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
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
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
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.
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.
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.
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.