(US) Health Insurance while traveling long-term internationally

[StetsTerhune]

I'm hoping someone one here has researched and thought through everything enough to save me the trouble. Here's my situation:

Wife and I are  completely healthy, early 30's, americans, who will be travelling outside the US indefinitely starting in about a month. In terms of health insurance options, here's what I came up with, sorry if this is a bit rambly:

A. Get an US exchange policy, which quick research indicates will cost us about $440 per month
B. Get a international/ex-pat medical policy, which quick research indicates will cost me about $220 per month.
C. Get both A&B
D. Get nothing (counting on the fact that I could move back to the states (a 'qualifying event') and get covered in an emergency

The issues I've come up with so far that I need to consider:

1. My expected use of health insurance in the next few years is $0
2. I have a large amount of assets that I'm fairly paranoid about protecting from large risks, couldn't care less about insuring smaller risks (i.e. less than...50kish)
3. Penalty for not having insurance (option B is not acceptable as far as this is concerned): I've been trying to research this but can't find anything definitive on whether being insured for half the year and being out of the country for half the year exempts me from the penalty (which would be approximately as much as I'd pay for option A).


My guess from what I've seen so far is that assuming I can avoid the penalty , option B or D is what will make sense mostly, but I'm not sure I get past the extreme risk that, say, I'd need a half a million dollar bone marrow transplant. Anyone already make this call? Anything I'm missing?

[forummm]

I've heard that having health problems internationally could be really expensive if you need to be medically transported. So I would definitely get the international coverage since it's so cheap. I have also heard that most health problems internationally are actually really inexpensive to deal with out of pocket. But it's a big unknown.

For domestic coverage, it seems not that useful since you won't be here. BCBS has some plans that provide some international benefits, but I don't know if they have those on the Marketplace or not. If you do move back to the US you can get insurance when you get back. Just make sure that moving back to the US from abroad is a qualifying life event (I believe it is).

Something like a half million dollar bone marrow transplant is not likely to be a surprise procedure. So you'd have time to get insured. Something like a half million dollar open heart surgery could be pretty urgent.

[expatartist]

Don't even consider D. Even if you're traveling through first world countries, it's unethical to become burdens on other healthcare systems in case you, say, have a heart attack.

Will you be resident anywhere in particular? Or will you be roaming? Sounds like you'll want worldwide coverage. Expat ins. is usually for those based in a particular place. WorldNomads and the like are relatively affordable for constant adventure travelers who do things like ride pillion on motorbikes or go skydiving.

[NumberJohnny5]

I'd shy away from A. You are required to have health insurance while you're resident in the US. If you're resident in the US and vacationing outside the US, you are still required to have health insurance. However, if you are NOT resident in the US, then you are not required to have health insurance.

What state are you in and what's your income? You may qualify for Medicaid? I wouldn't worry too much about mooching off the system, if you're not here you can't use it. If you're technically resident here, it would satisfy the requirements. Something to look into.

Will you be staying in a particular country for an extended period of time (month or more)? Why not look into getting health insurance in each country you'll be in? If you'll be country hopping for a bit, get a traveler plan. Maybe something that will pay for an emergency evacuation, and health care costs until you're evacuated. I'm guessing you can hold off on routine Dr's visits until you're in an area that has cheap/free quality medical care, so you may be comfortable not being insured for that.

[FrugalZony]

Go curry cracker had a good post on this recently
http://www.gocurrycracker.com/obamacare-expats-and-visits-home/

Also, if you are away from the US for a long time, I'd research long term travel insurance.
The policies are usually quite affordable. My SO, who has been a long time traveller until we met,
was on a plan, that ran roughly USD 1000/year and covered lots of countries, with the exception of his home country.

It really depends if you are going to to stay in certain places for longer or are changing countries quite frequently.

[forummm]

I've heard that having health problems internationally could be really expensive if you need to be medically transported. So I would definitely get the international coverage since it's so cheap. I have also heard that most health problems internationally are actually really inexpensive to deal with out of pocket. But it's a big unknown.

For domestic coverage, it seems not that useful since you won't be here. BCBS has some plans that provide some international benefits, but I don't know if they have those on the Marketplace or not. If you do move back to the US you can get insurance when you get back. Just make sure that moving back to the US from abroad is a qualifying life event (I believe it is).

Something like a half million dollar bone marrow transplant is not likely to be a surprise procedure. So you'd have time to get insured. Something like a half million dollar open heart surgery could be pretty urgent.

I looked into it a little because they updated the SEP requirements recently.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-05-06.html

Special Enrollment Periods

While SEPs provide a critical pathway to coverage for qualified individuals who experience qualifying events and need to enroll in or change qualified health plans (QHPs) outside of the annual open enrollment period, it’s equally important to avoid SEPs being misused or abused.  As it announced today, HHS is tightening the rules for certain special enrollment periods and making clear that SEPs are only available in six defined and limited types of circumstances.

New rules limit the circumstances in which someone may qualify for the permanent move SEP to ensure consistency with the original purpose of that SEP.  An Interim Final Rule with Comment (IFC) published in the Federal Register provides that individuals requesting a “permanent move” SEP must have minimum essential coverage for one or more days in the 60 days preceding the permanent move, unless they were living outside of the United States or in a United State territory prior to the permanent move. This ensures that individuals are not moving for the sole purpose of obtaining health coverage outside of the open enrollment period.

We are also making conforming changes to ensure that individuals who were incarcerated, or were previously in the coverage gap in a non-Medicaid expansion state and have moved and become newly eligible for advance payments of the premium tax credit (both of whom would previously have qualified for the permanent move SEP) may continue to qualify for a special enrollment period.  Because these individuals were previously unable to have minimum essential coverage or exempt from having minimum essential coverage prior to the qualifying event that qualifies them for this SEP, we are not requiring that they had prior minimum essential coverage to qualify for an SEP.

The IFC also removes a January 1, 2017 implementation deadline by which Marketplaces would otherwise have had to provide advance availability of the permanent move SEP and provide a SEP for loss of a dependent, or for no longer being considered a dependent due to divorce, legal separation, or death.  Marketplaces can still provide either SEP, but implementation and the timing of that implementation are at the option of the Marketplace.

Finally, clarified in separate guidance that SEPs are only available in six defined and limited types of circumstances: (1) losing other qualifying coverage, (2) changes in household size like marriage or birth, (3) changes in residence, with significant limitations, (4) changes in eligibility for financial help, with significant limitations, (5) defined types of errors made by Marketplaces or plans, and (6) other specific cases like cycling between Medicaid and the Marketplace or leaving Americorps coverage.

[Gimesalot]

This website seems to have some good information about choosing travel insurance:
http://alittleadrift.com/rtw-travel/#insurance

Might be of help.

[Drifterrider]

Check out www.horizonsunlimited.com  blog for international travelers.

Check out Med-jet assist.  Gets you to a US hospital from anywhere in the world (based on what policy you buy). 

[boarder42]

i'd hit up ARS he's probably got an answer for you or he will respond here i'm sure.

[arebelspy]

i'd hit up ARS he's probably got an answer for you or he will respond here i'm sure.

We have an international health insurance plan.  We just pay everything OOP, and keep it in case of emergency.  We stay out of the US enough to qualify as expats (at least 330 days/yr), so we aren't required to be ACA compliant or pay a tax penalty.  When we move back to the States (whenever that is), we'll get healthcare on the exchange.

That will cost ~6k/yr.  Our current plan costs ~1k/yr.  It's basically a 5k/yr tax to live in the US, which sucks, but we'll eventually pay since we have family there.

[Lake161]

Depends on your risk tolerance and the size of your nest egg.  Here in Panama, a very low cost country for routine medical care, a private hospital stay after a serious car accident could set you back $50-100k, and they'd want a significant deposit up front, without which you will be sent over to the public hospital where they can't treat anything major.  I'd get a high deductible international policy, and pay the routine stuff out of pocket. And then make sure you stay out of the US 330 days a year to avoid the ACA penalty.

[SimplyMarvie]

I would say read the policies VERY, VERY carefully. Especially the expat policy. You need to make sure you understand both what it covers and how it pays. Know that the international standard for medical care is cash on the barrel, and that hospitals will very often look at your wallet before they look at your injury, so in a lot of situations you may be paying and waiting for reimbursement.

So first, what does your international policy cover? Routine health care? Pre-existing conditions? Medications? Who is making the decision about what is covered, and how do they do that -- if you end up with some treatment that is the standard of care where you are, but wouldn't be done in an American or European hospital, will they pay for it? Whose responsibility is it to translate claims, yours or theirs? How do you get medication -- can you access US pharmacies through mail order? How do you get paid; in what currency and at what exchange rate? Does your policy cover medical evacuation -- and if so, to where? If they medevac you to the US (or your home country), does the international policy still pay? If not, you want to be VERY clear about under what circumstances you'd be medevaced and how that decision is made, and may want to carry a US Policy as well. You also want to be clear about what forms of Medical Evacuation are covered (life-flight? commercial air? with or without an escort? who pays for that?) and whether there are specific companies you need to work with and what their coverage areas are.

Understand that often commercial carriers in other countries are very, very strict with what conditions they allow people to fly under and may require medical documentation or a medical escort for things we consider to be mundane. Further, medical evacuation -- which can be necessary for all sorts of sudden-onset conditions, illnesses and injuries -- is enormously expensive. We used to have to fly people 150-200 miles to Miami and it would run $12,000 to $15,000 -- again, cash on the barrel. So that's some context to solve against when you're thinking about the kinds of fees you'd insure for.