Anna's Blog

A Complete Guide to Health Insurance for Digital Nomads

22 comments

(See my disclaimer before reading)

When you live in your home country, you have traditional health insurance. When you travel abroad for a few weeks or a few months, you get travel insurance. If you move to another country, you get health insurance in that country.

But what if you’re a digital nomad, and you can’t commit to being in any one country for very long at all? When I left the US last year, I wondered this very thing, and found very few answers when searching online.

In this post, I’ll let you know what kind of health insurance I use and why you should consider it if you’re going abroad to a yet-to-be-determined place for a yet-to-be determined amount of time.

Why You Should Not Rely on Travel Insurance

Philippines Puerto Galera Beach

Do you really need to worry about health insurance when life is this good? Yes. Yes you do.

Travel insurance is not designed to be a primary health care option. It is a supplement to cover the things you do while traveling that you probably don’t do in your normal life. It usually also includes basic coverage abroad, but nothing more.

Travel insurance is therefore not a good option for digital nomads and other long-term travelers. Expat health insurance is that beautiful middle ground between traditional location-based health insurance and travel insurance. It essentially gives you the ability to have the same quality of health insurance as traditional insurance no matter what country you’re in.

Pretty cool, right?

The insurance I currently have is called Integra Global, based in the UK. For 6 months of international insurance, I pay around $500 USD. This is pretty comparable to insurance in the US. Maybe even better. But there is one tiny drawback that helps me illustrate why American health care is indeed a clusterfuck: If you want your international health care from Integra Global to include coverage in the US, the price doubles.

Yes, let me reiterate that so that you can really see how completely absurd this is: Your international health care covers every single country in the world except for one: the US. To include the US, your health care for 6 months goes from about $500 to about $1000.

This is because health care costs in the US are totally and utterly outrageous. Integra Global is not capitalizing on my need to be insured in the US. They are simply covering the high cost of American health care.

American Health Care – A Complete Disaster

American flag

The land of the free– and expensive health care.

A quick note to any Americans (if they exist) who actually think that health care in the US isn’t totally fucked. If you’ve never left the US, had health insurance in another country, or had to look into other kinds of health insurance abroad, you might not realize this.

But as soon as you look into it, the realization will slowly land on you like the pile of crap that it is. (Sorry for that visual.) The biggest disadvantage of American health care is that it is private, usually obtained through your current employer.

In virtually every developed country, your health insurance is built into your citizenship, not your job. This allows you to keep your primary health insurance without paying for it every month as long as you retain the right to do so (as in, you don’t forfeit your citizenship or stop paying your taxes, of course varying from country to country).

Even now with Obama Care offering coverage not attached to your job, it is still through private companies, and you still must pay a premium each month. When people from the UK or Germany or Canada travel abroad, even for several months as a lot of gap-year travelers do, they are able to easily retain their coverage at home so that, if worse came to worst, they could fly home and receive extensive care there.

This is what happened to a friend of mine, who damaged his spine while abroad and required extensive physical therapy. He’s from the UK, so he went home and received top-notch care in the comfort of his home country and didn’t break the bank as a result.

Your Health Care Options Abroad

Philippines health care

Can’t say I recommend some of the healthcare in rural Philippines. Yes, that’s blood on the floor. NOT all health insurance abroad is like this, I promise!

Here are your health insurance options if you’re going abroad:

Option 1: Keep your insurance at home as your primary insurance and get travel insurance to cover the extra stuff short term.

If you’re American, this is what you’ll do to take a traditional-style vacation, the kind that lasts a few weeks tops. If you’re not American, you can do this as long term as you’d like, as long as your country allows you to go abroad and still retain your health care coverage at home.

Option 2: (Not recommended) Forfeit your insurance at home and get travel insurance.

For Americans, this is because they are leaving more than a couple of months and don’t want to pay 2 premiums each month. Some Americans probably do this not realizing that travel insurance is not particularly comprehensive. Or maybe they realize it and they are taking their chances, because US healthcare gives you little other choice.

For people from countries besides the US, this is because they have been abroad long enough to no longer qualify for their country’s universal health care or have given up their citizenship or something. They likely also don’t realize the limitations of travel health insurance.

Option 3: (Recommended) Forfeit your health care back home (if you’re American) and get international health care through Integra Global.

Listen. This is what you should do. If you’re American and you are quitting your job to travel, you should get international health care through Integra Global and, if at all possible, get the option that excludes American coverage.

If you are traveling for a few months and are not required to quit your job, and your employer agrees to still allow you on your company insurance plan while you’re away, let me know where you work because I want to work there.

But that’s not very likely in my experience. Even if you are from another country and have health insurance back home, I still recommend getting international health insurance to allow you to be treated affordably in the case of a health problem while you are abroad.

Are There Other Options for International Health Insurance?

Yes, but they suck. There are a lot of US companies that try to offer international health care plans. But they are consistently unaffordable and offer fewer benefits. Just for fun, I applied for a quote for one of these US health plans offered by Aetna.

The quote was for a minimum of 1 year coverage, and I was quoted $2000. This is comparable to the plan from Integra Global that includes the American option. But with Integra Global, I have two great options which I took advantage of:

  • A 6-month payment period instead of 1 year (because do digital nomads plan a year ahead of time? Hell no.)
  • The option not to include coverage in the US, which cut my premium in half.

Then I applied to another international health insurance I’d heard of, IMG Global, also known for selling travel insurance. The price for the same level of coverage at IMG that I have now through Integra Global: $1,965 USD Four times as much as I’m paying now.

Another surprise for the uninitiated American: American insurance companies are notorious worldwide for finding loopholes and fine print that mean that you are not eligible for a claim reimbursement in the way you thought.

Again, if you’re American you think this is just normal. If you’re from other countries, you find it really, really messed up. Because it is.

The Digital Nomad Health Care Method Known as “Taking Your Chances”

I also know a lot of digital nomads, particularly American digital nomads, who do not have any insurance at all. The reason for this is that health care in Asia and most other countries tends to be pretty affordable out of pocket.

Another reason is that many Americans are used to not being insured, as a lot of Americans have been uninsured in past decades. Plus, most young people tend to believe they are invincible, and don’t consider the possibility of accidents or a sudden health problem that could necessitate something seriously costly, such as being on life support for weeks or months, needing physical therapy long-term, or needing cancer treatment.

If you’re American, you can’t just fly home to get this treatment if you’re not insured back home. In fact, if you’re not insured in the US, that’s exactly what you shouldn’t do, since it’s the most expensive option internationally by a long haul. Not convinced? Okay then. Here’s another reason you should get insured.

Trapped in the Hospital?

In the US, no one is given the bill when they leave the hospital as if they’re leaving a hotel after a nice stay. Instead, the bill is sent to your house. If you can’t pay, you just get bill collectors herenging you forever. But you don’t get retained at the hospital.

Things don’t work the American way abroad. It’s their country and their (possibly warped) rules. In some countries in Asia, you are stuck at the hospital until you pay. Seriously. They won’t let you leave until you pay your bill.

Eventually they probably will, but either way, this is not a good situation to be in. This happened to a friend of mine in South Korea, and his family ended up raising money for him using crowd funding in order to pay his medical bills and have him released.

Korean medicine cocktail

My Korean medicine cocktail.

I should add that South Korea has extremely reasonable health care fees. But this friend had a very rare, seriously life-threatening condition that required long-term care and life support for a period of time.

Highly unlikely to happen, but it unfortunately does happen. Are you prepared if it happens to you? This is why I highly recommend digital nomads shell out for health insurance, despite the fact that many of us are broke and have never had a health problem in our lives.

Should Digital Nomads Get Traditional Health Insurance in One Country?

Speaking of undesirable practices in other countries, you should almost never get health insurance in the country where you will reside, even if you know you’re going to be staying there for a few months or more. Here are two reasons why this isn’t a good idea.

healthcare-obamacare 1. Because a lot of “insurance companies” are scams.

In many Southeast Asian countries, you cannot trust insurance companies to take care of you in the event that you suffer a health issue, even if the issue should be insured.

Unfortunately, there are a lot of insurance scams here in Southeast Asia: a company that poses as an “insurance company” gladly takes your premiums every month, but when you go to file a claim, you find out that you’ve just been paying some dude every month who has no intention of paying your medical bills.

This is confirmed true by locals in both countries where I’ve spent a lot of time in the last year: The Philippines and Vietnam. For this reason, most people in these countries don’t have health insurance at all. They just pay for medical problems out of pocket when they come about. Not ideal, but better than paying every month for nothing.

2. Because you’ll probably have no idea what’s going on.

Some countries, like the Philippines, have a lot of things in English as well as the country’s official language. Vietnam is not one of those countries. I would never get insurance in Vietnam because all the documentation and policyholder support would be in Vietnamese.

Go Forth (and Be Insured)

I hope you are now convinced of 3 things:

  • American health care practices and rates are seriously messed up, but most Americans have no idea.
  • You should never rely on travel insurance as your sole health care coverage, ideally even for short periods of time.
  • If you’re American (or from somewhere else and will be abroad for a good while), you should get Integra Global health insurance, and stay out of the US so that your rates are lower.

Questions about health care as a digital nomad? I’ll try to answer them. Leave me a question in the comments below for the benefit of other readers and I’ll get back to you. I might even do some research and write a post about it.

Also, let us know if you’ve come across another good international health insurance! I’d love to hear about it.

On a sidenote: it seems that I’m weirdly obsessed with talking about health care. If you’re into it as well, why not check out my articles about my experiences with Obamacare in 3 parts: part 1, part 2, and part 3, or my great experience with South Korean health care.

Disclaimer

I have never filed a claim with Integra Global. It could be a total nightmare, I have no idea. I do know someone who had to file a claim with Integra Global and said it couldn’t have gone smoother. And if you’ve ever filed a claim in the US, you know that it’s not exactly a walk in the park either.

So get Integra Global at your own risk and please check their policy to ensure that your pre-existing condition or extreme sports addiction is covered before signing up and yelling at me later. Got it, Anna! Take me to the top.

Health computer image via Flick user jakerust American flag image via Flickr user goodncrazy

AnnaA Complete Guide to Health Insurance for Digital Nomads
  • Kathrin Peters

    Thanks a lot Anna! That was incredibly helpful!!

    • So glad, Kathrin! Thanks for your comment 🙂 Best of luck to you.

  • David Greis

    I’ve been talking with IG and they don’t seem to offer plans for any time period less than a year. Are you sure that’s what you got with them or has their policy changed?

    • Hey David! Thanks for sharing your experience so others get a heads up. I’m positive I did insurance 6 months at a time, so maybe it’s changed? Also consider that the rules are probably different if your insurance includes the US or excludes the US. But if they have done away with the 6 months plan, then I’d still put the pencil to the paper to determine if it’s not a better deal even still to get the 1 year plan over some other shorter plans. Best of luck! And if you do secure a policy with someone, I’m sure readers (and I) would appreciate if you share your experience here!

  • Dan

    Hi Anna,

    Thanks so much for such a helpful post! Question for you: if I’m an American spending only a month per year in the US, do you still recommend the non-American option? Ideally, I’d love to be more-than-traveler covered wherever I go (including America!).

    Thanks!
    Dan

    • Hey Dan! Glad it was helpful 🙂 It would be a shame to pay double your rate for international insurance for the whole 6 month or 1 year period just to have US insurance for a month. I recommend instead using a short-term insurance like this one: https://www.ehealthinsurance.com/short-term-health-insurance for the month you’re in the US. Even if it overlaps your international coverage, you’ll still be better off.

      • Koen

        Hi Anna, we are a full-time travelling non-American couple but will be spending about 2 months in the USA later on this year. Do you think non-Americans can apply for this short term insurance (www.ehealthinsurance.com) or is it better for us to use IG for the whole year even though we only spend +/- 2 months in the USA?

        • Hi Koen! I’ve used e-health insurance before when there was a gap between my previous American healthcare and Integra Global. The rule of thumb is that you get 90 days of being uninsured in the US without being penalized by the new Obamacare fines: http://obamacarefacts.com/questions/90-day-waiting-period-do-i-need-other-coverage/

          You are allowed to be uninsured by Obamacare standards for up to 90 days. eHealthinsurance is a great way to be insured during this grace period without having to sign up for a cumbersome traditional healthcare plan in the US, OR paying so much for Integra Global insurance while abroad.

          The key is that you must be in the US LESS than 90 days. If it’s more, than you must have a normal insurance plan or you’ll pay the fine.

          AND just because you are free of being fined by not being insured for 90 days in the US, does not mean that you have coverage. You are still living without insurance, meaning that if something were to happen, you would be responsible for any of your medical bills in full. It’s just that you do not pay the fine for being uninsured. Hope that helps!

          • Koen

            Thank you very much for quick reply, Anna! Just one doubt for us, we are not USA citizens and are going to travel around the world for 1-2 years. So we will only be travelling to the US with a tourist visa. From what I can see when I try to apply for e-health insurance is that they need a USA zip code and USA tax return. Do you know of any other way to be insured in the US without having to pay IG with the high additional cost for the whole year for visiting the USA? We also had a look at getting travel insurance for the USA part of our trip but a travel insurance apparently needs to start and end in point A. Since we travel around the world we will probably be travelling to the USA from Latin America and then travel onwards to Asia. A complicated situation, I know 🙂

          • Ahhh ok, sorry I assumed you were an American citizen. Unfortunately I know of no other way to be insured in the US besides travel insurance or international insurance like Integra Global at a higher cost. Yes, it IS a complicated situation being insured while traveling the world! Best of luck to you guys 🙂

  • considerphi

    Thanks Anna, one question. If you were in a country that didn’t have great healthcare services and something went very wrong but you were still able to travel, could you fly to a second non-US country with better healthcare and use Integra global? Like say Canada?

    • Ummm yes, I don’t see why not! When I was living in Vietnam, I always thought about the possibility of flying to Japan or someplace if I needed medical attention. Don’t see how Canada would be any different, but you could call and ask Integra Global just to make sure. Hope that helps 🙂

  • Nathaniel Gustafson

    Hello Anna!
    This is a great post, very informative! Have you had to fill a claim with Integra yet? If so, how difficult was it?
    Thanks!

    • Hey Nathaniel! I’m glad it helped you 🙂 I have never filed a claim with Integra Global, so I can’t speak to that, sorry! Best of luck 🙂

  • AntiGrndhogDay

    Hello Anna, thanks for this informative post! As US Citizens my GF and I plan to spend 7-9 months in the US and 3-5 months abroad in different countries each year as early retirees. When filling out the quote they ask for a “Country of Assignment” but the USA is grayed out. What would you pick?

    • Hi there! I’m sorry, I must have missed this! I didn’t see it until now. What did you end up doing? Also are you US citizens?

  • andresthegiant

    Hi Anna, why did you choose Integra Global? Just curious because I’ve been researching international insurance and the two that keep coming up for me as providing really good coverage or even being considered premium products are offerings by Cigna and Geo Blue. Neither are particularly cheap I don’t think. My quote from Cigna was $217/mo for Central America (they said I could get care in Panama, Nica, or CR). I’m 50 years old FYI. The plan that included the USA was $496, and this included $68 per month for evacuation insurance. The coverage for the US is pretty good/comprehensive but of course there are no restrictions (I don’t believe) for not issuing a policy to you or cancelling you. One other thing is that you talk about not getting private plans within the countries where you will reside. My research (and from actually talking to people) concluded that in fact you can get great private health insurance in some Latin American countries, including Panama, Costa Rica, and Mexico. Both Panama and CR apparently have outstanding coverage and really nice, modern facilities in the bigger cities. But you do need some kind of official residency to get access to private health insurance so more than a tourist visa. I’m just looking into it all now. I’m currently a legal resident of the Netherlands so I have my $150 a month awesome coverage here. But I’m ready to head back to Latin America so I need to figure it out. And I’ve had like 7 knee surgeries so I need to get it right. Perhaps I’ll restart my old travel blog and write about my experiences. People seem interested and more every day. Thanks.

  • Kat

    International health insurance won’t satisfy the minimum essential benefits required by the ACA, right? So if you’re a US citizen, in addition to the $500/6mo for international insurance you would have to pay $600+ per person per year as a penalty on your taxes. I haven’t looked into it, but the US version of the international insurance might not even satisfy the requirements for the ACA, so you would be paying $1000+/6mo for the insurance, and another $600+ for a tax penalty.

    The only way to avoid the penalty is if you are only in the US for a maximum of 35 days per year (or you can demonstrate residency in another country ie you own a house and are paying taxes there, but that’s not something nomads can typically do). And if you’re in the US at all and you got the non-US version, you would have to cross your fingers that you don’t get sick or get in a car accident, right? Because that international insurance without US coverage won’t work in the US and you won’t have any other US coverage.

    • Mostly you’re right, but there’s one other thing: the so-called short coverage gap: https://obamacarefacts.com/obamacare-coverage-gap-exemption/ This means that you actually have about 3 months of a grace period within any calendar year where you can have no coverage and still not get penalized. If you get sick or injured and you’re not covered with insurance, then you still have to pay full price medical bills.

      But there is another way: you can get short-term coverage through other methods, such as ehealthinsurance.com or Integra Global (or other international health insurance). This is exactly the reason why Integra Global will not cover in the US over this time period. What this means is that you are insured so that if you were in an accident, you have insurance. But no, these methods are not ACA compliant. They will only work for less than 90 days per the short coverage gap provision.

      None of this matters if you are outside of the US for more than 330 days a year. In this case, you don’t need ACA compliant coverage and you’re not going to be penalized.

      Hope that helps!

    • Casey

      I believe the tax penalty might technically still be legal but is no longer enforced (since Trump took office), and will very likely no longer be legal/enforced going fwd. I read you could have even filed your 2016 return w/o it already (though personally I did have insurance). Insurance companies might still tell you otherwise right now however (since they need to abide by law as is – “not enforced” does not suffice for them).

  • Daniel Beck

    Hi.
    Integra Global is not very cheap.
    As a couple, we got a price of 4300 per year. They said they would never get down to 1000-2000 per year per person.

    • Hi Daniel! Does your quote include the US? If so, that makes it twice as expensive as I said above. But even at that rate you quoted, that’s only $179 USD per person per month which is incredible in the US. In the US, if you bought insurance outside of an employer, on the healthcare marketplace, and you are not eligible for a subsidy, you would pay around $400 per person per month for decent coverage (non catastrophic coverage). I know this because I’ve been using it for the better part of the last few years.

      Most people just don’t realize how expensive coverage is if they have never paid for it out of pocket outside of an employer before. If the rate you were quoted does not include the US, all I can say is I guess the price has increased since this article was published. If you can confirm with me what countries your quote covers, then I can update the article for those reading it in the future 🙂 Thanks!