Medical Care on the Road: Challenges of Nomad Life

Toy medical professionals

Last Updated on: 1st August 2021, 03:30 am

One of the biggest concerns people contemplating long-term travel have is handling medical care on the road. I am not going to sugarcoat it: it can be a challenge. And if the pandemic has taught us anything, it is that no matter how well-laid your plans are, something will come along to mess them up.

After more than three years on the road, Steve and I have had several medical-related experiences. All were positive except one. In this post, I will share those experiences with you so you can get a feel for the types of medical issues that may arise when you travel.

Medical Insurance Options

There are so many things to consider when choosing how to insure yourself and your family when you travel long-term. Do you keep your U.S. plan? Buy a travel insurance policy? Can you afford to self-insure?

These issues are beyond the scope of this post. If you want to dig deeper into medical insurance options on the road, I recommend starting with two articles by Nora Dunn, The Professional Hobo:

The Complete and Easy Guide to Insurance for Travelers

Expat Health Insurance: Travel Insurance for Full-Time and Long-Term Travelers.

U.S. Based Medical Insurance
Our  Medical Insurance Experiences

Steve and I both retired when we were 60. Since we were too young for Medicare and didn’t know how the whole world travel thing would go, we needed to have a solid U.S. medical insurance policy. We opted to stay with the plans we had through our employers.

In each case, we paid premiums through COBRA for the first 18 months after retirement. The combined monthly cost for COBRA was $1,500. If you do the math, you can see that it cost us a very scary $27,000 for the 18 months we were both on COBRA. I checked alternatives, but anything else would cost at least that much, even the Affordable Care Act (ACA), since you aren’t eligible for a subsidy if you have a viable insurance option available to you.

ACA Saves the Day

The good news is that once Steve’s COBRA period ended in July 2018, we were able to sign him up for insurance through ACA. This worked out great because we were living off savings, so we did not have taxable income. For the past three years, one or both of us have been insured through ACA.

I am currently the only one on ACA, and I pay $26 per month. We paid $65 per month in 2020 for coverage for both of us. The best part was that we got the most generous policy either of us has ever had. That’s saying something since both of our work policies were very good. The new policy is a PPO worth about $1,000 per month.

Disclaimer: everyone’s situation is different, and it is important to understand how ACA works. We happened to luck out with a great set of circumstances when our COBRA periods ended.

Happy Results

We have U.S. medical insurance policies in case we return to the U.S. to live or get medical care, but were pleased to find that our policies paid for a large part of coverage outside of the U.S.

The first time was when I had to visit a doctor in Quito, Ecuador. The total bill was $80. I was still on my PPO through COBRA, so I submitted a claim online. Insurance paid all but the $20 copay.

When Steve had his skiing accident in January of 2020, he was on a PPO through ACA. We decided to submit a claim but didn’t expect much. We were thrilled when they paid $1,800 of our $2,100 costs.

Since that time, we submitted all our medical bills and were reimbursed for most of them.

Travel Medical Insurance
The Choice to Self-Insure

We chose not to purchase travel medical insurance because everything we have read says how cheap medical care is outside the U.S., and we have savings to cover potential costs. And as discussed above, most of our costs have been reimbursed by our U.S. PPOs.

Then Steve turned 65 in January, meaning he was now eligible for Medicare. It also means he is no longer eligible for ACA. Since the basic medicare policy does not cover care outside of the U.S., and he needed proof of insurance to get a residence permit in Hungary, he signed up for Nomad Insurance through SafetyWing. It costs him $138 every four weeks.

One of the cool things about SafetyWing is that you can start and stop it in 4-week intervals. I cannot comment on how good the coverage is since we thankfully haven’t used it yet.

If you don’t have enough savings to cover an unexpected bill that could run into thousands of dollars, you should definitely get travel medical insurance.

The One Insurance We Won’t Be Without

One insurance we always have is evacuation insurance. We felt this was particularly important since we started our travels on a transatlantic cruise. As high as the amount of our COBRA coverage was, it pales compared to the cost of a medical evacuation.

According to this Forbes Advisor article, “The average emergency medical evacuation costs can set you back $25,000 within North America and up to $100,000 from Europe, according to estimates by Travelex Insurance. In more remote locations, a medical evacuation can cost as much as $250,000”. You can find out more here.

This article from USA Today also discusses evacuation costs.

We have used MedJet for our evacuation insurance since 2018. Medjet is available to citizens of the U.S., Canada, and Mexico. It is not medical insurance. It will not cover the cost of seeing a doctor or being hospitalized. Medjet Assist will arrange medical transportation to a hospital in your home country if you are hospitalized while traveling. It will also repatriate your remains should you die while traveling. The Medjet Horizon policy adds crisis response services for a variety of situations.

The price is based on age and the length of coverage. We are in our 60s and get coverage for the entire year. With the $100 discount for AARP members, it costs us $1,100 per year, a great deal since AARP membership for two is only $16 per year.

Beware that while Medjet provides a layer of comfort, it may not be available when you want it. In the early part of the pandemic, Medjet informed their policyholders that they would not be able to evacuate you for any reason because of travel restrictions. Eventually, they were able to resume some transports, including Covid related ones, in some parts of the world. They recently announced as of July 12, 2021, they will transport COVID patients globally.

Prescription Medicine
Our Original Plan

Before we left the U.S., we discussed our plans with our doctors, and they gave us prescriptions for a year. We filled each prescription for the first three months. For our inexpensive medications, we filled the rest of the prescriptions by finding the best prices using GoodRx and paying out-of-pocket.

Steve and I each take a few medications that are too expensive to pay for out-of-pocket in the U.S., so we left with only three month’s worth of these medicines, knowing we would have to refill them while traveling (which is discussed below).

We enlisted our daughter Stephanie’s help in filling our prescriptions for the expensive medicines. We order refills online every quarter, and Stephanie picks them up. The plan was that we would restock for the year on our annual return to the U.S., then we would repeat the cycle.

The plan was foolproof until it wasn’t. Because of the pandemic, we decided not to return to the U.S. in December 2020. That meant we couldn’t pick up the medicine Stephanie had saved for us or see our doctors for refills. That meant we now had to refill all our prescriptions in whichever place we find ourselves.

Traveling With Medication

Since we travel with hundreds of prescription pills, we follow these procedures:

Each of us has a letter from our doctor listing the medications we take, why we take them, and how long we plan to be away.

We also keep about a week’s worth of medication, the doctor’s letters, and copies of our prescriptions in our carry-ons and packed the rest in our checked luggage.

The medicine in our check luggage is kept in the pharmacy-issued bottles, although we do combine bottles to save space.

So far (knock wood), we have not had any issues bringing our medications into other counties.

Your Medicine Will (Probably) Be Cheaper Outside the U.S.

Our first experience with buying medicine overseas was in Croatia. Steve was about to run out of a few medications. He found out that he would need prescriptions for them, so he found an English-speaking doctor to write them. The cost of the doctor’s visit was only $15. The cost of the medicine was $212. The cheapest it could be purchased out-of-pocket in Jacksonville at that time was $1,832.

One month later, I noticed that I was about to run out of one medication. By now, we were in Bucharest, Romania. I was kicking myself for not having taken care of it when Steve did his. But all’s well that ends well. I stopped at a pharmacy to check that if I would need a prescription. The pharmacist said I didn’t. She asked how many boxes I wanted and handed them to me. The cost was $45 per box, compared to the lowest price in Jacksonville of $422 per box.

If you take away one piece of information from this post, it should be this: every country has different rules about which medications require a prescription. Before you visit a doctor, stop by a pharmacy and ask if you need a prescription for your specific medicine or check online.

Every time we have purchased medicine while traveling, it has been in boxed blister packs. The pro is that you can walk into a pharmacy, and as long as they have what you need (they usually do), you walk out a few minutes later all set. No waiting for the bottles to be filled. The downside is that you have to take each pill out of the blister packs.

But Your Medicine May Not Be Available

I found out the hard way that not all medicines are available in every country. I ran out of the thyroid medicine liothyronine in Ecuador. Since it wasn’t available in Ecuador, I arranged to have my daughter mail some to me. I never received it. Fortunately, it is something I can do without.

Liothyronine is also not available in Hungary. My doctor in Budapest explained why: liothyronine is a booster for Levothyroxine, so only a small percent of Levothyroxine users need it. There are not enough potential customers in Hungary to make it available.

So, two words to the wise:

If you have a medication you can’t live without, make sure you have enough with you or that it is available where you are going.

Do not count on getting it via mail. It may work, but in my case, it didn’t, and it was a costly experience both time-wise and money-wise.

OTC Medicines

You can’t walk into a store like Target or Costco and walk out with a year’s worth of pain relievers for $5. For one thing, some medicines that are OTC in the U.S. require a prescription in some countries. Secondly, if a medication is sold OTC, it will usually be in a box of 10 or 20 tablets and cost much more per tablet than we are used to paying.

And some aren’t available. In Budapest, I couldn’t buy diphenhydramine hydrochloride (anti-itch) medication (crème or pills). My doctor suggested another OTC medicine, and it seems fine, but once I get back to the U.S., I will be replenishing my diphenhydramine hydrochloride supply.

Our Experiences With Doctors

The second time we visited a doctor was in our second year of travel. We arrived in Quito, Ecuador, from the Galapagos Islands. Soon after we arrived, we both started feeling lethargic and slightly nauseous. At first, we feared altitude sickness because the Galapagos Islands are at sea level, and Quito is at an elevation of 9,350 feet (2,850 meters). Digestive issues followed a few days later. After a bit, Steve felt better, but my symptoms lingered long enough that I decided to see a doctor.

The visit couldn’t have been smoother. I found the name of an English-speaking doctor on my insurance company’s website. When I called, the receptionist put the doctor on the line. I explained what was going on, and he said to come right in.

I saw the doctor, and he ordered some tests, which were done right away in the same building. After a few hours wait, I got the results. Total cost: $80.

Before we traveled to Budapest in March of 2020, I ran across a blog that recommended FirstMed for English-speaking travelers. I made a note of it just in case, and I am glad I did. We have been in Budapest for sixteen months now because of the pandemic and have used the FirstMed services many times.

At first, we only visited to get prescriptions, and the out-of-pocket cost was reasonable. When it became evident that we would be here a while, we signed up for the Premium Plan. It cost $1,200 for the two of us ($689 for an individual). The plan covers a lot, including up to 28 doctor visits, annual checkups, and diagnostics. Learn about the plans they offer.

I was blown away by their efficiency when I had my annual physical (included in the Premium Plan). It started with a visit with my primary doctor, then a mammogram including ultrasound, an ECG, bloodwork, and two vaccines. All in 1 ½ hours and all in the same building.

Our Hospital Experiences

We have had two experiences with hospitals; one bad and one good.

The bad one was very bad. That was Steve’s nightmarish experience in Bulgaria after his skiing accident. He was in a small hospital in the small town of Razlog. But in speaking with others in Bulgaria, I believe that medical care isn’t very good anywhere in the country, even in the capital.

Our second experience with a foreign hospital was in Budapest when I had an e-scooter accident. That was much more in line with the type of facility and treatment we are used to.

The quality of medical care won’t stop me from visiting it a location, but it may limit what I choose to do there. For example, now that I know that medical care is not so good in Bulgaria, I wouldn’t choose to ski there.

Here are two articles that rank healthcare by country:

Best Healthcare In The World 2021

Healthcare Index by Country 2021 Mid-Year

I hope this post has provided you with some useful information about the medical care challenges long-term and full-time travelers face. I am not an expert, and everything I have written is anecdotal; however, if you have any questions, Steve and I would be glad to answer them to the best of our abilities.

As always, Steve and I would love to hear about your medical care experiences while traveling.

Safe and happy traveling,
Linda

Feature photo by Daniele D’Andreti on Unsplash.com

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