Everything You Need to Know About Health Insurance for Long-Term Travelers

All your options from Genki, SafetyWing, and more.

Jul 17, 2024

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This article has been updated.

The drama! The intrigue!

Two years ago, I started writing about health insurance for expats, nomads, and long-term travelers.

I never expected the marketplace to change so rapidly. New companies and products are constantly popping up, and older companies are rolling out new policies and revising old ones.

In retrospect, this makes sense. More people are traveling than ever before, and long-term travel is exploding in popularity too.

A vast marketplace is rising and evolving to meet our needs.

But healthcare costs are expensive and unpredictable — especially in America, which currently has a flat-out insane healthcare system. International insurance companies have been trying to figure out how to make money amid all the chaos.

Here is my usual caveat: I’m not an insurance expert — I’m just a guy on the internet. But I’m a nomad who uses these products, and I’ve been following this subject closely.

Writing about all this has been a little like watching an old movie with lots of surprising plot twists. I never know what’s going to happen next!

Let’s unpack all the recent developments, shall we?

First, as always, there are two kinds of health insurance for travelers. They are:

Travel Insurance. This temporary, term-limited policy covers you outside your home country. It pays only for emergencies and “medically necessary” treatments — and, hopefully, for medical evacuation to the best medical facility and, if necessary, back to your home country. Such a policy is usually purchased in addition to more comprehensive coverage in that home country, where you would probably go if you have a serious or chronic illness.
Full International Health Insurance. This is sometimes called “expatriate” or “long-term international” insurance. It’s full coverage outside your home country, covering even non-emergency care, and it’s not term-limited, continuing as long as you pay the premiums. These policies typically replace any other coverage you may have, although some people may also have some “national” coverage back in their home country.

Why not rely on cheaper, plain old “travel insurance” for your international health care needs? Why pay for “full” insurance?

It has to do with the limited duration I mentioned above. Travel insurance may pay for some or even all of your healthcare needs while traveling, and it will pay for the duration of your term. But the terms are short, and what happens if you come down with a serious or chronic illness and your term expires? You would then have a major “pre-existing condition,” making it essentially impossible for your illness to be covered by any other company.

At that point, you would have to pay 100% of your care out-of-pocket. And, of course, the whole point of insurance is to cover extreme, extraordinary mishaps that you couldn’t otherwise pay on your own.

But let’s look in closer detail at the two kinds of insurance, shall we?

Travel Insurance

Many people don’t know that most travel insurance companies require that you purchase their policies before you leave home. These companies are also likely to ask exactly where you’re going and when you’re returning.

This is a problem for nomads and other travelers who are away for long periods and don’t necessarily know where they’re traveling next month, much less six months from now.

But three major companies claim to be nomad-friendly, allowing you to buy their policies while on the road:

SafetyWing calls its travel insurance “Nomad Insurance Essential.” This coverage is available up to the age of 70, with terms of up to a year. It pays for “necessary” medical care up to $250,000 a year in most countries, with limited coverage in your home country, and even more limited coverage for everyone in the USA: 15 days after 90 days. Non-Americans have the option to get a USA add-on for better coverage, but it’s very expensive.
Genki calls its travel insurance “Genki Explorer.” This coverage is also available up to the age of 70, for terms of up to two years. It pays for “necessary” medical care, with no maximum payout, including in your home country (except the USA), with brief, limited coverage for everyone in the USA (six weeks per 180 consecutive days). Again, there is an optional USA add-on for non-Americans, but it’s also very expensive.
And World Nomads, which I do not recommend.

I think Genki Explorer is the far superior “travel insurance” product. In addition to no maximum payouts, they have a longer term, a more generous definition of “pre-existing condition,” and better home country and USA coverage. Meanwhile, I think medical evacuation coverage is really important — if the transport involves a helicopter, it can easily bankrupt a person — and Genki’s evacuation coverage is much better than SafetyWing’s: more broadly defined and (sometimes) with no maximum payouts.

Genki Explorer also covers any “medically necessary” treatments, not just “emergencies.” My anecdotal sense is that they’re much more liberal in what they cover than other travel insurance companies.

SafetyWing Nomad Insurance Essential, unlike Genki Explorer, does include some minor non-health-related coverages: trip interruption or delay (but not cancellation), lost luggage, and theft (but not of electronics, which requires a specific add-on). However, you may already have these coverages if you have a travel credit card.

Oh, and those optional U.S. add-ons for both SafetyWing and Genki? They can’t be added mid-term.

SafetyWing Nomad Insurance has no deductible, and Genki Explorer has the option of either a 50 euro deductible (per incident) or no deductible.

One other thing to keep in mind: SafetyWing Nomad Insurance Essential charges its premium every 28 days, which means you pay 13 times a year. Genki Explorer’s premium, meanwhile, is charged monthly.

Overall, SafetyWing’s no-deductible plan is cheaper than Genki Explorer’s no-deductible one, but Genki Explorer, with a 50 euro deductible, is the cheapest option of all — and because of all its other great features, I think it’s by far the better value.

Check out Genki Explorer here.

Check out SafetyWing Nomad Insurance Essential.

Full International Health Insurance

The situation is a bit murkier with “full” international health insurance.

First, in this category, many more options are available to long-term travelers: products from Cigna, Allianz, IMG Global, GeoBlue, and on and on. With these policies, you usually “declare” one foreign country where you plan to live. Even so, they generally cover you worldwide — although expensive countries like the United States always require specific and costly add-ons.

Meanwhile, the “nomad” companies Genki and SafetyWing both recently rolled out “full” insurance options too. They openly state they cover you worldwide, with a few exceptions, especially in America — but more on this below.

I was a huge fan of the first “full” Genki product, Genki Resident, which included no maximum payouts and extremely generous “home country” coverage for Americans.

But now both SafetyWing and Genki have “updated” their products:

Genki now calls its “full” plan “Genki Native.” But Genki Resident will continue for existing subscribers — and a few others too, details below.
SafetyWing still calls their “full” plan “Nomad Insurance Complete.”

Genki Native — unlike Genki Resident — is only available to people up to the age of 55 (though once you’re in, you’re covered indefinitely, as long as you pay the premiums).

Genki isn’t advertising it, but they also still offer Genki Resident for people over the age of 55 (and maybe for younger folks too, if you ask nicely). Genki Resident is a better, more generous plan than Genki Native.

With Native, Genki has two tiers, called Genki Native Basic and Genki Native Premium. With Resident, neither tier had a maximum payout for anything. Native Premium still has that feature, but Native Basic now limits total payouts to $1,087,000 USD per year.

I was a big fan of that no-maximum payout feature, and I’m disappointed that with Native, you now have to pay considerably more to get it.

Genki Native does now have an “instant,” automated approval process, and they’ve sped up their claims process: within three business days, they say.

Coverage in America

Both SafetyWing and Genki limit their coverage in America. (SafetyWing also limits coverage in Singapore and Hong Kong, and Genki limits it in Canada; please note these 30-day limits apply to all these countries combined: for example, Genki users can spend a total of 30 days every year in the U.S. and/or Canada).

SafetyWing does have an optional U.S. add-on for their Nomad Insurance Complete too — available even to Americans if America is not your country of residence — but it will almost double your premium.

Without the expensive add-on, Nomad Insurance Complete covers only accident and emergency care for up to 30 days. They say they’ll pay “usual, customary, and reasonable” expenses for “accidents” (up to the policy limit of $1.5 million) and up to $50,000 for “illnesses,” but only $500 for any “outpatient” treatment (excluding surgery).

I have previously written about a great Genki Resident hack: they offered six months of “full” home country coverage, and it even applied to Americans, which meant that American customers had six months of full American coverage every year, even with no add-on. But Genki Native does not have this feature (though it may still be available to Genki Resident customers — I would ask, and get it in writing).

With Genki Native, they limit coverage in the United States and Canada for everyone to 30 days in any insurance year, with a maximum payout of $270,000, and only for “life-threatening emergencies and transport to another country.” And unlike SafetyWing, they have no expanded U.S. coverage option for their “full” insurance product.

But here’s one big way the two companies differ:

SafetyWing has limited emergency coverage in America, and if you’re an injured non-American, they might pay for medical evacuation back to your home country for further treatment — but probably not; the coverage is very limited. And keep in mind that coverage stops completely after 30 days. What if you’re injured on the 29th day?

And if you’re an American, SafetyWing definitely doesn’t allow you to use their medical evacuation coverage for travel to another country for further treatment. And if you’re on Nomad Insurance Complete, you probably have no other U.S. coverage — and no, you almost certainly can’t immediately sign up for an Affordable Care Act, or ACA “Obamacare” plan.

That means that after 30 days, your coverage ends. And you could be stuck in America, unable to get on a plane, recovering but also racking up huge, unpaid, bankruptcy-causing medical bills.

Keep in mind this is true even for SafetyWing’s U.S. extended coverage add-ons, although you would have much longer to recuperate.

Genki Native, meanwhile, has more modest U.S./Canada coverage, even in their Premium tier, but they allow anyone to use their medical evacuation coverage for transport anywhere — even to another country for continued treatment. Yes, your U.S. total is limited to $270,000, including travel costs, but once you’re in another country, Genki will continue paying your medical bills (up to $1,087,000 for Genki Native Basic, but unlimited with Genki Native Premium).

“Regarding Genki Native, we explicitly state that medical transport to another country is covered in the USA,” says Genki’s Matteo Stefanoni. “Also, we have medical transport to any other country, not just the home country. Because this is very flexible for the customer, there’s also a high risk of abuse. For that reason, it requires prior approval, which means the customer and the insurer have to discuss and agree on the best course of action together.”

In other words, you can’t necessarily choose to be flown to an expensive country like Singapore for treatment. However, unlike SafetyWing, using Genki’s medical transport to a cheaper country for treatment is part of the plan — it’s how it’s supposed to work.

But what happens with Genki if you’re injured in America on your 29th day of coverage? All coverage also ends after the 30th day.

This is a real problem for nomads, who don’t have a “home” per se, and it’s not necessarily solved by buying a separate, dedicated medical evacuation policy: most of those products promise merely to return you to your “home country.” Most won’t take you from America to a country of your choice to get cheaper medical treatment.

When it comes to medical evacuation, in particular out of America, I still think Genki’s products — Native and (especially) Resident and Explorer — are more expat and nomad-friendly than other companies.

But even with Genki, I wouldn’t go close to their daily limits on any product: 30 days on Native or 45 days on Explorer. For Resident, I would check beforehand to see what their current policy is on U.S. coverages.

What do Michael and I do?

A brief interlude to explain how Michael and I — both Americans — insure ourselves, medically speaking.

Even though we spend most of our year outside of the United States, we keep a comprehensive ACA policy, purchased on the online exchange in Washington State. It’s really expensive: an annual premium of $21,511 for the two of us. But because our income has been low in recent years, it’s been heavily subsidized. This year, we’re paying only $2995 of our total premium.

The deductible is insanely high — $6000 a year! — so we see this as a kind of “catastrophic” policy. Still, the ACA protections and regulations are strong, so if one of us ever has a really serious or chronic illness, we know we could return to the U.S. and have good, regulated coverage.

While we travel, we also keep a Genki Explorer Travel Insurance policy. It has quickly paid out for all our recent mishaps, but it also gives us coverage for any medical transport back to the U.S., should we need it.

Our Genki policy has an annual premium of $2016 (or $168 a month) which results in a total annual health insurance cost of $5011 for both of us.

We think this gives us very strong coverage all over the world at a fairly affordable price.

Unfortunately, our income is way up this year — thanks to the success of this newsletter! — so we’re probably going to have to pay back some of our ACA subsidy. That means our insurance costs will be higher next year too. And the more our current premiums rise, the less affordable our current set-up becomes.

What will we do then? We’re still not sure.

My Recommendations

See? The travel healthcare insurance industry really is full of crazy twists and horrifying turns.

What does it all mean for an expat, nomad, or long-term traveler looking to insure their healthcare needs? Here are my specific recommendations.

For American nomads looking for total coverage

If you’re an American, and you return home at all (and keep a mailing address and “residency” somewhere), and your income is low enough to qualify for a decent ACA subsidy, I think Michael’s and my combination of Genki Explorer and a subsidized ACA policy is an amazing value.

And, of course, it completely protects you if you ever have a major mishap while being back in America. No, you can’t use Explorer’s evacuation coverage after 45 days, but you don’t need to: you’ll still have full coverage in America for as long as it takes to recover.

For all nomads looking for travel insurance only

I think Genki Explorer is a fantastic travel insurance policy, especially for nomads. It’s a bit more expensive than SafetyWing Nomad Insurance, but I think it’s a far better value.

But SafetyWing Nomad Insurance Essential does have those other non-medical coverages, if that’s something you absolutely need.

For non-Americans (and Americans who don’t qualify for an ACA subsidy) who want full international health insurance

This one is a bit more complicated. I think Genki Native is a bit less impressive than the company’s previous product, Genki Resident. If you’re over 55, Resident is still available, but I’d ask for it over Native even if you’re younger.

But if you can’t get Resident, Genki Native is still a solid choice. All Genki products seem more nomad-friendly to me — especially the fact that you can use their medical evacuation coverage to travel out of America to continue your treatment.

But they can be expensive, which is why I also recommend really shopping around and getting quotes from competitors such as Cigna, Allianz, IMG Global, GeoBlue, and any other international health insurance company you can find. You should also find a broker or two and work with them to see what they come up with for you.

Read reviews and ask lots of questions, and always make sure you’re not comparing apples to oranges — especially about coverage in America. What exactly happens if you have a bad accident there?

And, of course, always get everything in writing.

But then ask yourself: does this company really understand my needs? Is the fact that I have an unconventional lifestyle going to screw me over if I need to access some aspect of this policy?

If Michael and I have to do this search next year, I’ll seriously consider Genki Native — or Genki Resident, if we can still get it.

For more information:

Genki

SafetyWing

Which is the Best Travel Insurance: SafetyWing, World Nomads, or Genki?

Who Has the Best International Health Insurance: SafetyWing or Genki — or Someone Else Entirely?

I Went to Istanbul for Medical Tourism!

How is Healthcare Different Outside of America?

Brent and Michael Are Going Places

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