Living as an expat in Southeast Asia comes with its share of frustrations. Some of them you expect before you even arrive, like the visa paperwork or learning to find your way around in a new language. Others catch you completely off guard. For me, one of those surprises was the frustration that comes with the health insurance renewal each year.
You will know the feeling if you have been through it. The notice arrives, you open it expecting a number close to last year’s, and instead it has gone up by quite a bit. I have a family policy myself, so I get these renewals too, and I understand exactly how that feels.
It doesn’t come down to one insurance company, it’s happening across the whole industry. The cost of medical care across the region is rising much faster than everyday prices, and every insurer is dealing with it. The Mercer Marsh Benefits Health Trends 2026 report shows this year’s medical trend rates at 17.8% in Indonesia, 15.0% in Malaysia, 14.6% in Thailand and 11.6% in Vietnam. If you are planning to stay here for many years, these increases are not a one-time thing. They add up, year after year.
What I find more useful than complaining about the increases is asking what can actually be done about them. To understand this better, I spoke with Dr. Gerard Lalande, Chief Medical Officer at LUMA, who has been in Southeast Asia for more than thirty years. His thoughts on why costs keep rising, and how we can slow them down, played a strong part in how LUMA designed Expat Essential.
Why are premiums rising?
Dr. Lalande puts it simply: premiums keep rising for two main reasons, but we usually only hear about just one.
The first is straightforward: medicine is moving fast, and the newer the treatment, the higher the price tag. “The treatments now are becoming more and more sophisticated. Newer treatments are also much more expensive, and there will never be new option which is cheaper than the previous one, it’s always a higher cost,” he says.
He gives a simple example. Diabetes used to be manageable with relatively affordable monthly medication. However, as newer drugs become the standard, the monthly cost can jump several times over, and that higher baseline can stick around for years.
“In Thailand, what used to be around 3,000 to 5,000 baht a month can become 20,000 baht with newer medicine,” he says. “And that kind of jump is not unique to Thailand. You see the same pattern across Southeast Asia when new treatments become the default.”
The second factor is less obvious, but in his view just as important, especially in Bangkok. The traditional “GP as the first point of entry” model has been cut out of many private-hospital pathways. People are directed straight to a specialist, and once you enter care through a specialist, the case is treated as a specialist-level problem from the beginning, even when it may have started as something a good GP could manage.
Direct access to specialists isn’t a bad thing. It can be genuinely valuable, and it’s one of the big advantages of Bangkok’s private hospitals. The drawback is that it can sometimes bypass the GP “first step,” which can make care feel less coordinated and lead to more moving parts than necessary.
“Here, unfortunately, people can go straight to specialists. And specialists do not look at a general practice concern the way a GP would. They treat it as a specialist issue from the start,” he says.
In a traditional GP practice, a good GP, he explains, can manage the majority of routine conditions and refer only when the medical condition truly needs a specialist evaluation. When that gatekeeper role is missing, costs rise not because of bad intentions, but because the structure of the system naturally produces more consultations, more referrals, and more tests.
“A good general practitioner manages 90% of the cases… and knows when to refer and only when to refer,” he says. In private hospitals, that gatekeeper role is often missing, and the pressure to be “certain” can be intense. Add in medicolegal risk, and doctors may feel safer ordering more tests and investigations than medically necessary, which can drive costs very high.
All of this matters for premiums, because when medical costs rise and the system pushes more care into specialist and testing pathways, those higher costs eventually show up at renewal.
In a way it is a little like climate change. None of us can fix it on our own, but the small choices we all make day to day add up and shape what happens next. Healthcare works in a similar way, and at LUMA we call this responsible care.
What does “responsible care” mean in practice?
The name can sound a bit corporate, so let me explain what it actually means. It does not mean you have to manage your own care or become a medical expert. It means the plan is set up so that you are guided to the right care, when you need it.
This is where Medipro comes in. Medipro is a Bangkok-based medical expertise service that LUMA gives its members access to. If a diagnosis or plan of treatment are unclear or serious, Medipro arranges a second opinion with an experienced medical expert. If you need any specialist, they point you to the one you need. For a complex surgery or serious conditions such as cancer, Medipro can bring together a group of specialists to look at your case, holding a Multidisciplinary Tumor Board almost instantly. Increasingly, a multidisciplinary approach is the gold standard in managing the care of any form of cancer. The goal is to get you to the right level of care without you having to work it out alone.
“There is a psychological aspect,” Dr. Lalande says. “When it is a serious diagnosis or treatment, you need full confidence in the diagnosis and the plan. A second opinion is first about confirmation. If it confirms the first doctor, that is very positive and you can still go back to them. If it changes the picture, it is better to know early. And we are careful who we choose. We look at competence, an ethical approach, and soft skills, because it is the support and peace of mind you need throughout the medical journey.”
How does Expat Essential work?
You do not need a long benefits table to get the idea. Expat Essential focuses on the cover that matters most, and then lets you tailor the rest to your life.
At the heart of it is inpatient cover, solid protection for the big, unexpected moments like a serious illness, surgery, or a hospital stay. If you also want help with day-to-day care, you can add outpatient cover for routine visits, plus options like dental, vision, and maternity. That way, you are not paying for extras you do not need.
Options to help reduce your premium are also available, such as deductibles. The concept can seem strange at first, but it actually makes a lot of sense and can make your premium much more affordable. A deductible is the part of a bill you agree to cover yourself each year, and the more you take on, the lower your premium becomes.
And when you need care, you can use direct billing at hospitals in LUMA’s Essential Network, so you do not have to pay upfront. Some hospitals have a small amount of cost-sharing, which helps keep premiums steadier over time. Access to Medipro and guaranteed renewal are included too.
Who is this plan designed for?
This plan is best suited for expats and families who want reliable cover for the bigger, more expensive medical events, and who are looking for something they can keep year after year.
It is a good fit if you value a plan designed to stay sustainable over time, with support to help you get to the right level of care when it matters most. If what you want most is the freedom to use any hospital with no cost-sharing at all, an open-access plan may be a better match.
For Dr. Lalande, this is the most important point. “After thirty years here, what I care about is whether good cover is still affordable for a family fifteen years from now,” he says. “If a plan keeps getting more expensive every year, people eventually will be left with no coverage. Our goal is to keep cover sustainable, so that when it is truly needed, it is available.”
A final thought
None of us enjoy seeing the renewal price go up, myself included. The point of a plan like this is not to ask more of you. It is to keep your cover in place and your costs steady over the long term, while the harder parts are handled for you when you need help the most.
This is the part we care about most at LUMA. As an insurance solutions provider, our role is to help expats and families across Southeast Asia find cover that suits them and keep it working over the years, not only at the point of sale. Rising costs are not going to disappear, so we continue to make good healthcare both reliable and sustainable.
If you would like to see the plan options and prices for your own situation, a LUMA consultant can walk you through the details.
