Health insurance as a US resident doing lots of international travel?
January 27, 2017 3:18 PM   Subscribe

I am a US resident planning some extensive international travel ; let's say 6-8 months of the year in Europe and/or Asia. What kind of health insurance should I be looking for, and what are the kinds of questions I should be asking of my potential policy?

My past experience in the US has been entirely with relatively good insurance through a full time employer, so that's the level of policy I'd like to maintain (I realize this will probably be costly to obtain outside of full time employment). I have purchased "travel insurance" that has a health coverage component in the past, but that has always been for short trips (several weeks at most) and honestly I have never fully understood whether that was really useful in the context of also having reasonably good employer-based health insurance. Without that, and with a lot more travel going on, I'm kind of lost in terms of knowing what I should be looking for.
posted by kanuck to Travel & Transportation (9 answers total) 7 users marked this as a favorite
I live in Amsterdam for 3 months a year. I don't do anything special, I just maintain our current coverage. Last year my wife had a root canal and several fillings done in The Netherlands. We paid cash, less than €500. Before the ACA, my wife and I lived for 2 decades without any insurance whatsoever.

These are my datapoints for you.
posted by humboldt32 at 3:54 PM on January 27, 2017 [1 favorite]

No advice on a specific policy, but keep an eye on Affordable Care Act news as you travel. If the health insurance repeal is handled poorly at the Federal level, the individual health insurance market may be drastically altered or ended altogether, affecting people who currently have and/or want to purchase individual health insurance.
posted by cnc at 4:06 PM on January 27, 2017

You want to maintain a local US health insurance policy or be prepared to pay the ACA penalties, because you won't get a non-US resident exclusion (that requires being gone for 330 days in a year). In the current climate, I would also want to maintain US coverage in case when you get back it is very difficult to get new coverage. (You may not be eligible to get new coverage on your return under the current system, depending on whether you are considered to change your residence or not. If you decide to go without US coverage and purchase a policy on your return I would clarify this with the state you will be returning to).

In general, travel insurance covers disaster scenarios in a foreign country better than most US policies would - they will often include repatriation benefits, or even paying for a friend or relative to fly out to join you if you are stuck in hospital in a foreign country. They are also likely to be better capable of handling billing from a hospital in a foreign country. They won't cover any preventative care and I don't think they cover long term care - so if you realized you had cancer while away, you would need a US health insurance policy to cover you once you got back to the US.
posted by the agents of KAOS at 8:39 PM on January 27, 2017

Previously I had posted about insurance to visit the U.S. The same sites offer insurance options to other countries as well. In addition to and, I'd also check out for their policies. Some of these travel medical insurance policies offer renewals up to a year, so those would be viable options to consider for your long trips. I would also try to maintain some coverage in the U.S. because of the reasons others stated above.
posted by thewildgreen at 9:34 PM on January 27, 2017

You want a U.S.-based PPO that treats all overseas claims as in-network. Any HMO plan obviously won't work for you, but many (though not all, and maybe not most) PPO plans at all "levels" of coverage treat overseas claims this way.

The one thing you have to look out for is costs that exceed your "plan allowance" - that is, what your plan has agreed to pay for a certain procedure to in-network providers. If you go to an in-network doctor in the US, the insurance company will already have negotiated a rate with them that falls within the plan allowance and you generally won't need to worry about extra charges on top of your copay/deductible. Overseas, however, this won't be the case, so if your plan says a reasonable cost for an operation is $100 in the U.S., but your European doctor is charging $300, you'll be stuck paying $200 plus whatever copay you would have normally payed under your plan. This doesn't tend to be a problem in most of the world, where fees for procedures are generally less than they are in the U.S., but if you'll be spending a lot of time in western Europe or Japan it might make more of a difference for you.

Although I haven't found a good way to eliminate that risk entirely, the way that you take it into account when choosing your health insurance plan is to ask how they calculate the plan allowance overseas. If their allowance overseas is equal to how much they would pay for treatment in NYC, that's going to be much more generous than if they calculate it as 50% of the plan allowance to medical providers in Podunk, Nebraska.
posted by exutima at 10:37 PM on January 27, 2017 [1 favorite]

Think carefully about your needs and the worst-case scenarios. If it's available, a long-term version of the coverage bought to cover a couple week's of tourism is likely to be appropriate.

Health care systems differ from country to country. A solution that works in the country you're in this month may not work in next month's country.

If your U.S. insurer provides *any* overseas coverage, it should be able to detail that for you in a phone call and also provide documentation. (Which you want.)

If your American insurer does provide some international coverage, you will still be dependent on a foreign provider's willingness and/or ability to file claims or provide you with the info to file your own claims. (The latter depends on you being physically able to prepare and file the claims.)

The flip side of of this is getting the provider to cooperate with the claims process required by your American insurer. Ask yourself if it is reasonable to expect providers in whatever country you're in to know how to file claims to an American insurer. Assuming that's permissible/legal.

Your primary concern should be the cost of dealing with expensive care you cannot pay for out of pocket. One obvious example: Needing medivac back to the U.S. This is tremendously expensive. Think tens of thousands of dollars.

Another example: Emergency, triage, care may be provided by the local providers without reference to your ability to pay, but any subsequent care will require convincing the provider they will be paid. E.g., an injury could force you into long-term rehabilitation, or medivac to the U.S.

You don't want payouts to be on a reimbursement basis. I.e., you want your insurer to pay claims directly to the provider. You do not want the insurer to reimburse you after you pay the claims.
posted by justcorbly at 6:12 AM on January 28, 2017

Maybet GeoBlue? (I don't have personal experience with them, but sounds like a possibility.) You might also talk to an insurance agent. Especially one who has American clients in a similar situation.
posted by mono blanco at 6:48 AM on January 28, 2017

If you plan to be self-employed or self-insured (not on a group plan through your employer or future employer) when you return you have different things to think about. Currently, you can not be denied insurance for a pre-existing condition. However, if the the ACA gets yanked there is a very good probability that in the future you can be denied for almost anything (if you've never shopped for individual insurance before the ACA this includes things like acne, not just "serious" things like heart attacks or cancer).

The changes I've seen thrown around the past week include the ability to deny insurance based on pre-existing conditions if you've had a lapse in coverage. This is tricky, because back when I left my group plan to travel around the world for more than a year I tried to buy a policy that covered me in places like Asia and the US, as well as was considered continuation of coverage. Nothing existed that was for sale back then. Specifically, the insurance needed to qualify/provide a certificate of continuation of coverage. This is how I came back from traveling and found myself unable to buy insurance again until the ACA went through—I had a gap in coverage because I left the US too long.

Now, if you come home and go back on a group plan and/or the ACA is not gutted this won't be an issue. Well, the group plan could potentially deny you coverage on any pre-existing conditions for a period like 1 year or something. This is not something you can necessarily look for, but I wanted to put it out there that it is a potential issue to be aware of even if you can't do anything about it.
posted by Bunglegirl at 11:41 PM on January 29, 2017 is often recommended on relevent sub-Reddits. I've no personal experience.
posted by DarlingBri at 8:56 AM on February 1, 2017

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