Author Topic: Long term International travelers with chronic (expensive) health conditions  (Read 1705 times)

LateToTheParty

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DH and I are nearing lean FI now. We are interested in RE with long-term, international travel.  Healthcare is my reservation, and I have an expensive (medication costs) chronic health condition.  I have heard how “inexpensive” healthcare is internationally.  But devil is in the details, and I would love more detail.

Are there any of you doing this with chronic health conditions who have monthly expensive specialty medications?  Anyone blogging about this?   I would love to hear your experiences.   

Freedomin5

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Are you planning to keep your home country as your base, and just travel internationally while returning home between travels? Or are you planning to retire abroad?

I’m in Asia, and lots of people go to Thailand for treatment. Also, if it’s just medication you need, and not expensive medical procedures, then China is generally quite cheap, as long as the drugs you need are approved by the government and available for sale.

If I had an expensive-to-treat medical condition, i would make sure that the country I plan to retire to has approved the medication I need to take. If the mess are available, then you can just bring over your medical record or a letter from your treating doctor in your home country, and you can generally find a doctor here who is willing to prescribe refills, particularly if your condition is already well-managed. At least that’s how it seems to work in China.

Aunt Petunia

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Schedule an appointment with a medical social worker, they can help you set up what you need.

Freedomin5

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Schedule an appointment with a medical social worker, they can help you set up what you need.

The medical social worker would have to be in the US. We don’t even have social workers in China, let alone specialized ones focusing on medical care. In which case, would you be able to find one who is familiar with the availability of care and/or medication in the foreign country in which you plan to retire?

expatartist

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The medical social worker would have to be in the US. We don’t even have social workers in China, let alone specialized ones focusing on medical care. In which case, would you be able to find one who is familiar with the availability of care and/or medication in the foreign country in which you plan to retire?

That's the challenge, you'd want to have a two-pronged approach, one coming from each side: home country and destination country. There's not always a great fit but with time people can often find a solution eventually. It's possible the condition and its potential medications / treatments could direct the travel and eventual location.

OP have you determined a location for retirement yet? Or are you leaning toward somewhere? Would you be looking to receive prescriptions from local doctors or would you have prescriptions from home? Depending on the condition, you'd want to build a relationship with a trusted doctor rather than leaving it to multiple countries - also one not like the posh doctor I know in small-town Sicily who brags about treating all the mafiosi in town and drives an Alfa Romeo.

A theoretically good approach could be:
* Research various destinations and their treatment / medication costs
* Holiday(s) taken to those/near destinations while still working to move from 'lean FI' to 'FI'
* Determine destination country and try it out for 1 year
* Reset and repeat elsewhere or settle in to your home base from which to do more travel, if you like

Very timely and relevant question, OP.

Aunt Petunia

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Schedule an appointment with a medical social worker, they can help you set up what you need.

The medical social worker would have to be in the US. We don’t even have social workers in China, let alone specialized ones focusing on medical care. In which case, would you be able to find one who is familiar with the availability of care and/or medication in the foreign country in which you plan to retire?

I guess I am spoiled working at big teaching hospital. We get lots of international visitors so our social workers are well versed in these things. Our regular patients also sometimes travel to other countries and the social workers help them set up the care they need.

Fig

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LateToTheParty - I can't offer any guidance but I'm very interested in this. Please do let us know what you discover. Good luck!

LateToTheParty

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OP here. Thanks for the replies.

We are interested in either Costa Rica or Thailand, although open to exploration. Honestly, we would like to experience various cultures, and would prefer slow travel - 6 months to 1 year in various locations, and open to suggestions.    I do like the advice about having one central location/provider to manage the care delivery, though.  The info you suggested freedomin5 is super helpful.  My condition is well managed as long as I get my medication.  The medication is widely available in the United States, and is a cash cow for big pharma. 

This is really good advice and sort of what we are thinking:
Quote
A theoretically good approach could be:
* Research various destinations and their treatment / medication costs
* Holiday(s) taken to those/near destinations while still working to move from 'lean FI' to 'FI'
* Determine destination country and try it out for 1 year
* Reset and repeat elsewhere or settle in to your home base from which to do more travel, if you like

MsWolfeRN:  Good call about asking a MSW this question.  I can seek this out. 

 It’s a little depressing researching healthcare on the exchanges. Healthcare will by far be our largest line item in the retirement budget. Specialty drugs are 40 to 50% coinsurance and not subject to the maximum out-of-pocket costs on the US exchanges. But better than the old days of being excluded from being able to get coverage at all.

 And I am thankful to know about this condition now, rather than after we FIRE.  We are definitely padding our budget to have adequate health coverage.

 I’ll post back as I find additional information.

Freedomin5

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If you’re planning to slow travel and then return to the states between trips, you can even see if your provider is willing to prescribe 6-12 months worth of meds for you to take with you abroad. That way you know the meds you are taking are real meds, not fake meds.

wanderin1

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I’m close with someone from the US who has a rare medical condition requiring daily pills, and has spent lots of the last 20 years happily travelling despite that. Here are my observations:

--Figure out exactly what you need from your US healthcare provider, what you need from the worldwide providers—and how that fits with your general travel plan. For example, if your condition is stable, you see your doc once a year, and you take medication that can tolerate a temperature range, then maybe come back to the US annually, and get a 12 month meds supply. It may take some time get the over ride amount approved, but my friend never gets turned down.

--Talk with your doctor, especially if you need to be seen by a specialist outside the US. Your doc may know, or will be able to easily research, specialists in other countries.

--Talk with your pharmacist about availability of your medication in other countries.

--Call the company that makes your medication and ask if you will be able to purchase it in your destination country. (my friend says this used to be easier to do before big US pharma got so worried about medication purchase arbitrage, but it’s still possible)

--Talk with a travel insurer. My friend uses World Nomads, and they’ve been helpful confirming the availability of his meds. in various countries around the world.

--Think about how other illnesses might impact your condition. It’s pretty common for travelers to get COBE sick sometimes. (COBE: coming out both ends) What happens if you’re so sick for three days that you can’t keep anything down. How will that impact your chronic condition?

--Think about drug interactions. Malaria medications? Full spectrum antibiotics? Will you be able to take these while taking your regular meds?

Despite the seeming gloom and doom of some of the above, my friend’s experience of round the world medication has always seemed pretty positive. I was there in Ulaan Bataar Mongolia, for example, where an amazing pharmacist spent more than half an hour with us translating from English to Mongolian to Russian (where their meds come from) to make sure that she got things absolutely right. And the time in Kashgar, China, when a pharmacist didn’t carry my friend’s meds, but used her own phone to make more than eight calls to find out where he could get what he needed.

So maybe treat this as another interesting challenge of your travel? Good luck!

 

Dr Kidstache

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Thanks for the great tips @wanderin1 . I'm hoping to get back to international travel after becoming disabled (but no complicated medication needs) and your list of suggestions is really helpful.

LateToTheParty

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Thank you very much for the thorough and thoughtful ideas, @wanderin1.  These are great.

wanderin1

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Thank you very much for the thorough and thoughtful ideas, @wanderin1.  These are great.

Thanks for the great tips @wanderin1 . I'm hoping to get back to international travel after becoming disabled (but no complicated medication needs) and your list of suggestions is really helpful.

You’re welcome! Three more thoughts:

Have your doc write a letter that you take on your travels saying that you’re under the doc’s care, have a medical condition, and require the prescribed meds. A couple of times, my friend has gotten questions at borders. He shows his letter (yes, it’s just in English) and that takes care of everything. 

Consider your meds as a  “valuable” you’re taking on your trip—and develop practices to keep them safe. For example, my friend never puts his meds in a checked bag—out of concerns for theft or exposure to very high/low temps. He also keeps about 5 days worth of meds in a secure “secret stash,” usually on his person. And ahead of his travels to a new region/country, he thinks though how he would handle his medication issue if all his stuff—including the meds--got stolen.

Know that there really are fake medications out there. In the last 10 years, my friend has encountered fakes three times: in India, China and Thailand. The Chinese fakes were pretty obvious. But the Indian and Thai fakes were undetectable until he started taking them. His India fakes are the most recent, and he brought them back to the US to show his pharmacist and doc—neither of them could tell the meds were fake. Because my friend mostly travels Asia, and the smaller countries  there often import their meds from India or China, he switched from buying his meds locally to buying everything from his US provider for now.

Don’t let any of this discourage you—just make a plan that prioritizes your health. Happy travels!