Managing Health Care
As we announced our plan to travel around the world full-time, I think the most frequent question we got was about how we’d manage health care while outside of the US. Which is fair. We’re retirement age. We will be needing health care.
But that’s really two completely different questions, when you break it down: How will we manage routine care, and how will we manage emergencies? Unsurprisingly, those two questions have completely different answers.
Routine Care
One option for managing routine care is to purchase a US-style insurance plan that’s good all over the globe. Those plans have deductibles, copays, and out-of-pocket maximums, just like a traditional US plan.
They also have sky high premiums. It would be at least $1,500/month for both of us to pick up coverage like this.
And we just don’t think the expense is necessary.
Chauvinistic USA-USA chanting notwithstanding, our health care system is… OK. Most other countries have both lower costs and better outcomes than we’re able to produce. So when it comes to I-sprained-my-ankle, or I-need-a-prescription-refilled, it seems like we’ll spend way less than $1,500/month between the two of us in retail routine health care. So we’ll forego any special coverage for routine care.
Emergency Care
Urgent and emergency care is another matter entirely. While the risk we take in not having insurance for routine care is that we’ll spend more on retail care than we would on insurance (as unlikely as that seems), the risk in not having adequate coverage for emergency and urgent care is a little more existential.
So we’re going full belt and suspenders on this one (a recurring theme for the obsessive planner).
First, our Medicare Advantage plan covers urgent and emergency medical care outside the US, even if we’re away 365 days/year. There’s no extra charge for that coverage over and above our basic Medicare Part B premium. That should be enough coverage, but we’ve added a policy from MedJet. In the event that one of us is hospitalized, MedJet pays to have the both of us medevaced anywhere we like.
To be fair, the primary credit card we’re using for travel, CapitalOne VentureX, provides medevac coverage, but it’s capped at $100,000/incident. That might sound like a lot, but if we’re off the beaten path at all, which is the whole point of this exercise, medevac expenses can run north of $200,000/incident. So for about $900/year for the both of us we’ve added the suspenders to our otherwise sturdy belt.
Medications
Medications have proven to be the toughest nut to crack regarding health care. I had thought we could just take a US prescription to a local doctor, explain our needs, and get a local prescription to fulfill at a local pharmacy. Having spoken to someone who lived this lifestyle for nine years, it’s not quite that simple.
The same medications aren’t available in every country, so a doctor can’t just prescribe something similar without going through a testing and evaluation process. That’s a lot more complicated than just taking a fresh prescription to the local pharmacy.
As a result, we’re going to have to rely on US medications. Our insurance company won’t authorize a year’s worth of prescriptions at once. The best we can get out of them is six months. However, there is a way to get a year’s worth of meds at once: skip the insurance. Pharmacies will pretty much fill whatever your doctor prescribes. The limitations come from what your insurance will cover.
We’re using a combination of GoodRX for prescription discounts and DiRx, an online pharmacy, for fulfillment. We can pick up a year’s worth of meds for a very reasonable cost and just skip having to worry about what our insurance covers. This works, of course, because we’re not taking anything exotic. This path might not work for everyone.
The remaining challenge is the method we use to get our annual meds. It’s not legal to ship medications from the US to another country. Does that mean we couldn’t have the meds safely FedExed? Probably not. But that doesn’t mean there’s no risk of confiscation. Likewise with someone bringing the medications to us on a visit. If they’re caught at customs with someone else’s medications, confiscation is the best possible outcome.
As of now, we may have no choice but to return to the US annually to pick up meds. It’s not ideal, but it’s better than going without. We’ll update this if we come up with a better plan.
Update
Well, it didn’t take long before our theories about health care while traveling were put to the test. Less than two weeks into our journey, I developed a kidney stone. Once I realized that it was, in fact, a kidney stone, and not the onset of my painful and protracted death, I knew I could wait it out. But not without some help on the pain management side.
Our host procured a visit to a nearby urologist that afternoon. We waited less than five minutes before being seen, and while his English was actually worse than our Spanish, Google Translate came to the rescue. I was given an ultrasound to confirm my self diagnosis and locate the stones in their narrative arc, and prescriptions for pain meds and an antibiotic, just to be careful. We took the prescription to the pharmacy around the corner, which was filled in real time.
Total elapsed time, from walking into the clinic and leaving the pharmacy with prescriptions: about half an hour. Total cost for retail, uninsured services: $30 for the office visit and $35 for the meds.
Early days, but our assumptions about forgoing insurance for routine care have so far been borne out.
So glad you had such a good experience with the doctor and pharmacy. That’s been our experience in Mexico, too. Our hotel arranged for a doctor to visit me quickly when needed — can’t imagine that happening in the US.
We’re hoping for two things: that we don’t develop deep expertise in consuming health care outside the US, and that when we do, it’s as easy to navigate as our Mexico experience.