One of the more common questions I get is “What sort of travel insurance do you use?”
After being on the road for a certain amount of time, full-time and long-term travelers (including expats living abroad) don’t qualify for standard travel insurance, as most health care plans and programs from our home countries also lapse with a long enough absence.
Here’s a full explanation of how I insure myself, along with some helpful tips and definitions if you are in a similar position.
Also known as International Health Insurance or Worldwide Travel Insurance
It goes by many names, but the idea is the same; without a country to call your own (at least, as a resident), you don’t have any basic medical care to rely on, and all medical expenses must be paid out-of-pocket. For full-time/long-term travelers and people living abroad, expat insurance is the answer.
In some countries where the cost of living is low or where medical tourism boons, self-insuring can be viable. But if a medical emergency is dire enough or if you are traveling somewhere this isn’t the case (or where medical care is inappropriate and you are need to be taken to a place where you can receive the care you need), you could find yourself in a crippling financial bind.
I’ve written about the dirt on travel insurance before, including reasons why you need it and when you don’t, and even what it’s like to endure a serious illness requiring hospitalization on the road. So I won’t create a further case for why you need travel medical insurance here; let’s assume you already know why you need insurance, and want specifics about what to get.
Where to Apply: Use a Broker
Expat health insurance plans are offered by insurance companies around the world. They tend to be insurers that also offer travel insurance and standard health plans, but you’ll find the occasional dedicated expat insurance company as well.
I like using insurance brokers to help me find the best rates and policies. With one request, I get a summary of various insurance companies and plans, costs, and general policy specifications. I can read up on the policies that best suit my needs and budget, and ask questions of the broker about the quotes, policy administration, applications, and claims. Their answers are usually unbiased, and can be illuminating since they hold experience working with these insurers and can indicate if some are easier or more difficult to manage.
Considering the insurance world is mired in ambiguity and legalese, and making claims can be hell on wheels, I find that working with an insurance broker who can advocate on your behalf throughout the application and claims process is well worth it.
And it’s free! Buying a policy through a broker doesn’t cost any more than if you go directly to the insurance company, and in fact can sometimes cost less if the broker gets volume discounts.
Prior to (or in addition to) using an insurance broker, you can also check out some insurance comparison sites online to give you a sense of what’s out there. Insurance premiums vary dramatically, so it pays to have a good cross-section of quotes.
Expat Insurance Tips
(check out the glossary of terms below if you don’t understand some of this terminology)
Read the fine print before you buy, as well as after. It might be soul-destroying to sift through 30+ pages of policy legalese, but it pays to know your policy inside and out. You don’t want to discover your policy’s limitations in the throes of a medical emergency.
The higher your deductible, the lower your premiums will be. You can adjust this accordingly in the quotation process to get a policy suited to your needs. If you only plan on using the policy for major medical emergencies and you have a cash buffer, then setting a high deductible makes sense.
The higher the co-insurance/co-pay, the lower your premiums will be. Again you can tweak this during the quotation process to suit your needs and budget.
Excluding USA Coverage reduces premiums. Many policies have an option for worldwide coverage that excludes cover in the USA, and with the exclusion these policies are considerably cheaper (as much as 50% cheaper) than their worldwide counterparts.
If you get a policy like this and plan to visit (or return to) the States, you can simply buy a separate policy for just the dates of travel in the States and it will end up costing you much less than blanket annual coverage.
Pay annually for discounted rates. This concept applies to most types of insurance policies; the more frequent your payments are, the more money you pay. By paying annually you’ll get the best rates. And if you end up canceling the policy, you’ll get retroactively refunded for the portion of the year you didn’t use, so there’s no loss.
Check for direct pay clauses for hospital stays. Most insurance companies will directly pay the hospital for your in-patient expenses so you aren’t out-of-pocket and looking for reimbursement. But it’s worthwhile ensuring that this is the case; the last thing you want is to foot an unexpected hospital bill that could be in the tens of thousands of dollars.
Policy Maintenance and Claims
Always call the insurance company before seeking medical care. Some insurers are so sticky about this that they can actually refuse to cover you if you don’t contact them before seeking medical care. Obviously if you are unconscious or completely unable to pick up the phone, they’ll make an exception, but they expect a call within 72 hours of your being admitted to a hospital, or as soon as is reasonable. You can have somebody call on your behalf if you can’t do it yourself.
Part of the reason for this requirement is because the insurance company might have special arrangements with certain health providers and hospitals (which I’d like to think have been vetted for their standard of care, but alas I may be naively optimistic on this front). Either way, it’s always best to call them first since they hold all the cards when it comes to paying out. They’ll create a file for you, make arrangements to pay the hospital directly, and enhance the chance of your claim going through without complications.
Keep copies of your insurance info everywhere. You can’t have it in too many places, as far as I’m concerned. I have a card in my wallet, the policy info and documentation on my computer (which gets backed up), a copy on my hidden USB stick, and full policy documentation with a family member back home. (If you travel with a partner, they should have your policy information as well).
As a worst-case scenario, if I’m lying on a hospital bed and have one phone call to make with five minutes of consciousness to enjoy, I can call my Mum (who is my designated representative) and ask her to do the leg-work with the insurance company for me. Otherwise, regardless of the accident or illness that hits me, I’ll have multiple copies of policy information and claims phone number just in case my wallet is stolen or I lose the information in one spot.
Glossary of Terms
Here are some practical explanations of the terms you’ll universally find in the expat and travel insurance realm:
The money (benefit) that’s paid to you in the event of a claim.
Somebody who receives money (usually the person receiving a life insurance payout if you die).
You “have a claim” or are “filing a claim” if you are applying to the insurance company to for a payout (benefit) in the event of receiving medical care that’s covered under the policy.
Co-paying is having to pay a percentage of the medical expense yourself (not to be confused with a deductible, below). It’s usually 10-20% of the total cost, up to a limit.
For example: You incur $1,000 in medical expenses. If the co-pay/co-insurance amount is 10%, you pay $100, and the insurance company pays the remaining $900.
Before the insurance company covers anything (even on a co-insurance basis), they can require that you pay a deductible, which means you pay for the first portion of expenses.
For example: You incur $1,000 in medical expenses, and have a $250 deductible. You’ll pay the $250 deductible, then the remaining $750 is shared between you and the insurance company dependent on your co-insurance deal (ie: you co-pay 10%, which is $75).
Watch out for the fine print about deductibles; some are per policy year, and some are per claim or medical provider. If you have multiple claims (which is possible on a more comprehensive policy that covers regular doctor/physio/chiropractor/etc visits), then you could end up paying a deductible many times over before qualifying for any reimbursement.
Emergency Medical Evacuation
If medical care is unavailable or inappropriate, an emergency medical evacuation benefit will cover the cost to get you to a place where you can receive the treatment you need, or even back home if it’s deemed reasonable by the insurance company. This can be horrifically expensive once you’re looking at things like medical helicopters, so you usually see large benefit amounts allotted for this clause.
Policy exclusions are things that aren’t covered. They can either be pre-existing conditions (see below), or injuries as a result of certain activities you participate in (like skydiving or scuba diving), or claims resulting from being in war-torn or politically unstable regions.
Inpatient vs. Outpatient
An inpatient is somebody who has been assigned a hospital bed, even if it’s only for a day visit. Outpatients are everybody else. Some basic emergency medical policies only cover for inpatient expenses, which can be quite exclusive, so watch out.
If the application process involves a medical questionnaire, they’re looking for pre-existing conditions, and if you have one, they’ll often refuse to cover you for future related incidents. I had exercise-induced asthma for a short time when I was 16 years old, and now – almost 20 years later – I have an exclusion on any claims that may arise related to asthma. Go figure.
Even if the policy doesn’t have a medical questionnaire, a pre-existing condition is something that you knew about or had symptoms of prior to your application. And some policies exclude all pre-existing conditions for the first 2 years. So if you make a claim for a heart attack within 6 months of getting a policy, and the insurance company finds out that you saw a doctor 3 months before applying for the policy with complaints of chest pain, it’s a pre-existing condition and you might not be covered.
The money you pay the insurance company for coverage.
Sending your body back home to your family if you die abroad.
Does this answer your questions about travel medical insurance / expat insurance for long-term/full-time travelers? Are there any travelers out there who would like to weigh in with their own experiences or advice? Let ‘er rip in the comments!