UPDATE: DO NOT USE CIGNA GLOBAL HEALTH PLAN - it’s been a disaster.
(Original Blog Post)
Healthcare insurance while sailing internationally can be a bit of a sore subject because now that we have quit our jobs the full impact of the cost of buying our own medical insurance is slapping us across the face. When we were working, our portion was getting taken out of our paycheck, which isn’t a small amount I might add. The issue is first, you don’t see it because it just magically gets deducted but also, you're working so you have regular income coming in. Now that we are on a fixed budget (well, as our self-discipline allows), spending a thousand bucks a month just doesn’t sit well. I mean, for that price you could buy a brand new anchor every month and chuck it off the side.
Some people opt to not have any insurance, get catastrophic coverage, or get full plans.
For the next couple years we will need some kind of coverage in the US because we will be coming back at least 3 months a year. While we are both in good health now, you just never know what will happen and don’t have to worry about pre-existing conditions if something were to arise. We also wanted predictable costs and not be surprised by some insane cost sharing for care we received, especially in an emergency. Years ago we were hit with a $35,000 bill for an emergency airlift because the helicopter that did the transit was one of the two that our insurance didn’t cover. Also, we are in a global pandemic and the estimated costs of a four-week ICU stay in the US is between $500K and $1 million dollars (gulp).
Generally, you can get good healthcare in Europe (which is where we will be in the next couple of years). You can walk off the street with no insurance into an emergency room in France with a broken leg and pay $500USD after MRIs and CAT scans, medication, cast, crutches, and a team of medical experts. Filling a prescription in the EU is like $5 dollars out of pocket with no insurance. So the real cost that drives up these plans is US coverage overall and an option to have outpatient care.
The core plans cover emergencies (you break a leg or have a heart attack), then there are options for urgent transportation and logistics (you need to be flown somewhere), wellness (regular annual visits), dental/eye (that is cheaper to just pay out of pocket), and outpatient care (you get a sinus infection and need to go visit your doctor to get an antibiotic, OR, any follow up visits you have because you had a heart attack). So again, the cost of your plan doubles if you choose the option of outpatient care that you would only really use in the US; even if you are healthy and go to the doctor regularly for mammograms and colonoscopies.
We evaluated three companies that offer international coverage; Cigna Global, GeoBlue and Aetna International Mobile. I detail all the costs and differences in the podcast so listen to that for more detail. The net is to start by looking at Cigna Global to orient yourself. They have a great website and plan configurator then compare everything else to that. We found their plan to be very flexible, you can mix and match the options and coverage levels, choose your deductible and whether or not you want cost sharing and how much. The others were a bit more fixed and harder to contain the costs and understand what the exclusions were.
Speaking of exclusions, did you know if you are hospitalized due to any form of war, riot, protest or act of terrorism you aren’t covered under any plan? Bizarre right? Not sure what piracy is categorized as, I’ll have to ask.
For these plans you have to pick the country you will be in but since we move around, they said to just pick the one you will be at for most of the time, (sic) the cheapest country.
Warning, editorial opinion coming up so avert your eyes if you don’t want to read it, but hey, it is my blog.
Exploring this topic we couldn’t help think about the concept of freedom. We strive for financial freedom to be able to pursue this lifestyle and it’s just crazy that healthcare of all things is one of the biggest hindrances of that. I love our country, but I just don’t understand how many of us resist universal healthcare because we are afraid we will lose the ‘freedom to choose.’ I would take fewer choices in doctors (which we are already restricted on by the way depending on who our carrier is) if it meant more freedom to pursue our dreams. For many of us who travel, we can see a broader, more global perspective and universal healthcare in most developed nations does not mean bad or restrictive healthcare, it means you can get high-quality, affordable healthcare, aspire to be self employed and live a happy life.
