Almost Fearless

Getting Health Insurance When You Travel: Day 13 of 30w30d

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.

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30 ways in 30 days, health insurance, medical system, hurdles, travel around the world

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.

Resources:

Bootsnall Medical Travel Insurance Plan Breakdown

A nice explanation of pre-existing conditions

Media Bistro’s members only insurance plan

American Diabetes Association of High Risk Pools

Check if Medicare covers “Travel Outside the US” by your state

Tricare Rules for Traveling

Georgetown University Health Policy Institute: Get state by state guides to health insurance

Expat Forum: Healthcare Overseass

pic: dullhunk

Christine Gilbert

I’ve been dragging my husband around the world since 2008 always with the promise that, “Yes, Drew there will definitely be hammocks there.”

THERE ARE RARELY HAMMOCKS.

http://christinegilbert.com

16 comments

  • I am loving this series Christine-bravo!

    As very healthy people we see health insurance really as asset protection, so always get a high deductible policy while in the US or during the last 4 years of our open ended world tour.

    We actually save a bundle while traveling the world by not having to worry about high US medical/dental & insurance costs, thus it makes it easier for us to live large on just 25K a year total for a family of 3!

    I am not a big believer in insurance as clearly they make big bucks & keep the odds always in their favor. We gladly pay out of pocket for most things & have gotten excellent care for free or very low cost thus far!

    That said if one has the bad luck to get something that has medical bills in the hundreds of thousands of dollars…one wants to be covered by insurance so one does not lose all of ones assets.

    At the moment, I happen to be recovering from a bike wreck in Austria that landed me in the hospital for a week with a broken arm & surgery. I had excellent care & even paying out of pocket with our high deductible, we will still easily stay within our yearly budget! If this had to happen, this is a much better place to have it happen rather than the US.

    Since we have been traveling so long we have been to doctors, dentists and hospitals in many countries & have had excellent care for free or little cost.

    Another good idea is to add evacuation insurance if you go to a place with bad medical care. We did that when we went into Morocco, especially for our time in rural areas and the Sahara.

  • Great post Christine! This is something I have given a lot of thought to and wish I didn’t have to. I was always very healthy and for years I never even had health insurance. Then on a whim I got some for about $100/mth thru Blue Cross. (I didn’t have employer sponsored insurance and that was why I eventually bought it on my own.) Anyway, about a year after I got sick, very sick. I was diagnosed w/ thyroid cancer and Hashimoto’s (which is an autoimmune disease that affects the thyroid). It wasn’t a good time. It was also my first stumbling block with going on the trip.

    The intention was to leave that year but that was before I was diagnosed. After surgery, recovery and several months of being sick the big trip was put off (and is now slated for April 2010!) for what seemed to me like an eternity. Originally I was planning on canceling my insurance and I was just going to get travel ins. for the RTW. Now there is no way I will be doing that. I will end up getting 2 policies- my regular one & my travel one. It sucks that I have to pay all the extra money but I just saved up the money and put it aside specifically for insurance. Not an exciting thing to save for but a necessity.

    Being healthy is great but it’s not an excuse to go uninsured. In a moment your life can flip upside down for no apparent reason and leave you completely broke if you are unprepared. I was 31 when I was diagnosed and no one in my family has ever had anything wrong with their thyroid and there is no history of cancer either. There was no logical reason for me to get sick but I did.

    It’s not worth it to risk getting sick (& diagnosed) overseas and not have U.S. coverage. I would advise everyone to get even a very basic policy (Blue Cross Anthem/Tonik has a cheap one and it’s great!). If you are diagnosed w/ something serious you will not be covered after the fact. Like you said the insurance companies hire tons of full time people just to find loopholes to kick you out. Insurance is big business and when you actually need it, they really don’t want you around anymore. My surgery alone cost 28k! If I didn’t have insurance I’m sure I would not be going on the trip and instead I would still paying off my medical bills.

    I’m excited to see what comes out of Obama’s health care plan because I really think the U.S. needs to seriously change things in the insurance dept. Too many people don’t get the care they need because they can’t afford it.

    My advice to anyone, if you are going on a long term trip, do not sacrifice by skimping on the U.S. insurance. At the least get something with a lower payment/higher deductible just in case the unimaginable happens.
    .-= Bethany´s last blog ..No More Mondays! =-.

  • Kudos for churning out a post on a topic so dry but important. I worked for a health insurance company the 5.5 years before leaving on my RTW trip – customer service management. Spending my days helping consumers navigate the healthcare world was humbling. Like the Friday evening when a frantic spouse called us from Jamaica – her husband had a broken pelvis and leg(s) from jumping into shallow water. Bad things can happen – whether illness or injury – and it was important to my parent’s that I get regular medical insurance for my trip. They didn’t want me to bankrupt their retirement savings with an unforeseen calamity. I’m surprised by how many people go with emergency coverage only (a la World Nomads). I think that’s too risky, but I guess everyone has to decide for themselves.

    I went with International Medical Group’s (IMG) Global plan, which I’m still extending even now that I’m home in the US. I saw a doctor and dentist in Thailand, and a dentist again in Colombia, along with a few pharmacies for basic prescrip drugs, and have had no need to submit claims because the costs are all so low.
    .-= Dave´s last blog ..Travel Video – Kathmandu Street Scene =-.

  • Health insurance is so important while traveling. I have had health emergencies abroad and spent some time in the ER in England. 99% I’m a completely healthy person but you really can’t know when disaster will strike. I’ve also been uninsured in the US and it is a scary scary thing. In this arena it’s definitely better safe than sorry.
    .-= Stephanie´s last blog ..Planning Your Travel Budget (Part 3 of 4) =-.

  • Its not an American, but I’m not 30 (or 40) anymore and basically if you start really moving around you become uninsurable. We did have cover in our home country – but you can only carry insurance if you live overseas for a year – and then it cancels – we have been away nearly 3 so we are uninsured there. In Australia we are uninsurec because it was insanely expensive because we hadn’t been insured since we were 30 (like duh we weren’t in the country guys).

    Now going home it will probably be too expensive/too restrictive to get insured again – at least healthcare is cheaper pretty much everywhere in the world than the US!

  • its nice to know that we have alot or shall i say thousands of options when buying,travel insurance that only question is, which one is easy on your pocket and which one do you really need. The article posted is interesting however it is leaning towards something else.

  • […] However, if you plan to re-enter living in the US at some point and want to remain eligible for insurance without pre-existing exclusions – it may be in your best interest to keep a US policy in force.  AlmostFearless did an excellent article outlining these unique considerations. […]

  • I recently went to Bogota, Columbia with my fiancee for a pre-wedding de-stressing vacation and I broke my leg and clavicle in 3 places, while riding a horse. the worst time ever, not to mention I did not have travel insurance at the time, and I had to fork over $1400 cash just to be released form the hospital. Never go to Bogota, and never leave home without travel insurance. Point Blank!!!!!!

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