What really changes after a few years living in Thailand as an expat
The wins and the long-term friction
After a few years in Thailand, many expats describe a consistent journey, where the initial honeymoon period usually gives way to something messier. Cost-of-living advantages and personal growth sit alongside identity questions and practical reckonings many don’t see coming.
While some things improve over time, others creep up quietly and catch you off guard. Healthcare and insurance sit at the intersection of both. Here’s what actually changes when Thailand stops being a vacation and starts being Tuesday afternoon.
On this page
| Heading | Summary |
|---|---|
| The good: What improves over time | Financial breathing room and cultural belonging deepen over the years. Surveys show 85% of expats feel their income is enough to enjoy life, although rising rents and school fees add pressure. |
| The less obvious: What changes quietly | Long-term living can bring identity limbo, loneliness, and ongoing visa uncertainty. Daily comfort often contrasts with legal realities and policy shifts. |
| The parallel journey of healthcare | Healthcare typically follows three phases, from paying out of pocket to facing large bills after a medical event. Surgery quotes of 300,000 Thai baht and accident bills nearing 2 million baht illustrate the risk. |
| Cigna coverage for long-term Thailand residents | Cigna’s international plans offer lifetime renewability and high annual limits, from US$500,000 under Close Care to US$2,000,000-plus under Platinum, including mental health cover. |
| What actually changes | Financial and cultural gains are real, but identity, visa stress, and healthcare risk remain constant. Securing insurance earlier reduces the chance of future financial strain. |
The good: What improves over time
Financial breathing room compounds
According to InterNations surveys, financial advantages rank as the primary benefit of Thailand for expats. The cost-of-living advantage is an actual financial relief that accumulates year after year.
A 12-year Phuket expat writing on The Working Traveller put it plainly: “My internet is better here than back home, and I only pay US$24 per month. The specialist at my local hospital is managing a chronic health issue perfectly. I have an app on my phone that can get meals from all my favourite restaurants delivered for a US$1.40 fee. I am living my best life here.”
The advantage itself is that everything compounds. The same survey found 85% of Thai expats feel their disposable income is enough, or more than enough, to lead a life they enjoy.
That said, costs are climbing. Bangkok rents rose 8 to 12% in 2024 to 2025. International school fees (US$8,500 to 23,000 annually per child), imported goods, and premium groceries add up faster than many expats anticipate
Cultural comfort deepens into something real
Long-term residents talk about shifting from “tourist brain” to actually living here. Maria, a 25-year Bangkok expat interviewed by DMNews, explained the difference: “Thai friends don’t need a calendar to help, they just show up.” When she caught dengue fever, her landlord’s family delivered home-cooked soup.
Language opens doors that tourism never reaches. Even basic Thai changes daily life in concrete ways, negotiating without being quoted tourist prices, finding where locals actually go, and accessing experiences that don’t appear on Google Maps.
A Wochenblitz article describes how understanding the Thai concept of “Kreng Jai” (consideration and respect for others’ feelings) helped him integrate into his Thai neighbourhood. He learned that restraint and subtle communication work better than Western-style directness.
Small cultural adjustments like this accumulate over the years into genuine belonging rather than perpetual visitor status.
The less obvious: What changes quietly
The identity limbo
This is what long-term expats discuss most candidly. You feel like a permanent outsider, and that feeling seems to only get stronger over time.
Tom Tuohy, a journalist who spent 28 years in Thailand, wrote on Medium: “Many expats, myself included, say we ‘feel at home’ here. We know our soi, our morning market, our favourite pad krapow vendor, but scratch beneath the surface and you’ll find something less certain.
“We don’t vote, don’t own land, live on a visa that must be renewed like clockwork, and we must report our whereabouts every 90 days like parolees.”
What Tuohy captured is the gap between daily comfort and legal reality. You can know every vendor on your street, speak fluent Thai, and prefer Thai food to Western cuisine, but Thai immigration law makes sure you never forget you’re a guest.
One AseanNow forum member with 34 years in Thailand put it bluntly: “I didn’t burn my bridges [in Thailand], but after 34 years they appear to have rotted and collapsed.”
The loneliness
IAmKohChang, a long-running expat blog, described when this realisation hits: “There is a strange moment that hits a lot of foreigners in Thailand. You have the apartment, a regular coffee spot, and a favourite noodle stall. People back home think you are living the dream.
“Yet on a Tuesday afternoon, you look around and realise you do not actually know who you would call if something good or bad happened.”
As one HoneyKids Asia piece noted: “It just wasn’t in the brochure that life could be so incredibly lonely in such a happy, sunny place.”
The expats who seem to handle this best don’t have a formula. Some throw themselves into work, others join expat groups, football leagues, or volunteer. What helps varies wildly person to person, and what worked in year two might not work in year eight.
Visa stresses
Visa uncertainty remains universal among many expats. Dave, a 25-year Chiang Mai expat interviewed by DMNews, described immigration as “the only place in Thailand where smiles disappear.”
In late 2025, Thailand limited visa runs to two per calendar year, effectively putting an end to the informal visa-run lifestyle that kept many expats legal for decades. A Thai Examiner survey found 55% of expats considered leaving Thailand over the proposed 2024 remittance tax change affecting residents staying 180-plus days.
After 5+ years, most expats transition from tourist visas to more stable options. Education visas for those studying the Thai language, Elite Visa for those who can afford the upfront cost (600,000 to 2,000,000 baht for 5 to 20 years), retirement visas for over-50s with 800,000 baht in a Thai bank, or marriage visas for those with Thai spouses.
Each has trade-offs in cost, flexibility, and requirements.
The parallel journey of healthcare
Just as expats move from honeymoon to realism about Thailand, they follow the same arc with healthcare, typically in three distinct phases.
Phase 1: “I don’t need insurance”
The ExpatDen editor described this phase: “To be honest, I didn’t always have health insurance. I was one of those expats in Thailand who always paid out of pocket because healthcare, even at private hospitals in Bangkok, is affordable to an extent.”
Phase 2: The wake-up call
But the trigger is almost always a specific medical event. For the editor, his gallbladder infection was the turning point: “They told me that my gallbladder was infected and that I’d need to have it removed immediately. The cost? Upward of 300,000 Thai baht [approximately US$8,500].”
For comparison, the same gallbladder surgery in the United States averages US$15,000 to 20,000 without insurance. Ultimately, he went to public Chulalongkorn Hospital instead and paid 85,000 Thai baht (approximately US$2,400), less than a third of the private hospital quote.
Motorbike accidents are also a common trigger. Thailand ranks 9th globally for traffic fatalities (WHO), making traffic-related medical emergencies a real risk for expats.
In 2025, A 27 year old Belgian man was detained with nearly 2 million baht (approximately US$57,000) in medical bills after a motorbike accident. His travel insurance excluded motorised vehicle accidents, a common exclusion expats discover too late.
Even seemingly minor illnesses escalate quickly. Dengue fever costs up to US$2,500 to treat, whilst severe food poisoning requiring hospitalisation can reach US$5,000.
Phase 3: “I wish I’d done this sooner”
The editor was later diagnosed with a brain tumour, fully covered by his insurance. He wrote: “I don’t regret getting health insurance as an expat in Thailand. It was one of the smartest financial decisions I’ve made, and it still offers me peace of mind knowing I’m covered not if, but when, life’s medical emergencies arise.”
Thrive in Thailand, an expat resource site, noted: “The biggest regret I see isn’t the plan someone chose, it’s waiting too long to choose at all.”
Premiums escalate steeply after 50. A 73 year old expat writing on ExpatForum reflected on the progression: “Age mid-60s without any significant medical issues, you can get good coverage here for around US$500 per month. [By your] late 60s, it can be around US$700 per month, and over 70, it can exceed US$1,000 per month.”
Many insurers stop accepting new applicants at 70 or 75.
Cigna coverage for long-term Thailand residents
Cigna Healthcare’s International plans offer lifetime renewability and coverage that local Thai insurance typically can’t match.
Plan structure:
- Close Care℠: US$500,000 per year for Thailand, plus your home country
- Silver: US$1,000,000 annual maximum, essential hospital and emergency cover
- Gold: US$2,000,000 maximum, adds maternity, cancer screenings, specialised treatments
- Platinum: US$2,000,000-plus with mental health coverage, a notable differentiator given Thailand has only 1.28 psychiatrists per 100,000 people, according to LMG Insurance data
Lifetime renewability is critical. Local plans often drop you at 70 to 75, whilst international plans continue for life. Getting coverage earlier locks in better rates permanently.
An ExpatDen review of Cigna noted: “Not the cheapest option out there, but their total coverage and cost are good for expats in Thailand. With Cigna, you can visit any hospital in Thailand and have it covered.”
Explore Cigna Global’s plans for long-term Thailand residents.
What actually changes
After a few years in Thailand, what changes go beyond your address or your tan? The financial advantages and cultural depth are real. Eighty-five per cent of expats feel their income is enough to enjoy life, according to InterNations data.
But identity questions, visa stress, and fading relationships back home are just as real. The healthcare journey follows the same pattern: initial optimism, eventual reckoning, and retrospective regret.
Thailand rewards people who adapt their expectations rather than wait for the country to change. TheThailandLife.com, a long-term expat blog, said it plainly: “If you’re waiting for Thailand to become more like where you came from, you’re likely to end up bitter and disappointed. You either adapt, or you stew.”
Get a quote from Cigna Global for living in Thailand. Whether you’re two years in or ten, the healthcare reality remains constant. Having coverage before you need it makes the difference between peace of mind and a financial crisis. Securing coverage earlier typically means better rates long-term.
The good changes are real. The less obvious ones matter just as much. Planning for both is what separates thriving from just surviving.
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