negotiable: certain types of cancer, complex heart conditions, or neurosurgical emergencies simply cannot be treated locally. You must also ensure the contract covers hospitalization and care in the countries to which patients are typically transferred: Taiwan (notably Shin Kong Wu Ho‑Su Memorial Hospital), the Philippines, Guam, or Hawaii.

Pre-existing and chronic conditions: a delicate issue

Expats living with chronic diseases (diabetes, heart failure, cancer, kidney failure, autoimmune diseases, COPD, severe psychiatric disorders) face a harsh reality: most international insurers refuse to cover these known conditions, or accept them with exclusions and/or significant surcharges.

It is crucial to understand the systematic distinction between:

– Pre-existing conditions (diagnosed or manifest before enrollment)

– New conditions (diagnosed after the policy takes effect)

For those with a serious pre-existing condition, two paths exist:

– Group contracts negotiated by an employer or large organization, which can sometimes be arranged “medical history disregarded”, i.e., without exclusion of pre-existing conditions

– A combination of international coverage (for new risks) and local or home country national coverage for the known condition, accepting that part of the care will be out-of-pocket

In all cases, full transparency upon enrollment is imperative. Omitting a medical history can lead to a denial of coverage when a claim is made, or even to policy cancellation.

Why simple travel insurance is not enough for an expat

Some people arriving in Palau confuse travel insurance and expat health coverage. Travel policies are designed for short trips. They typically cover:

– Unforeseen medical emergencies

– Evacuation and repatriation

– Trip cancellations, delays, lost luggage

But they do not cover the regular management of a chronic disease, nor check-ups, nor planned care. They are time-limited (a few weeks or months at most) and do not automatically renew for a long-term resident.

For an expat settling in Palau, travel insurance can only serve as a temporary measure, for example during the first few months while setting up appropriate international coverage. Beyond that, it is absolutely necessary to switch to long-term health insurance.

Medical evacuations: a scenario to anticipate, not endure

In Palau, the quality of basic care is generally satisfactory. But for many specialties (interventional cardiology, advanced oncology, complex orthopedics, neurosurgery), the country is officially classified as a “medically underserved area.” Reliance on evacuations abroad is structural.

National statistics show the state spends over two million US dollars per year on medical referrals outside the country. Between 2020 and 2022, the total cost of specialized evacuations exceeded seven million dollars. Oncology and cardiology are the most costly items, with annual amounts in the six figures. Preferred destinations are Taiwan and the Philippines, with Hawaii and Guam involved for a portion of cases.

For an expat, this has several very concrete implications.

The real cost of an evacuation from Palau

A medical air evacuation from Palau — typically to Manila, Taipei, or Honolulu — can easily reach or exceed several tens of thousands of dollars, depending on:

Add to this the cost of the hospital stay at the destination, which can quickly become very high in a country like the United States or Japan. Without appropriate coverage, such an episode can lead to massive debt or force one to forgo optimal care.

How medical referrals work for residents

For Palauans, the Ministry of Health’s Medical Referral Program organizes transfers. The National Health Insurance generally covers 80% of the estimated cost, while the family must cover the remaining 20%. A case study shows a patient whose treatment in Taiwan was estimated at about $17,345 US: national insurance absorbed 80%, leaving the family to pay around $3,500.

Key partner hospitals include:

– Shin Kong Wu Ho‑Su Memorial Hospital (Taipei, Taiwan), a large multidisciplinary facility with over 40 medical departments

– Specialized care centers in the Philippines

– Tripler Army Medical Center and Shriners Children’s Hospital (Hawaii), under specific programs, often with tele-follow-up

What good insurance should provide for evacuations

In Palau, medical evacuation should be considered a central component of your protection. The “evacuation and repatriation” clause in an international policy should be judged on several key points:

– Who decides on the evacuation? Ideally: a joint decision between the local treating physician and the insurer’s medical service, not solely the insured.

– Where can you be evacuated to? Some contracts limit it to the nearest hospital capable of treating the condition. Others allow a return to the home country if medically justified.

– What is covered? Medicalized transport, an accompanying person, admission to the destination hospital, possible subsequent return to Palau or the home country.

– Are there specific limits for evacuation? They must be high enough to cover a trans-Pacific journey.

In the absence of this coverage, you must be prepared to pay for the entire operation yourself, which is unrealistic for almost anyone.

Daily access to care: what the local system can really do for an expat

Once insurance and emergency scenarios are clarified, there’s daily life. The good news: for everything concerning basic care, prevention, common infections, minor injuries, and part of chronic disease management, Palau offers a relatively solid provision.

Consultations, exams, and routine care

Expats can receive care in Palau, both in public facilities (Belau National Hospital, Community Health Centers) and private clinics. Services routinely available include:

– General medicine consultations

– Management of hypertension, diabetes, dyslipidemia

– Pediatric consultations, free childhood vaccinations for residents

– Basic gynecology and pregnancy follow-up

– Wound care, minor trauma

– Common lab tests and standard imaging

Population health studies show that just over half of adults have had a recent annual medical exam, indicating fairly frequent use of care. Most facilities operate by appointment, but emergencies can be seen without prior notice.

Dental care: accessible, but sometimes slow

Oral health is a major issue in Palau. A significant number of adults report having lost at least one tooth due to cavities or gum disease. Regarding access, studies indicate:

– 94% of surveyed individuals have seen a dentist in Palau at least once

– Nearly 84% have had at least three dental visits in their lifetime

– But less than 40% report having seen a dentist in the past year

The main obstacles mentioned are:

– Long appointment wait times (several months, sometimes up to six to eight months)

– Perceived high costs, especially in the private sector

– Consultation hours conflicting with work schedules

For an expat, this means it’s better to:

Telemedicine and international partnerships: an underutilized resource for expats

Thanks to the connection to the SEA‑US submarine cable in 2017, Palau is much better served by high-speed internet. The country has begun building telemedicine programs, including:

– An online referral program with Tripler Army Medical Center in Hawaii, existing since the 1990s, for complex cases

– Tele-follow-ups after surgery with Shriners Children’s Hospital for pediatric orthopedic surgeries

– Remote training and consultations with Shin Kong Wu Ho‑Su Hospital in Taiwan

– A project to create a telemedicine network between Community Health Centers and the national hospital

For an expat, this infrastructure means some specialist opinions can be obtained remotely, without leaving Palau, in partnership with a specialist abroad. But for now, this resource remains mainly organized for the benefit of Palauan residents and official programs; individual use by an expat relies mostly on personal tools (e.g., video conferences with doctors from their home country).

Living with a chronic condition in Palau: continuity of care and medications

Moving to an isolated island country poses particular challenges for those with a pre-existing chronic condition: type 1 or 2 diabetes, heart conditions, autoimmune diseases, kidney failure, psychiatric disorders, etc.

Before departure: preparing your medical file and strategy

Advice from studies on expat health converges:

– Schedule a complete medical check-up before departure, ideally at least four weeks before

– Obtain a detailed medical summary: diagnoses, current treatments (drugs, dosages), important test results, past interventions

– Request this summary in English, even adding a translation in another language if your future doctors require it

– Prepare a concise “health profile” to keep with you: allergies, vital medications, contact details of your doctors in case of emergency

– Scan all these documents and store them securely (health app, encrypted cloud, international medical record service)

Medications: availability, imports, and prescriptions

Continuity of access to medications is a critical point. The Belau National Hospital pharmacy has many basic medications, but the supply is far from exhaustive, and some specialized products may be unavailable or frequently out of stock.

Recommendations are clear:

– Check, before departure, if the drugs you take are available locally, and under what brand names

– Plan for a longer supply of medications than your initial stay duration, to deal with potential resupply delays or customs issues

– Transport medications in their original packaging, accompanied by the prescription and a doctor’s letter explaining the indication and dosage

– Inquire with Palauan customs about the legality of importing each product to avoid confiscation upon arrival

Adapting disease management to the Palauan environment

Palau is a tropical maritime environment. Heat, humidity, mosquitoes, sun exposure, and local diet can influence the balance of certain conditions. For example:

– Intense heat can alter insulin needs in diabetics, or promote dehydration in heart failure patients

– The presence of mosquitoes carrying dengue or other arboviruses can complicate the management of hematological or immune diseases

– The relative distance from certain advanced exams requires reviewing the frequency or mode of monitoring (e.g., performing certain check-ups outside the country during planned travel)

Hence the importance of building, with a local doctor, a realistic follow-up plan that accounts for available resources on-site, and planning for returns or stays in better-equipped countries for comprehensive assessments.

Specific health risks in Palau: protecting yourself intelligently

Living in the tropics has health implications. Palau does not have all the dreaded tropical diseases, but some risks do exist.

Vector-borne diseases and the tropical environment

Dengue fever is present in Palau, with sporadic outbreaks. Recently, several local cases were reported after years of relative calm. There is no universally recommended vaccine for all travelers; prevention therefore relies mainly on mosquito control:

– Long, light-colored clothing

– Suitable skin repellents

– Mosquito nets, ventilation, and air conditioning when possible

– Eliminating stagnant water around the home

Digestive illnesses (traveler’s diarrhea, typhoid) remain a classic of tropical countries. Even if drinking water is generally better controlled than elsewhere in the region, caution is still advised:

– Avoid untreated water

– Be mindful of hygiene in restaurants outside tourist areas

– Wash hands regularly or use hand sanitizer

Recommended vaccinations before moving

There is no systematic vaccination requirement to enter Palau (except specific cases like arriving from a yellow fever endemic zone). However, international organizations recommend that any long-term resident or visitor be up-to-date on a number of vaccinations.

– Basic boosters: diphtheria-tetanus-polio, pertussis (Tdap)

– Complete vaccination against measles-mumps-rubella (MMR)

– Hepatitis A, highly recommended in tropical areas

– Hepatitis B, especially for long stays or occupational risk

– Typhoid, for those who will often eat outside hotels

– Seasonal flu and COVID‑19, especially for vulnerable individuals

Depending on age, health status, and length of stay, other vaccines may be relevant (pneumococcal from age 65 or if immunocompromised, tuberculosis for children who will live there long-term, etc.). Ideally, consult a travel medicine center at least one to two months before departure.

Emergencies, natural disasters, and personal preparedness

Palau is exposed to typhoons and the effects of climate change. Authorities have developed response mechanisms, but in a small island country, the system’s resilience remains limited.

Emergency services and numbers to know

In a medical emergency, the number to dial is 911, notably in Koror, to request an ambulance. The Belau National Hospital can also be contacted directly by phone. Emergency teams treat both residents and foreigners, without discrimination.

Response times remain reasonable in urban areas but can lengthen significantly once you leave the center of the archipelago, especially on the outer islands.

KLEMAT: a national emergency medical team in support

Since 2022, Palau has established a national emergency medical team, called KLEMAT. It brings together doctors, nurses, logisticians, and environmental health experts trained according to WHO standards to intervene during disasters or health crises, including in remote areas.

Natural disasters: what to prepare individually

National emergency plans (via the National Emergency Management Office, NEMO) provide for preparation, evacuation, and shelter phases in case of typhoon or major crisis. In practice, an expat would benefit from:

– Familiarizing themselves with NEMO instructions and alert levels (Condition III, II, I)

– Identifying evacuation centers and solid structures near their home

– Maintaining an emergency kit including personal medications, copies of documents, water, non-perishable food, flashlight, radio, etc.

– Ensuring their international insurance also covers injuries or illnesses in the context of a natural disaster

How to build a coherent health strategy as an expat in Palau

All the elements presented lead to one conclusion: in Palau, an expat’s health relies on a balance between smart use of the local system and setting up a solid international safety net.

In practice, a coherent strategy involves several steps.

1. Assess your personal risk profile

Before even choosing insurance or a doctor on-site, ask yourself some clear-eyed questions:

– Do I have chronic diseases or serious medical history?

– Am I in a higher-risk age group (e.g., over 60)?

– What types of activities will I engage in (diving, sailing, offshore work, extreme sports)?

– Will I need regular treatments (psychotropic drugs, insulin, biologics, etc.)?

The more these answers point to vulnerability, the more essential it is to opt for robust international coverage, with few specific limits and options for covering pre-existing conditions if possible.

2. Choose insurance adapted to the Palauan reality

The decision between local and international insurance must be based on concrete criteria, not just the premium amount. In Palau, it is rarely reasonable to rely exclusively on local insurance, unless:

For most expats, an international health insurance remains the most secure option. It guarantees continuity of coverage when traveling to other countries, more flexible management of evacuations, and access to a vast network of quality hospitals in the Asia‑Pacific region.

3. Organize your care between local and abroad

Once insured, it’s about organizing your actual care pathway:

This “shared care” logic requires more organization but allows you to make the best of each system.

4. Become integrated into the Palauan healthcare system

Living in Palau also means accepting to enter the local network:

– Identify in advance the doctor and clinic you will consult first

– Learn the practical procedures (making appointments, payment, opening hours)

– Consider local customs (frequent request for cash payment, importance of family in medical decision-making for Palauans, etc.)

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Moving to Palau means accepting to live in the heart of an island paradise that lacks the density of medical facilities of a large metropolis or the full range of subspecialties. The local system can adequately handle the majority of common needs and some emergencies. But as soon as serious conditions arise, it relies heavily on foreign partnerships, costly evacuations, and complex logistics.

For an expat, the key is not to avoid this reality, but to account for it from the very preparation of the project: a well-organized medical file, up-to-date vaccinations, anticipated medications, international insurance covering evacuation and serious care, and precise knowledge of what the facilities in Koror and surrounding islands can — and cannot — offer.

This is the price to pay to enjoy translucent lagoons and Palau’s forests serenely, without any health hiccup turning into a personal or financial disaster.

Cyril Jarnias

Cyril Jarnias is an independent expert in international wealth management with over 20 years of experience. As an expatriate himself, he is dedicated to helping individuals and business leaders build, protect, and pass on their wealth with complete peace of mind.

On his website, cyriljarnias.com, he shares his expertise on international real estate, offshore company formation, and expatriation.

Thanks to his expertise, he offers sound advice to optimize his clients' wealth management. Cyril Jarnias is also recognized for his appearances in many prestigious media outlets such as BFM Business, les Français de l’étranger, Le Figaro, Les Echos, and Mieux vivre votre argent, where he shares his knowledge and know-how in wealth management.

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