If I hadn’t told my dad I was writing this post Wednesday night, I would be wondering if I had dreamed up the coincidence. Healthcare while traveling is a complicated topic that few bloggers write about, so I thought it would be a good resource for others if I went ahead and shared the decisions we made – and then Jason’s tooth broke a few hours later. So, let me tell you first how we prepared for something like this – and then in order to avoid making this post a novel, I’ll write about Jason’s dental work in another post 🙂
If you’ve decided to quit your job and give up your home like we did, you probably have questions about healthcare and health insurance. You probably have asked Google what to do and not found many answers. My husband and I just left the US about two weeks and this was the single most complicated issue we dealt with when preparing for our trip. I started seriously researching it the first week in December and we finalized things on January 13th, so it took about six weeks. Despite not leaving until three weeks later, on February 4th, we still missed the delivery of our US health insurance cards by about a week – that’s how close we were cutting it without even realizing it.
(Please know this isn’t advice and you should do your own research before you make any final decisions. This is simply what we learned and the choices we made based on our individual circumstances. Also, I don’t receive any benefit for you choosing the companies mentioned in this post.)
I’m going to go ahead and make the assumption that you’ve already decided you want access to healthcare and health insurance for your trip. Not carrying health insurance is irresponsible because even the healthiest people could be the victim of a hit-and-run scooter or need to have their appendix removed. Stuff like this can be complicated and expensive if you don’t have the resources when you need them. In some areas of the world you won’t even receive treatment until you can prove that you can pay for it.
Jason and I carry two policies. Our US policy would cover us when we decide to return home or if we experienced a medical situation so serious that we’d want to be treated at home, like cancer or an injury with a long recovery time. Our travel medical policy covers us for stuff that happens while traveling, like a broken ankle, infected cut, or illness like Dengue Fever.
If you will be out of the US for more than 330 days in a year, you can purchase a single policy. However, because those plans are not ACA (Obamacare) compliant, we’d also be paying a significant fine since we are planning to be in the US more than 35 days this year. I’ll write a bit more on this further down just in case this applies to you.
Our US policy – Sutter Health Plus Bronze – pricing based on age & zip code, we pay $340 for each of us per month.
During the early planning of this trip, we assumed we’d go on the ACA Covered California website, indicate that we were not making any income this year, and be allowed to purchase a policy with a reasonable subsidy. Turns out this is absolutely not the case. If you tell Covered California you are not making any money, they will put you on Medi-Cal, which is the free health insurance for low-income Californians and not appropriate for Jason and I. We are happy to pay for our insurance and also wanted to keep our doctors. I tried having them adjust our income up to about $25,000 a year to bump us out of Medi-Cal, but they require proof of income, like an offer letter or last year’s W-2, so that wouldn’t work for us. Eventually we came to realize that we weren’t going to be getting any subsidy and started looking outside of Covered California for more options. The cheapest plan on the exchange was about $250 pp/pm, but it was a Kaiser plan that would require us give up our doctors and the cheapest with our doctors in network was a Blue Shield plan for $415 pp/pm.
Our doctors are at Palo Alto Medical Foundation, part of the huge Sutter Health system, and with a little bit of research, we found that Sutter has their own HMO, Sutter Health Plus. This was going to be the least expensive option to keep our doctors and similar to the Covered California plans, they offer four plans: Bronze, Silver, Gold, and Platinum. We went the Bronze plan for $340 pp/pm. While the Silver would have been our choice if we were staying local, we are not expecting to use this insurance plan very much and wanted to spend as little as possible.
Send me an email if you’d like our broker’s contact information or you can read more about the plans at this link: http://www.sutterhealthplus.org/about/PDFs/B-17-001%20SHP%20IFP%20Plans%20ADA.pdf
Our travel medical policy – GeoBlue Xplorer Select – pricing based on age and maybe zip code, we pay $133 for each of us per month.
Shopping for travel insurance can be confusing. I suggest you start by asking yourself “what am I actually looking for?”
Are you looking to be reimbursed for your trip if you can’t go due to injury or illness? Are you looking for money to help replace luggage if it is lost? Are you looking for rental car coverage? Are you looking for help rebooking cancelled flights?
When you’re taking a shorter trip, one where time is a limiting factor, you probably want these benefits. However, Jason and I don’t and didn’t want to have to pay for them. What we did want was rock solid health insurance that would cover medical issues (both emergencies and non-emergencies) and not try to send us home as soon as possible to then be covered by our US policy. What we realizes we were actually looking for was closer to ex-pat health insurance than the usual travel insurance.
We found GeoBlue both through an insurance broker recommended by our financial advisor (even though she doesn’t sell it) and also suggested by a cruising couple I met on a sailing Facebook group. These are several plans to choose from based both on length of your trip and whether you are keeping US health insurance or not. We have the Xplorer plan – their ex-pat plan for trips longer than 6 months. The Xplorer has 3 options –
(1) Select – this is our plan. It does not cover you in the US AND you must have US health insurance to qualify for it. This plan is for people like us that are planning to be in the US more than 35 days this year.
(2) Essential – this plan will not cover you in the US, but you don’t need US health insurance to qualify. Essentially, this means you are not planning to go to the US for a visit or for treatment of a serious injury or illness.
(3) Premier – this one DOES cover you in the US, but does not meet ACA minimum requirements. This plan would work for people who will be in the US fewer than 35 days a year AND would be willing to pay the ACA fine if you overstayed that limit.
Send me an email if you’d like our broker’s contact information or you can read more about them at this link: https://www.geobluetravelinsurance.com/products/longterm/xplorer-5-overview.cfm
FAQ:
I’m sorry this post got to be so long! Let me try to wrap it up with some questions we’ve been asked and some answers we received –
Q: So you only have travel medical insurance? What about insuring your stuff?
A: We have insurance on our laptops because they are the only really high value item we carry with us. We have a State Farm Personal Articles policy that covers both of them. If it covered cell phones, we’d include them too, but State Farm won’t allow it. Our clothing and other smaller electronics are not insured.
Q: What about cancelled/delayed flights?
A: Since Jason and I have a completely flexible timeline for this trip, we don’t mind waiting an extra day or rerouting to reach out destination.
Q: Does our travel medical cover EVERYTHING?
A: No – it has a 6 month waiting period for pre-existing conditions and it has limited coverage for some extreme sports. Because of this, Jason and I have DAN insurance for scuba diving (and if you dive, you should, too.) Also, if you hurt yourself doing something stupid, most (all?) travel medical plans reserve the right to refuse coverage.
Q: Do I need a travel medical policy if my credit card provides travel insurance?
A: Generally yes, if your trip is longer than a certain number of days. For example, our Chase Sapphire Reserve cards limit trip insurance to trips 60 days or shorter.
Q: Should I skip US health insurance and just pay the ACA fine because it’s cheaper?
A: Probably not, because most travel insurance plans I’ve found (like World Nomads) require you keep US health insurance OR pay for their plan that includes US health insurance (like GeoBlue Xplorer Premier.) If you are thinking about applying for the GeoBlue Xplorer Essential, ask yourself where you’d want to to be treated if you were diagnosed with something very serious, like cancer. Probably near your family, right?
Q: Can I be denied travel insurance due to my medical history?
A: Yes, because they are not held to the same requirements as ACA plans in the US. Jason and I had to fill out an application that included several medical questions, including one that was something like “have you ever been diagnosed or treated for anything not listed in the questions above?” However, I will tell you that I am obese by BMI and have mild asthma and was approved with no premium increase, so they are not looking for small reasons to deny you.
Q: When applying for US health insurance, what address do I give?
A: At first we were told that Sutter Health will not provide us with insurance if we would not be physically present in the state of California. I had to call them directly and speak to a supervisor to explain our situation. The ACA dictates that we had to keep insurance, so if they would not insure us, who would? I was put on hold, and then the supervisor confirmed that we should provide our current address at the time of application (we were still living in our apartment in California) and then could change our address to the mail service later.
Q: This all sounds great, but it’s too expensive for me. What’s the least I can spend and still be pretty well covered?
A: This was a question that was added after I wrote the blog and to be honest, I only have a vague suggestion of where to start. If you live (or are leaving from) Santa Clara County, I am pretty sure Kaiser Bronze HMO will be your cheapest plan. For us at age 32 and 33, it would have cost about $225 a month each. For travel insurance, check out World Nomads. This company is recommended by a lot of backpacking and low-budget traveler blogs I’ve read, but the reviews on actual claims are somewhat mixed. I’ve heard the cost is between $50-75 a month, depending on if you want extreme sports covered. This means the total cost would be around $300 a month for both – not too bad considering the consequences of skipping coverage!
If you have any other questions, let me know and I’ll add them!
I hope this post was helpful. I tried the write the post we were looking for when we started doing this research 🙂
Happy travels!
At that point we tried to figure out our best plan for Jason getting seen that next day. We have good travel health insurance and while I was pretty sure we weren’t going to reach our deductible with one filling, they have a great online resource for finding well-educated, English speaking doctors almost anywhere in the world. Unfortunately however, they only had one dentist listed in Taiwan, Dr. Jackson Liu, and he was in Taipei, a three-hour train journey in the wrong direction. This was important though, so even though it was late at night, I sent them an email requesting an appointment for the following day. We also did a bit of research online and found a couple other good English-speaking dentists, both in Taipei, that we had planned to call in the morning if we didn’t hear back from Dr. Liu. At that point, we realized that we would no longer be going directly to Tainan, and instead would be returning (temporarily) to Taipei in the morning.
