We're occasionally asked if we have health insurance and how that works for a travelling family. To cut to the chase, yes we do, but we did quite a bit of research before finalizing our decision and finding the solution that was right for us.
Technically Mickelle is a volunteer teacher at the LIFE School and I'm self-employed so we're on our own with regards to health insurance.
We've met expats that don't have insurance and others that do. In the end it's a personal decision each individual or family needs to make based on risk tolerance, their current health, personal finances and other factors.
Here are some of the pros and cons we analysed when making our decision. All financial references in this post are in US Dollars.
Pros of NOT Having Health Insurance
- As my mom recently proved, you can receive good healthcare at hospitals in Central America for little to no money. I've also brought my kids to a local clinic where a Guatemalan doctor provided fantastic care for only $5/visit (and that's the "expensive" gringo rate).
- There's also the option of skipping the doctor and going straight to the pharmacy. You don't need a doctor's prescription for medicine in Central America. You just tell the pharmacist the name of the drug you are looking for and, assuming it's in stock, they'll sell it to you. Alternatively you can explain your symptoms and they'll recommend something. While there's no insurance subsidy on the medications we've often found them to be cheaper than in the States. I've paid less than $12 for medications that in the States would have required a prescription and cost me $20 just for a co-pay.
- You save money each month because there are no premiums. Yes, you'll have to pay the full expenses for anything you need, but as I already mentioned, it's typically cheap. On the extreme end, we know a boy who contracted Typhoid Fever and the medications for his treatment were over $100. Even if something this unfortunate were to occur to my family once a month, it would still be cheaper than paying monthly premiums.
Cons of NOT Having Health Insurance
- While my Mom and our kids have received good care for very little money, they were not critically ill or injured. If they were, the costs would have been much higher and we'd potentially run the risk of making trade-offs on our healthcare or risk financial instability.
- If something really bad were to happen and you could not afford it, you might be putting an unintended burden on your close friends or family to help offset what you can't cover. Thus putting them at risk for financial instability as well.
These cons are the reason we decided to purchase health insurance. Our thought process is that you don't need it, until you REALLY need it. Admittedly, this is not a universal feeling of ours, i.e. we don't have car insurance.
Health Insurance Options
Getting health insurance as an expat is easy. You go online and buy it. The process is straightforward but just like buying any insurance there's more than one choice and you need to read the fine print in order to properly weigh your options.
In general we are a healthy family. We stay active, the adults eat healthy (the kids eat like kids), and we rarely get sick. Because of this we knew that whatever insurance we purchased would rarely be used. Additionally we knew that getting reimbursed for an occasional $12 medication and/or a $5 doctor visits would be impractical with our vagabond lifestyle.
We decided catastrophic health insurance was the right product for our family. It's was also the easiest to shop for and the best value for our needs. As the name implies, catastrophic insurance is coverage that is designed to protect the customer from financial disaster in the case of a serious medical issue (think cancer or a life threatening injury).
A google search turned up a slew of different companies that could "help" me with our insurance needs. To narrow my choices I reviewed a few expat travel forums and other travel blogs to see who they were recommending. My search quickly narrowed to two vendors: World Nomads and Cigna Global Health.
World Nomads was (and still is) the company I see most promoted on blogs. A number of people I follow online have had personal experience with their insurance and found it a good choice. However, these recommendations were missing one key ingredient. With a few exceptions, most came from single people or couples with no kids...not families. Regardless, World Nomads did offer a family plan so they were still in the running.
Cigna Global was (and still is) the most talked about and advertised option in the online travel forums I frequented. An equal number of expat individuals and families expressed good sentiments towards them.
Our Insurance Decision
The Cigna plan we were considering was roughly 10% more expensive than the World Nomads plan. The World Nomads policy also came with a lot of extra insurance bundled in that Cigna did not have. Things like $300,000 of Emergency Evacuation, $2,500 of Trip Cancellation, $2,500 for Trip Interruption, $1,000 for Theft Protection, and $5,000 for AD&D. These were great enticements but in the end we opted for Cigna.
We chose Cigna for one reason, their policy included $1,000,000 of medical coverage. The World Nomads policy included only $100,000. Even though I can't possibly imagine needing more than $100,000 of medical coverage, Mick and I felt better knowing that for 10% more in premiums our family would get 10x more coverage in the event of a catastrophe.
NOTE: The above is not an endorsement for either World Nomads or Cigna Global Health. My family is a current customer of Cigna Global Health, but fortunately we've not used their services to date.
The inclusion of an evacuation service in the event of an emergency was something not included in our Cigna policy. It's something we were interested in and a friend of ours had recommended. After some additional research I picked up a separate policy for this service via a third party, GEOS Alliance. If you're interested in this service, shop around and be sure to read the fine print.
Expat Family Health Care Tips
- If you are requesting a particular medication from a pharmacist, it may be in your best interest to ask about alternatives. We've discovered that pharmacies often have similar quality medications manufactured in Mexico, South or Central America. Often it's almost the exact medication under a different name and with a much lower price. In our experience pharmacists won't offer the alternatives upfront.
- While the pharmacist might be experienced and know their medications, he/she is generally not as experienced as a doctor. It's not always a good idea to go straight to the pharmacy to save a few bucks. Additionally we've never been asked by the pharmacists if we're taking any other medications that might make for a bad cocktail. We've had great luck, but buyer beware. This is an environment that relies on the consumer knowing or asking the right questions.
- If you are travelling to another country and staying for an extended period of time we encourage you to get familiar with the CDC recommended vaccines. For Guatemala this includes Hepatitis A and Typhoid Fever. All four of us are vaccinated, and we're glad we are. We know people who've contracted both.
We hope this helps explain some options for other as they plan their travels. If you've had any related experiences or recommendations leave us a comment below.
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