Madagascar has its own unique landscape with incredible biodiversity, rich culture and endless academic possibilities for the international student. Yet, to relocate your family to the “Red Island” is much more than packing up and getting that visa. Probably one of the most significant but least discussed challenges for you as you consider studying abroad in Madagascar is acquiring health insurance for your spouse and children.
Although there are several countries that offer a national student family health insurance (Western and Asian countries) , Madagascar does not have a nationalized “Student Family” health insurance program. As such, you and your family must find international expat private health insurance.
The purpose of this guide is to provide you a detailed overview of what options exist when purchasing health insurance for your spouse and children while pursuing education in Madagascar. In addition to explaining the structure of the local healthcare system we will also provide recommendations on which companies offer the best coverage options and outline the cost associated with keeping you and your family healthy.
The Reality of Healthcare in Madagascar
To get an understanding of what it takes to get quality insurance, one needs to understand the conditions in which we are operating. Unfortunately, Madagascar’s public health system is in dire straits. The Malagasy people are resourceful and their healthcare professionals are working diligently however the country lacks a sufficient amount of money to support its own healthcare infrastructure.
As such, the public hospitals suffer from frequent shortages of basic medicines and much needed equipment. There is also a severe lack of specialized care available in many of the regional areas. As a result of this shortage, the average citizen of Madagascar will encounter a void each and every day that will present a large risk to the visiting International Student Family if a member of the family experiences a life threatening accident or complex medical condition requiring extensive treatment that cannot be provided by the local facilities.
The Role of Private Facilities
In the capital, Antananarivo, there are private clinics that offer a higher standard of service. These facilities are cleaner, better equipped, and more likely to have English or French-speaking staff. However, they are expensive. Without insurance, a single hospital stay could derail your entire education budget.
The Necessity of Medical Evacuation
Perhaps the most vital information here is that medical evacuation isn’t an extravagance in Madagascar; it is a necessity. Patients with life-threatening medical conditions or needing to undergo more complicated surgeries are often referred to regional hospitals with better equipment for example; South Africa or Reunion Island. A private air ambulance can be as expensive as $50,000 USD. If your insurance does not pay for the cost of a private air ambulance then the costs will be devastating.
Top 10 Insurance Options for Student Families
Since there is no local student plan, you must look toward International Private Medical Insurance (IPMI). These companies specialize in “global citizens.” They understand the risks of living in Madagascar and offer plans that allow you to add a spouse and children as dependents.
1. Cigna Global
Cigna is a heavyweight in the expat world. They are widely used across Africa because their plans are modular. You start with a core “International Medical” plan (which covers inpatient care and evacuation) and then add modules like “International Outpatient” or “International Vision & Dental.”
- Why it works for students: You can adjust your deductibles (the amount you pay out of pocket) to lower your monthly premium. This flexibility is perfect for a student budget.
2. Allianz Care
Allianz is known for its robust administrative support. They offer comprehensive inpatient cover and have a massive international network.
- The Advantage: Their emergency evacuation protocols are some of the most efficient in the industry. For families living in a country with limited infrastructure, this peace of mind is invaluable.
3. International Medical Group (IMG)
IMG offers specific products designed for international students and expats. They are particularly adept at providing coverage in “high-risk” or developing areas where local systems are weak.
- The Advantage: They offer several tiers of coverage, allowing you to choose a “Bronze” or “Silver” level to keep costs manageable while still maintaining high limits for catastrophic events.
4. Indigo Expat / Indigo Expat Junior
Indigo Expat is a specialist that specifically markets to expats in Madagascar. Their “Junior” plans are specifically tailored for international students and young professionals aged 18 to 30.
- The Advantage: They offer “first-euro” coverage, meaning they pay from the very first cent of your medical bill, which simplifies the claims process in a foreign country.
5. April International
April International is a favorite in French-speaking territories. Since Madagascar is Francophone, April’s local expertise and French-language support can be a massive asset when dealing with local clinics.
- The Advantage: Their modular plans are highly flexible, and they have a very user-friendly mobile app for managing claims and finding doctors.
6. Bupa Global
If budget is less of a concern than absolute quality, Bupa is the gold standard. They provide access to the world’s best private hospitals and have exceptionally high coverage limits.
- The Advantage: Their “Global Elite” style plans often include premium maternity benefits and wellness checks that other insurers might exclude.
7. AXA Global Healthcare
AXA offers reliable, tiered coverage. They have a strong presence in regional hubs like South Africa, which is the primary destination for medical evacuations from Madagascar.
- The Advantage: Their “Foundation” and “Standard” plans provide a solid baseline of hospital-only cover for those who want to save money on outpatient visits.
8. Now Health International
Now Health focuses on emerging markets. They are a “digital-first” company, which makes it easy to manage your policy from a smartphone.
- The Advantage: Their claims processing is famously fast, which is vital when you are paying upfront at a clinic and need a reimbursement to cover your rent.
9. Pacific Prime (Broker)
Pacific Prime is not an insurance company, but a broker. They specialize in the African market and can provide you with a side-by-side comparison of all the insurers mentioned above.
- The Advantage: Using a broker is free for the consumer. They can help you navigate the fine print of “student status” and ensure your family is fully compliant with visa requirements.
10. Mondassur
Mondassur is a French broker that excels at matching students with the right insurance. They have a deep understanding of the Malagasy context and can offer specific student-centric products.
- The Advantage: They are excellent at helping you compare “top-up” insurance versus full private cover.
Understanding the Costs: A Budgetary Breakdown
How much should you set aside? Pricing for international insurance is complex. It depends on the age of the primary insured, the number of children, and the level of benefits chosen.
Here are indicative monthly ranges for a typical student family (e.g., a 28-year-old student, a 28-year-old spouse, and one toddler) living in Madagascar:
| Coverage Level | Estimated Monthly Premium (USD) | What You Get |
| Basic / Budget | $150 – $300 | Inpatient (hospital) only, emergency evacuation, high deductible. |
| Mid-Range | $350 – $650 | Hospital cover + limited outpatient (GP visits, labs), moderate deductible. |
| Premium / Comprehensive | $750 – $1,200+ | Low/no deductible, full outpatient, maternity, dental, and global coverage. |
Note: These are estimates. Premiums can fluctuate based on the “risk rating” of Madagascar at the time of your application.
Features You Must Prioritize
When you are comparing quotes, do not just look at the price tag. In Madagascar, a cheap policy that lacks specific features is essentially useless. Prioritize the following:
1. Emergency Evacuation and Repatriation
Ensure the policy covers evacuation to South Africa or Reunion Island. Some “cheaper” policies only cover evacuation to the “nearest competent facility,” which might still be within Madagascar. You want a policy that guarantees transport to a regional center of excellence.
2. High Inpatient Limits
A major surgery or a week in intensive care can cost tens of thousands of dollars. Ensure your annual limit is at least $500,000—though most international plans will offer $1 million or more.
3. Chronic Disease and Medication
If you or a family member has a pre-existing condition, like asthma or diabetes, check the “Chronic Condition” clause. Some insurers exclude these or limit the amount of medication they will pay for. In Madagascar, specialty drugs can be hard to find and expensive to import.
4. Direct Billing
Ask the insurer if they have a “Direct Billing” arrangement with major clinics in Antananarivo (like Clinique et Maternité Ankadifotsy). Direct billing means the hospital bills the insurer directly, so you don’t have to pay a massive sum out of your own pocket and wait for reimbursement.
Practical Tips for Your Application
Choosing the right plan is a strategic decision. Follow these steps to ensure you get the best value:
- Consult a Broker: Don’t go it alone. Brokers like Pacific Prime or ExpatFinancial know which companies are currently “friendly” toward Madagascar residents. Their advice is free, and they can often negotiate better rates.
- Verify Visa Compliance: Check with the Malagasy embassy or your university. Some visas require specific wording regarding repatriation of remains or a minimum coverage amount. Ensure your certificate of insurance meets these benchmarks.
- The “Deductible” Strategy: If you have a healthy “emergency fund” in the bank, opt for a higher deductible (e.g., $1,000 or $2,500). This will significantly lower your monthly premium, making the insurance more affordable for the duration of your studies.
- Buy for the Full Term: It is often cheaper and safer to buy a policy that covers your entire 1-year or 2-year study period rather than renewing month-to-month.
- Check the Waiting Periods: If you are planning to grow your family, be aware that most international plans have a 10-month to 24-month waiting period for maternity benefits. You cannot buy insurance after becoming pregnant and expect it to cover the birth.
Final Thoughts
Living in Madagascar with a family as an international student has its rewards and risks; however, by obtaining an excellent international health insurance plan for your family, you can eliminate the “what ifs” associated with traveling abroad and ensure that your spouse and children would be able to receive the world’s finest medical treatment and get a flight to the best hospital in the area if needed.
References:
Allianz Care. (n.d.). Global network. https://www.allianzcare.com/en/business/globalbenefits/global-network.html
April International. (2026). Long-term international health insurance. https://www.april-international.com/en/long-term-international-health-insurance
AXA Global Healthcare. (n.d.). International health insurance plans. https://www.axaglobalhealthcare.com/en/international-health-insurance/
Bupa Global. (2025). Expat health insurance. https://www.bupaglobal.com/en/for-you/expat-health-insurance
Cigna Global. (n.d.). International health insurance for wherever life takes you. https://www.cignaglobal.com/quote/pages/quote/CountrySelector.html
Expat Financial. (n.d.). Madagascar insurance guide. https://expatfinancial.com/regions/africa-insurance/madagascar-insurance/
International Medical Group. (n.d.). IMG Patriot Exchange – Travel medical insurance for students. https://www.internationalinsurance.com/img/patriot-exchange/
Moncey Assurances. (n.d.). Indigo Expat WeCare table of benefits. https://www.moncey-assurances.com/doc/indigoexpat-wecare-individual-tob.pdf
Mondassur. (n.d.). Health insurance in Madagascar. https://www.mondassur.com/en/visas-and-health-madagascar/
Pacific Prime. (n.d.). International health insurance for expats in Madagascar. https://www.pacificprime.com/country/africa/madagascar-health-insurance/
Pacific Prime. (n.d.). Now Health International: Expat medical insurance. https://www.pacificprime.com/insurers-and-partners/now-health/
