Navigating Healthcare

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This is written from the perspective of an American. Some of this may not apply if you are not.

Navigating healthcare as a digital nomad, especially as an American, is frustrating. Notice we said healthcare and not health insurance.

Health insurance is only 1 part of the healthcare picture as a digital nomad.

After hours of research online and talking with friends this is where we've landed. Note, please double check our research for yourself and ask qustions of whomever you are purchasing insurance from.

Feel free to skip to what I do for healthcare if you want an example.

What You'll Learn

What to consider as a digital nomad (4 components)
Options to cover components of healthcare
Specific plans with various risk & cost levels
What I, Pat, do

4 Healthcare Components to Consider

1. Emergency care

Accidents happen. What will you do if one happens to you?

2. Long-Term & Preventative Care

Regular health check-ups and monitoring are important for everyone, regardless if you're on the move or not.

3. Medical Evacuation

Severe injuries may require costly emergency transportation. How will you finance it?

4. A Plan in Your Home Country

If you become seriously ill, will you return to your home country for treatment? What's your strategy for healthcare access, especially during emergencies? This applies both abroad, but also while home (if home is America).

Even if your a nomad, you make visits back to America. Do you have plan if a medical emergency strands you in the U.S.?

Options to Finance the 4 Healthcare Components

Let's break down a couple of options and share which of the 4 this may be good for.

Travel Insurance

Description: Limited, short-term insurance, mostly only for medical emergencies. It often also covers other travel-related issues (theft, trip cancellations, etc.)

Good Options: SafetyWing (opens in a new tab), Genki (opens in a new tab)

Component	Good For?
1. Emergency	X
2. Long-Term/Preventative
3. Evacuation	X
4. Plan - Home Country

International Health Insurance

Description: This is “full” health insurance, and it covers long-term care and chronic illnesses like cancer, not just one-time emergencies.

Unlike limited plans, it doesn't end after a set enrollment period, avoiding issues with 'pre-existing conditions' and potential uninsurability.

Good Options: SafetyWing (opens in a new tab), Genki (opens in a new tab) (Offer health insurance plans in addition to the travel insurance)

This depends on the plan, but most options are good for:

Component	Good For?
1. Emergency	X
2. Long-Term/Preventative	X
3. Evacuation	X
4. Plan - Home Country	maybe

4 (maybe) - Companies like SafetyWing (opens in a new tab) are now rolling out full health insurance plans. See their travel insurance vs. nomad health plans.

Dedicated Emergency Evacuation Insurance

Description: Very cheap insurance that includes no other benefits except medical evacuation.

I have yet to purchase a plan like this, however the next time I plan to spend an extended time skiing abroad, I plan to.

Good Options: EA+ (opens in a new tab)

Component	Good For?
1. Emergency
2. Long-Term/Preventative
3. Evacuation	X
4. Plan - Home Country

Out of Pocket

Description: Paying cash for various medical expenses.

Component	Good For?	Note
1. Emergency		Maybe if have the resources
2. Long-Term/Preventative		Maybe if have the resources
3. Evacuation		Big risk
4. Plan - Home Country		Highly not recommended if you plan on traveling back to America

Credit Card Insurance

Description: Depending on the credit card you use, you may have some minor coverage. In most cases, you have to use that credit card for a purchase directly related to the injury.

Ex: Scooter rental accident (must pay for the rental with your card)

Good Options: Chase Sapphire Preferred ($95 annual fee) (opens in a new tab)

Component	Good For?
1. Emergency	X
2. Long-Term/Preventative
3. Evacuation	X
4. Plan - Home Country

What it's good for depends on your credit card.

Obamacare Health Care Plans

Description: These are health insurance plans not through your employer. Most providers who offer health insurance to employers, also have Obamacare plans.

They follow an "open enrollment" period. This means at the end of ever year, anyone can signup for a plan, with no denial based on pre-existing conditions.

If you have an illness outside of America, it's possible to return to America and access "semi-affordable" health care coverage on January first of the following year.

Component	Good For?
1. Emergency
2. Long-Term/Preventative	X
3. Evacuation
4. Plan - Home Country	X

Most Obamacare plans do not cover 1 and 3, however they may. Ask questions when looking at insurance.

Specific Options for Coverage

If you've made it to this point, there's 4 components to consider, and 6 methods of meeting those components.

Unfortunately, unless you have a great employer, it's unlikely you'll have coverage for all 4.

Fortunately, you can mix-and-match to cover just about all you need, depending on how much you want to spend and how risky you want to be.

Let's break it down into these options:

Full Coverage, Expensive Method
Full Coverage, Inexpensive Method
Perfectly Respectable Coverage, More Expensive Option
Perfectly Respectable Coverage, Less Expensive Option
Riskier but Very Inexpensive Coverage
Very Risky Coverage But Free — and Better Than Nothing

Full Coverage, Expensive Method

What to get: international health insurance

You can get one through companies like:

Blue Cross/Blue Shield
Cigna
Aetna
Safety Wing
Genki

Make sure it includes ongoing/healthcare. Since you're looking at international plans, make sure it also covers you in America.

If adding America coverage is too expensive, you can lower costs by choosing a high deductable plan. That means, you'll pay more out of pocket until you hit your deductable, from which insurance then kicks in.

Component	Covered?	Covered how?
1. Emergency	X	international health insurance plan
2. Long-Term/Preventative	X	international health insurance plan
3. Evacuation	X	international health insurance plan
4. Plan - Home Country	X	international health insurance plan

Full Coverage, Inexpensive Method

What to get: nomad-specific travel insurance, Obamacare plan

Nomad plans like:

Safety Wing
Genki
World Nomads

Obamacare - look for silver and bronze plans in your state.

Component	Covered?	Covered how?
1. Emergency	X	nomad-specific travel insurance
2. Long-Term/Preventative	X	Obamacare
3. Evacuation	X	nomad-specific travel insurance
4. Plan - Home Country	X	Obamacare

Perfectly Respectable Coverage, More Expensive Option

What to get: international health insurance (with preventative care features, but no America add-on)

International health insurance:

Blue Cross/Blue Shield
Cigna
Aetna
Safety Wing (Nomad Health & not the Nomad Insurance)
Genki

Component	Covered?	Covered how?
1. Emergency	X	international travel insurance
2. Long-Term/Preventative	X	international travel insurance
3. Evacuation	X	international travel insurance
4. Plan - Home Country

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Note - some policies will cover emergency treatement in America for atleast a few weeks, even without the American add-on.

For instance, present Safety Wing travel insurance policies provide coverage in the United States for fifteen days within each ninety-day cycle, though this requires ninety days of uninterrupted coverage beforehand.

In case of a significant health concern, this fifteen-day window can offer an opportunity to seek alternative solutions, such as enrolling in an Obamacare plan, which accepts individuals regardless of pre-existing conditions.

Perfectly Respectable Coverage, Less Expensive Option

What to get: international health insurance (no preventative care features, but no America add-on)

International health insurance:

Blue Cross/Blue Shield
Cigna
Aetna
Safety Wing (Nomad Health & not the Nomad Insurance)
Genki

Look for one with a high deductable.

Component	Covered?	Covered how?
1. Emergency	X	international travel insurance
2. Long-Term/Preventative	X	out of pocket
3. Evacuation	X	international travel insurance
4. Plan - Home Country

Riskier but Very Inexpensive Coverage

What to get: nomad travel insurance

Nomad travel insurance:

Safety Wing (Nomad Insurance & not the Nomad Health)
Genki

Use your travel credit card travel insurance for anything the nomad insurance won't cover.

Pay out of pocket for regular visits.

If you do have a serious health issue, plan to stay in the cheaper country until you can apply for Obamacare (open enrollment or qualifying life event).

Component	Covered?	Covered how?
1. Emergency	X	nomad travel insurance
2. Long-Term/Preventative	X	out of pocket
3. Evacuation	X	nomad travel insurance
4. Plan - Home Country

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You are risking a financial catastrophe, not to mention stress and anxiety while on the trip.

Very Risky Coverage But Free — and Better Than Nothing

What to get: nothing (assuming you have a travel credit card)

Use your travel credit card travel insurance for any emergencies or accidents. Charge everything to that card.

Pay out of pocket for regular visits or expensive accidents.

If you do have a serious health issue, plan to stay in the cheaper country until you can apply for Obamacare (open enrollment or qualifying life event).

Component	Covered?	Covered how?
1. Emergency	X	nomad travel insurance
2. Long-Term/Preventative	X	out of pocket
3. Evacuation	X	nomad travel insurance
4. Plan - Home Country

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You are risking a financial catastrophe, not to mention stress and anxiety while on the trip.

What I do for Healthcare

What I have: nomad-specific travel insurance (Genki (opens in a new tab)), Obamacare plan (UHC bronze)

I split time between America and abroad, so not full time digital nomad.

I'm currently in America but heading abroad from Jan-Apr (Thailand, Vietnam, Spain, Ireland).

I'm not a W2 employee so I had to get my own health insurance via Obamacare. I enrolled in this plan when I left my previous job, where I was a W2 employee. That counts as a life event.

While I'm aboroad, I flex my nomad-specific travel insurance. I use Genki (opens in a new tab) for this.

Genki has an almost no overall pay-out limits, which I like, and fewer exclusions. I'm a healthy, young-ish guy (29), and they cover non-emergency illnesses that require treatment.

They also do not limit destinations.

Component	Covered?	Covered how?
1. Emergency	X	nomad-specific travel insurance
2. Long-Term/Preventative	X	Obamacare + out of pocket
3. Evacuation	X	nomad-specific travel insurance
4. Plan - Home Country	X	Obamacare

Special Thanks

Special thanks to /u/MichaelJDigitalNomad who runs a great newsletter, Brent and Michael are Going Places (opens in a new tab). Their newsletter helped me tremendously when trying to navigate healthcare as an American digital nomad.