This post is part of 30 Ways in 30 days to Redesign Your Life and Travel the World. This series seeks to give you the practical, real world steps you need to take to get from wherever you are, to exactly where you want to be– traveling the world and living the lifestyle you want.
Most of this post is directed at Americans. I know that many people (at least 35% of you) read this blog from other countries, but here’s the deal. Healthcare in the US is tough. It’s more expensive than where you live and we have very smart people working full time to try to cancel our insurance the moment we get seriously sick.
If you live somewhere other than the US, you may want to look into additional travel insurance that specifically covers medical expenses. Bootsnall has a great break down of the plans and what they cover and there is someone you can call if you have questions. (Not all of these cover international non-US travelers, so be sure to read the fine print).
For Americans (be sure to read all the way through):
Employer-based coverage (the plan offered by your work, like Cigna, Blue Cross, Aetna and so on):
Will they cover you overseas? Maybe. It will vary from plan to plan. There is no way to predict the level of coverage, until you drill down into your company’s policy. If you get stuck, ask HR for help.
Things to look for: Will they cover emergency evacuation? ER visits? Routine care? Is there a copay? Deductible (for instance you’re responsible for the first $1000 of care)? Will you just pay out-of network fees? Is there a cap on coverage?
Medicare: Will they cover you overseas? Probably not. It varies from state to state, but unless you’re on the border of Mexico or Canada and their hospital is closer than the nearest US one in an emergency or you’re on a cruise ship docked in US waters, then you’re not getting reimbursed, you also need to makes sure you get testing for hep c which is very important.
CHAMPVA/TriCare (Veteran’s ins): Will they cover you overseas? For Champva, probably not. They follow the same reimbursement rules as Medicare. For TriCare, probably yes. There are multiple plans, but more information is here.
Privately purchase insurance: It depends. The same as your employer based coverage, this will be specific to your policy. Before purchasing, be sure to look for the same things as employer based coverage: Will they cover emergency evacuation? ER visits? Routine care? Is there a copay? Deductible (for instance you’re responsible for the first $1000 of care)? Will you just pay out-of network fees? Is there a cap on coverage?
So you don’t have overseas coverage or you’re under insured. Now what?
The cheapest option is to buy something called Medical Travel Insurance. Bootsnall has a great roundup of options, that I mentioned above for our non-US readers. Depending on your age, length of travel and which plan you choose you could pay between $40/mo for the under 30 set to over $200/mo for over 65. These plans are typically for up to one or two years. (Most of these plans don’t pay for pre-existing conditions, so routine care for a known medical condition will not be covered. See below for more on pre-existing conditions).
However, there are risks of not carrying traditional insurance like pre-existing conditions rules and gaps in coverage. Pre-existing condition is a term used in the insurance industry that basically means you got sick before you they started insuring you. Even if you don’t detect the sickness, for example breast cancer, if they can reasonably prove that your breast cancer started before they covered you and you should have detected it with routine exams (which you skipped because you were traveling) they can refuse to pay your claims (sometimes effectively stopping your treatment). The only way to get around being excluded for a pre-existing condition is to have continuous coverage. That means having no more than a 63 day gap in health insurance. Travel Medical Insurance is probably not going to be considered insurance for these purposes. And since it’s in the insurance company’s best interest to not approve you, they will not give you slack.
This isn’t to scare you. I’m mentioning this, because some people asked me about it and you should know what you’re worse-case-scenario is. The good news is that if you did get denied for pre-existing condition. you do have other options. First, it’s not forever. Every state has a limit on how long they can deny you, so eventually can get care (12 months for some, 24+ months for others) so if it’s something minor, you may be able to put it off. Otherwise, you may qualify for a high-risk pool in your state, which will allow you to buy insurance at a very high rate, but will cover you for expensive illnesses.
By the way, pregnancy is never a pre-existing condition, so if you get pregnant, then get insurance you will always be covered.
Preventing a gap in coverage:
Obviously if you have a medical condition, like diabetes, that you receive regular medical treatment for or you are of the age that you would be concerned about having gaps in coverage, then there are options for buying coverage. Even if it doesn’t cover you overseas fully, you can supplement with travel insurance for any emergencies and pay routine medical costs out of pocket (I’m making some assumptions here that we’re talking about insulin shots, not chemotherapy).
The cheapest option is to get something through an employer. Now’s the time to double check and see if being a digital nomad– working remotely for a US based employer as you travel, is a good fit. If so, you can get coverage and finance your trip at the same time.
If this is not an option many professional and trade organizations offer their members insurance at a discounted rate. This is cheaper than buying on the open market, because they can buy in bulk, like your employer does. If you’re a lawyer, work in the medical profession, have a trade group for design, acting, writing, boat making– anything like this, be sure to check out the member benefits. You could save a few hundred bucks just for signing up. For the writers out there, Media Bistro has an insurance plan for it’s members.
Finally, if you’re not able to find an employer or organization to get affordable insurance, you can begin looking on the open market. If you’re high risk, you may have a hard time getting coverage or be quoted extremely high rates. Some states in the US have a high-risk pool that makes it cheaper.
For those seeking permanent residency:
Be sure to check the rules for your specific country, because it’s not uncommon for them to require health insurance (often quoting specific coverage amounts) before giving you a residency visa or permit.
Summary– What Should I Get?
Medical travel insurance is always a good idea, because even if your health plan covers overseas ER visits, they may not cover everything (like medical evacuation).
For most people under 30, gaps in coverage aren’t a big deal. If you decide to pay out of pocket for normal hospital bills (as they come up) and given that you’re a normal healthy 20-year-old, you’ll probably be okay as long as you have some medical travel insurance in case something major happens.
For folks over 30 and more so every year, I would have both traditional medical insurance plus travel insurance to cover those gaps. Until things change in the US, I would personally be really scared about having my life-saving treatment postponed because it’s considered a pre-existing condition.
For those with medical conditions, you have a big expense. It really may be worth it to look seriously into finding an employer who you can manipulate/bribe/beg to let you work overseas, because high-risk insurance can be extremely expensive. On the other hand, if you save for it, it’s similar to paying off the mortgage for a year.
What’s the healthcare like overseas?
I can’t speak to most places, but I found the ER in Madrid to be very nice. Hopefully you won’t have to find out. If you want research in advance, the Expat Forum as an excellent round up by country.
Georgetown University Health Policy Institute: Get state by state guides to health insurance