One of the most daunting aspects of relocating abroad is the uncertainty around managing health needs. Many countries have quality healthcare at much more affordable rates than the US. But navigating a foreign, often bureaucratic, healthcare system, can pose significant challenges. Without good plan in place to manage the most fundamental of questions — how can I ensure that my family and I are safe? — it can be extremely difficult to find peace of mind.
How can I take care of the day-to-day medical and emergency care needs of me and my family?
Exactly how to approach the medical coverage question will be somewhat dependent on your situation. The medical needs of a twenty-something digital nomad and a retiree in his/her 60’s will be quite different. However, in general, you’ll need to consider three things:
Do you have insurance that covers you in the country you’ll be moving?
What is your plan to get your primary care needs addressed?
What is your plan in case you need emergency care?
Many countries allow access to national health care plans once you become a resident. In some instances, you will be obliged to pay into the national health care system. That said, relying only on national insurance schemes has limitations.
Depending on your needs, and the quality of the national healthcare system, it will likely be to your benefit to blend national health care coverage with some type of international insurance coverage. Besides providing peace of mind, international insurance can: give you access to a wider range of doctors, facilitate better access to those doctors and emergent health-care services, and sometimes provide more comprehensive coverage (for things like vision, dental, emergency flights, repatriation, etc). The downside to international plans is, of course, cost, although that can be managed by choosing a plan well-tailored to your needs.
In terms of which insurance products could meet your needs, this will depend on your age and medical situation. For those approaching retirement or already retired, Medicare needs to be factored into the equation. Medicare will not cover medical expenses outside of the U.S. and U.S. territories, but it is generally recommended to keep Medicare Part A (“hospital”) coverage if you qualified for the premium-free coverage. Because it’s free, there is very little downside to keeping it to cover any hospital trips when you visit the States. If you plan to eventually move back to the States, it could make sense to maintain Part B (“medical insurance”) coverage, although it will require you to pay monthly premiums. This can be quite expensive, so if you don’t plan to visit the U.S. frequently, and don’t intend to move back to the U.S. at any point, it could make sense to discontinue your Part B coverage. Keep in mind that if you do move back to the U.S., you will have to wait until the General Enrollment Period, which extends from January 1 through March 31st, with coverage starting July 1. Alongside national insurance schemes and Medicare, Cigna provides solid and flexible plans for those approaching retirement or who are already there,
For younger expats, there are a host of solid international insurance options. For digital nomads or those moving frequently across countries, Tin Leg is a good international insurance option at an affordable rate. Cigna and IMG also offer good plans for this demographic.
Primary care needs
Beyond questions about insurance, you’ll want to make sure you have a good understanding of how to meet your day-to-day medical needs in the specific geography you’re moving to. This includes access to the facilities with the right kinds of treatment options to meet your pre-existing conditions and anticipated issues, as well as access to the medications you’ll need. You should list out these needs for you and any loved one that will be making the move with you before you choose where you’re relocating to. Map out the healthcare facilities in the area, what treatments they offer, which medications are accessible, and what insurances they accept, to make sure that all of your needs are covered.
If you anticipate having regular medical questions or needs, it could also benefit you to engage a local, vetted primary care physician on a concierge basis. Doctors offering concierge services generally charge an up-front fee, and then are available to you, in-person or on-call, as your needs dictate. This option will give you someone to call in any event, and also allow for very easy planning for regular check-ups. If you select a physician based in the region or town you are relocating to, he/she could also work with you to develop your specific day-to-day and emergency care plans.
What matters most in addressing your emergent care needs is having a very clear plan in place before anything happens. Hopefully, you will never need to use the plan, but just like insurance, it is much better to have it and never have to use it.
Your emergency care plan should include: knowing who to call, knowing where to go, knowing where you’ll have access, and knowing if you can and/or should be evacuated to the US. I recommend having all of the phone numbers you will need saved in your phones, as well as having a printed sheet somewhere very visible in your house, like hanging on your refrigerator. The numbers should include your local primary care physician, the local equivalent of 911 (if applicable), your insurance provider, and the nearest quality hospital.
You also want to have a very clear idea of how to get to that hospital if you need to. Depending on where you’re located, ambulance services could take longer to get to you than it will take you to get to the hospital. Everyone in your household should know the route to the hospital. Make sure you understand how to navigate the hospital system, and leverage your international health insurance, to get improved access to the critical services you need.
Last, if you’ve chosen a premium insurance option that covers medical evacuations to the States, you may need to plan to be evacuated to the US. If you do have evacuation coverage, once you or your loved one is stabilized at the local hospital, call the evacuation-flight provider to make plans to get back to the US. They should help you coordinate flight purchase, hospital reception, and hospital care back in the US.
Recommendation: Work with a specialist to craft a plan.
Making sure the health care needs of you and your loved ones can be incredibly daunting. You should absolutely develop a plan to meet day-to-day and and potential emergency care needs. But remember, you don’t have to go it alone. You can engage insurance providers to help find the right plan for you. To take even more of the burden off of your plate, holistic, concierge-services like StartAbroad can help provide peace of mind by connecting you with a local, vetted primary care physician, and working with him/her to craft day-to-day and emergency care plans for you and your loved ones so you don’t have to.
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