What Are We Doing for Health Care Insurance in 2023?

Some nomads say, "International health insurance isn't that complicated." I say they're bonkers!

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Update: See my most recent healthcare article here!

I’ve written before about health care for digital nomads and long-term travelers, and how it can be very complicated, especially for Americans.

I believe that “health care” for long-term travelers includes four necessary components:

1. Emergency Care. Accidents happen. What will you do if one happens to you?

2. Long-Term and Preventative Care. Everyone — even a nomad — needs a medical professional to monitor their overall health: keeping records, filling prescriptions, tracking vaccinations and other medical needs, and dealing with concerns related to aging or other issues that may not be obvious. Who is your long-term health care provider?

3. Medical Evacuation. In the case of extreme injury, getting transported to the hospital, and/or back to your home country, can be very expensive. How would you pay for this?

4. A Plan for Your Home Country. Some travelers prefer their long-term health care provider (#2, above) to be in their home country. But even if your long-term provider is outside of your home country, what’s your plan if you become seriously ill? Will you return home? If your home is America, how exactly will you access health care there? If you’re planning to stay outside of your home country in the event of serious illness, do you have a partner or other support system to help you maneuver through a foreign medical and visa system when you’re at your most vulnerable? Are you comfortable being away from friends and family indefinitely in this time of intense trauma? And no matter what your overall plan is, if you’re American, you still need to account for at least your brief visits back home. If you do have an emergency that strands you in the U.S, how will you handle the sky-high medical costs? If you’re diagnosed with cancer, would you then immediately leave the country to be treated elsewhere?

I believe that every traveler needs to consider and have a plan for all four of the above concerns. Unfortunately, there isn’t necessarily a simple, cheap way to get a handle on all four, at least for many Americans.

Here are the various ways you can finance these four healthcare issues. Many long-term travelers mix and match from these different payment options:

• Travel Insurance. This is limited, short-term insurance, mostly only for medical emergencies (and it also often covers other travel-related issues, like theft and trip cancellation). It’s very affordable, and it covers you for #1 and #3, above, but not #2 or #4. For nomads, good options include SafetyWing or Genki — in part because unlike most travel insurance, which must be purchased before leaving home, these are “nomad” policies that can be purchased mid-trip.

• International Health Insurance. This is “full” health insurance, and it covers long-term care and chronic illnesses like cancer, not just one-time emergencies. These policies are also open-ended, so you won’t be dropped at the end of a limited enrollment period, and, therefore, any serious illnesses won’t be deemed “pre-existing conditions,” making you essentially uninsurable. Most of these policies will cover #1, #2, and #3, above, and may cover #4. But if you’re an American, this last one could be an expensive upgrade or add-on. Both SafetyWing and Genki, which have previously offered only “travel” insurance, are now rolling out full international health insurance for individual travelers, with options for coverage in America too.

• Dedicated Emergency Evacuation Insurance. This is very cheap insurance that includes no other benefits except medical evacuation. One option is EA+.

• Paying Out of Pocket. If you choose to live full-time outside of America and have resources, it’s possible to pay out-of-pocket for #1 (at least for minor emergencies), and #2 (assuming nothing really horrible happens). But unless you’re very wealthy, you’re taking a huge risk by assuming you can pay out-of-pocket for #3. And if you ever plan on traveling to America, you’re insane to rely on paying-out of-pocket for #4.

• Credit Card Insurance. Depending on your specific credit card (we recommend Chase Sapphire Preferred, because I like the low annual fee), you may be able to rely on this coverage for #1 and #3. But (a) these benefits usually have low caps, and (b) accessing the benefit usually requires you to have used the credit card for a purchase that is directly related to your injury. If you’re in a scooter accident, and you’re injured while out on the road, you’re covered if you used the credit card to rent the scooter. If you didn’t, you’re probably out of luck. Does purchasing an airline ticket cover anything that happens after that? For how long? It all depends! In short, this is limited coverage.

• Obamacare Health Care Plans (if you’re an American). This is a really good option for #2 and #4, especially if you qualify for a subsidy, but outside of America, most Obamacare policies offer no coverage for #1 or #3. But keep in mind that one extraordinary thing about Obamacare is that there is an “open enrollment” period at the end of every year that allows anyone to sign up for an American health care plan, with no denial based on pre-existing conditions. This means that if you have a major illness outside of America, and it’s before the November enrollment period, it’s possible to return to America and access full, semi-affordable health care coverage on January first of the following year. Assuming you keep a home address in the United States, it may also be possible to access Obamacare at any time by returning home and moving to a different state — since moving from state to state can qualify as a “life event,” waiving mid-year enrollment restrictions. But simply leaving your home state to be a nomad and then returning again to that same state is probably not considered a “life event” since, technically, you haven’t really moved.

So how are Michael and I handling our health care needs in 2023? We’ve researched all our options, including the brand new full health care policies from both Genki and SafetyWing.

What did we think of these plans — and all the others we considered? And what did we ultimately decide?

Read on, Macduff!