“What do you do for health insurance, now that you’re a nomad?”
Health care is a hot topic question, no matter what your situation is these days. When I was in corporate, it was slightly easier, though the contribution costs kept going up. Launching my own business added a new adventure, and I discovered lots of the ups and downs of the ACA (also known as “Obamacare”). I accessed my ACA health insurance through the NY State program because that’s where I owned a home.
The adventure is in the challenge. As someone says, the insurance challenge is “it’s own level of hell”! Insurance isn’t the pretty nor exciting side of living on the road. To be honest, doing anything related to insurance makes my stomach hurt with fears. I’ve put off researching this aspect as long as possible because I’m afraid of – well, several things. Of looking foolish because I don’t understand the terms. Of getting it “wrong” and buying the wrong level of coverage that shows up later costing me an “arm and a leg.” Of losing hours talking to round after round of insurance agents and getting no-where fast, I have a fear of dealing with ineptitude. I know I’m not the only one who feels this way! The number of people living the wandering lifestyle is growing, and finding ways to be insured is getting easier. Looks like it’s time to dive deep into what’s next for health coverage!
Age issues
On the podcast I listened to (The RV Entrepreneur), one question the podcaster often asked was what the interviewee did for health insurance. My ears always perked at this question. Turns out, the podcaster and his wife were under 26 and able to still be on their parents’ insurance! Not an option for me. Others older than me are able to go on Medicare, which is basically a nationwide option. Again, not (yet) an option for me. What I’ve come to discover is that my age range is now described as “pre-Medicare”.
Two options I learned about are for younger people. One is called health-share programs, or rather “catastrophic health insurance.” While this used to be more broadly available, recent changes by the current administration now mean it’s available to those who are under 30 years old (and it’s very bare bones!). Another health-share type program is run by Christian Healthcare Ministries (and they do ask you to give them a statement you follow Christian beliefs). While not as directly meant for the young, if you have any kind of chronic condition – this is not for you. It’s meant more for one-time events (like a kid falling off a bike and breaking an arm, not diabetes management).
Location issues
Another thing I’ve discovered is that companies do not like people in America to not have an address. They all want you to be rooted in a spot. Many insurance options, like HMOs, PPOs and others like that have limited geographic areas for “in-network” care. There are some nationwide PPOs, but they are getting more and more rare. I’ve heard of one out of Florida that is supposed to be “full-time traveler” friendly. Florida is one of three states that are good for nomads to use as their “domicile residence” (South Dakota and Texas being the other two).
Other options
The market seems to be expanding with options. Now that the ACA mandate ended for 2019, more Non-ACA Compliant choices are becoming popular. One is a “fixed benefit indemnity insurance”, another is short-term medical (which now can be renewed yearly instead of the prior requirement of every three months) and the one I will be watching is called “Association Health Plans” which is becoming a better opportunity for entrepreneurs.
Many in this nomadic community are vested in natural, non-traditional (meaning western) healthcare options, the kind not often covered by traditional insurance. Some suggest popping over to Mexico for inexpensive medical and dental work. The digital world is also offering ease for reaching doctors within insurance networks. I like the options of “TeleDoc” or the app “Dr. on Demand.”
There are so many options, it can be overwhelming. I did discover that there are health care brokers out there who specialize in the full-time traveler audience. I have enough experience with trying to pick a good plan on my own (and not always having success), that it’s time for this adventurer to do things differently! I plan on reading more about my options, so I am familiar with what some of these names mean, and then finding a broker to help me. Adventure challenges don’t have to be done alone – right?
So what am I going to do for health insurance? I am going to get over my fears, research a little more, and make the call to a broker! With this nuts-and-bolts information, maybe you’ll be inspired to take a mundane, icky task that can make your stomach tie up in knots and turn it into an adventure challenge too!
Health Insurance Resources:
https://www.escapees.com/affordable-healthcare-options/
https://www.rv-dreams.com/FMCA-Health-Plan.html
https://www.rverinsurance.com/wp-content/uploads/2018/12/FixedBenefitUHOne.pdf
http://www.gonewiththewynns.com/mexico-medical
https://thedogisdriving.com/healthcare-2019/
https://www.entrepreneur.com/article/318814
http://www.rverinsurance.com/health-insurance-guide/
More nomad insights
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Fabulous timely topic Stacey! Keep the fabulous information coming as you journey through healthcare for nomads! Very timely for a broad audience! ??
Thanks Beth! It looks like it will be a mish mash of programs and lots of preventative wellness habits, and ever-changing with whatever happens with the regulators!
A good scenario to work through is what happens when you have a bad health emergency on the road? This can range to you some minor injury, car accident, to something really serious, or maintenance of a chronic condition. Sooner or later..
Things to consider are if your insurance is portable between states. A few plans now seem to fit that bill, but seem to be very expensive. Other, perhaps more affordable plans can be very State, city and facility specific.
Urgent Care now seems a more affordable option than ER for day to day health problems. ER is really meant for extreme events, and the care you get there will be oriented to that, and you can quickly run up quite a bill, whereas often UC is just a copay, and I’ve been finding things like XRays done in house are actually pretty reasonable. Have used them a few times now on the road and foudn the care good and the cost quite reasonable.
Wherever facility you choose, check with your insurance company first that it is in-network. Most insurance companies have tools for determining this on their websites or apps. Even if your insurance company says a facility in in-network, ask aggressively before committing (if you have that luxury), or have someone advocate for your billing, if are too sick. You are certain to encounter facilities that claim in-network coverage, but in reality are made up of out-of-network contract providers – which can leave you with a huge and unexpected bill. You thought you were covered but because the ER doc at 4am is a contractor, your insurance will not pay, or at some inflated rate.
A typical scenario on the road is that you have a health emergency in the boonies, and are far away from care of any sort. Small towns often have little to nothing available. Your options are to travel to a city or be evacuated. Of course the first is preferable if you can. The latter – you can easily be looking at astronomiacal air ambulance bill, say 50k or more. Air ambulance emergency evacuation insurance is something you might want to consider when evaluating insurance, but it is costly.
For older people on a strict budget, all this is very difficult, and a single big health event on the road can ruin you financially. Many you encounter will have very limited or no insurance whatsoever and just are winging it hoping for the best. No easy answers. If you can afford road worthy insurance at mid-life you are one of a lucky few.
If you anticipate needing care, use your phone to locate nearby Urgent Care and ID those that take your insurance. UC also take cash and it seems at a much reduced and more realistic rate as it keeps their costs down. Cash is probably even preferable to them! Let them know you are a cash customer up front and ask for a cost estimate, and that you need to minimize charges.
Excellent thoughts Harlow! Reminds me of what my kids went through…lol. The insurance I have now will be changing. But I will keep all your advice in mind!
Yes, to all this. Much of which I anticipate multiple patchwork of programs because I don’t think any one thing will be exactly what I need. We’ve bought the emergency travel insurance for airlifts (out of the desert, for example) and I’ve read I can get this type thing as a year-round extra coverage.
Interestingly I just went through this in North Carolina. Good topic Stacey – more on this! Enjoying your great blog too!