Roughly 180,000 Americans packed up and left the country in 2025, according to a recent Boston Globe analysis. It’s the largest outbound migration in decades, give or take, and the data is messy because the U.S. doesn’t really track this stuff. Still, the trend line is clear enough.
Most guides on relocating overseas cover the obvious bits. Visa. Language. A place to land for the first few months. Fine. But there’s a second layer of stuff that tends to catch people sideways, the kind of thing you don’t really think about until you’re sitting in a foreign pharmacy trying to explain a prescription. Sorting out something like global medical insurance early in the planning, before the move feels real, is one of those quiet decisions that saves people a lot of grief later. Not glamorous. Just useful.
Anyway. Four things that keep surprising people, in no particular order of importance.
This one’s less intuitive than it sounds. If you’re a U.S. citizen, you don’t stop being one when you board the plane, and that comes with luggage. Federal income tax filings, for one thing, which you still owe regardless of where the income is earned. The State Department’s living abroad resources lay it out, but it tends to get glossed over until tax season rolls around in your new time zone and you’re scrambling.
There’s also voting, social security, sometimes Selective Service if you’re male and under 26. Bank accounts back home can get weird too. Some institutions will close them if you list a foreign address, and a few people learn this the hard way, when a card gets frozen abroad and the customer service rep on the phone wants to verify a U.S. residential address that no longer exists.
Everyone has heard that other countries have “free healthcare.” Which, fair enough, in a lot of places the system is more generous than what Americans are used to. But “free” usually means free for residents, and becoming a resident takes time, sometimes years. In the meantime there’s a gap, and the gap is where people tend to get caught out.
It seems that the bigger issue isn’t routine care anyway. It’s the unexpected stuff. A torn ligament. A weird infection. The thing a doctor back home would have shrugged at, now requiring a translator, a foreign hospital, and some way to pay for both before anyone explains anything in English. Standard travel insurance usually won’t cover long-term residents either. It’s a category gap that people don’t notice until they fall into it.
Side note: prescription medications work differently abroad. Brand names change, dosages change, some drugs aren’t available at all. Worth checking before the move, not after.
Furniture. Cars. The box of stuff you can’t get rid of for reasons that don’t survive being said out loud. International freight is its own world, and rates fluctuate based on shipping lanes, container availability, and what’s happening at ports halfway around the planet. Some people end up paying more to ship a sofa than the sofa cost in the first place.
A bit of a tangent here, but certain countries will actually pay you to move there, which can offset shipping costs in some cases. The amounts vary wildly. Worth a look, at least.
The other shipping question people forget is timing. Sea freight can take six to ten weeks. So unless the plan is to live out of two suitcases for two months, the move-out date and the move-in date probably need to be on entirely separate calendars.
Loneliness. There. Said it.
Most articles about expat life skip over this because it doesn’t fit the narrative of adventure and reinvention, but it’s the thing former expats mention more than anything else when they look back. The first six months are exciting. The next six get quieter. Friend groups take a while to build, holidays hit differently when home is eight thousand miles away, and small bureaucratic frustrations stack up faster than they would in a native language.
One possible explanation is that people prepare for the logistics and not the emotional logistics, if that’s even a real thing. Some of it just takes time. Some of it gets blunted by visiting home more often than feels reasonable in year one.
Nobody really has a clean answer on this one.
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