Wealthy Americans are leaving the U.S. for countries with lower taxes and a different lifestyle — but those aren’t the only drivers.
The soaring cost of private health care has become a major factor in “millionaire migration,” steering affluent households toward countries that offer lower health insurance premiums and easier access to specialized private care.
“Global mobility is becoming a core risk-management strategy for wealthy families,” Christian H. Kaelin, chairman of Henley & Partners, told Business Insider (1).
Based on an analysis of client data and the global SIP Health Cost Index 2025, he said his firm’s clients are “scrutinizing not only access to residence and citizenship, but also the real cost of sustaining that lifestyle — especially the price of reliable private health care.”
Kaelin said destinations that “look attractive on paper” may not be as attractive once the true “health care exposure” is understood,
In 2025, it’s estimated that 142,000 millionaires relocated across international borders — the highest ever recorded, according to the Henley Private Wealth Migration Report 2025 (2). That number is expected to climb to 165,000 in 2026.
While the U.S. was expected to receive an inflow of 7,500 new millionaires in 2025, Henley & Partners note that American nationals “represent the largest source market for investment migration applications worldwide by a significant margin, accounting for over 30% of all applications processed by Henley & Partners so far in 2025.”
Since many of these affluent households are aging into years of higher health care use, we could see a magnification of this great wealth flight.
The U.S. tops the list as the most expensive private health care market in the world, according to the SIP Health Cost Index 2025 (3), a global benchmark of private health care and medical insurance.
The benchmark ranks 50 countries on the cost of private health care based on international private medical insurance (IPMI) premiums. The U.S. has an average annual IPMI of $17,968 per person.
While Hong Kong and Singapore are close on its heels, countries like China and Thailand have broken the top 12, “driven by demand for premium hospitals and rising inpatient costs,” according to Business Insider (1).
Even for affluent families, steep premiums may be a factor for those heading into retirement.
“It can make a significant difference whether you pay $30,000 plus for private health insurance versus $10,000,” Kevin Bürchler, CEO of SIP Medical Family Office (behind the SIP Health Cost Index 2025), told Business Insider (1).
Mid-range markets include South Africa, Saudi Arabia and Monaco, which range from $7,100 to $7,600, while more cost-effective options include Vietnam, Netherlands and Morocco.
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Within the U.S., some states are losing wealthy residents — such as California and New York (4) — but the main reasons continue to be high taxes and a high cost of living. But health care issues could be a growing concern, particularly with Medicare Advantage network restrictions and limited access to specialty care and top-tier hospitals.
Some states may start seeing more millionaire migrants because of their health care ecosystems. According to SeniorSite’s research-based rankings, 15 states are clear winners for senior health care (5).
Massachusetts “dominates national health care rankings, with Boston-based facilities claiming the top spots in America’s Best-in-State Hospitals 2025 rankings,” SeniorSite notes. While California has one of the most progressive senior health programs; its In-Home Supportive Services program “leads the nation in home-based care models.” And Hawaii, noted for “health care excellence,” offers a “comprehensive system of aging and caregiver support services.”
High-net-worth migration can change local economies. According to Henley & Partners, “a migrant bringing USD 10 million is equivalent to a country generating USD 10 million in export revenue as both transactions generate USD 10 million of forex revenue for the country” (6).
They say millionaire migrants can also boost the local stock market through equity investments, create local jobs by starting a business and indirectly bring money into the economy through their spending power, from luxury retail to fine dining.
This, in turn, can have a “multiplier effect.” The firm notes that, “100 high-net-worth individuals moving to a country can result in its high-net-worth population increasing by well over 200 as it pushes local asset prices up and therefore drives up the wealth of locals living in that country”(6).
If more wealthy Americans are now prioritizing affordable, high-quality health care, a millionaire migration could signal broader stress in the U.S. health care system — one that affects all locals, not just the wealthy.
Their choices may forecast which cities, states and global regions are best positioned for rising medical costs and an aging population. This, in turn, could push certain areas into boomtown status — and leave others struggling to retain high-income residents.
Even if you’re not a millionaire, keeping track of these migration patterns could help you evaluate your own relocation or retirement plans.
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Business Insider (1); Henley & Partners (2), (6); SIP Medical Family Office (3); Marcus by Goldman Sachs (4); SeniorSite (5)
This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
