I’m a Nomad: Here’s My Experience With Global Expat Health Insurance

(Note: I am American. This blog is geared towards Americans. If you’re of a nationality that doesn’t have this crazy problem, feel free to skip this one, or, read on and prepare to gasp in horror at the abysmal cost and complexity of U.S. healthcare.)

Health insurance! 

With the astronomical cost of healthcare in the U.S, I’ve heard from a lot of Americans that losing company-sponsored health insurance is one of the main concerns they have when it comes to quitting their job before they’re of retirement age — and that was once one of my main concerns, too.

The company I used to work for paid 100% of my medical, dental and vision premiums — meaning, I did not pay anything additional out of my biweekly paycheck. Not a bad deal!

And I’m a healthy person with no pre-existing conditions, so I’ve never really had to deal much with health insurers… until 2021. In May 2021, I broke my foot jumping into the ocean in Belize (I sought treatment in Texas) — and then a few months later, in September, I tore my bicep during a fall while hiking in Maine. Minus a few co-pays, everything else was paid for.

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And so, because it was a huge relief to have my employer mostly cover my health care troubles in 2021… I wondered what I would do once I quit my job, became uninsured, and started traveling outside the U.S. Here’s my experience (and some thoughts for you to consider!).

Travel health insurance vs. global expat health insurance: Time for a nomenclature check!

But first… what is the difference between travel health insurance and expat/global health insurance?

Travel health insurance oftentimes focuses on emergency situations, and aims to get you back to your home country for care — as in, it will help pay for your initial treatment or to stabilize you for transport, then, it typically wants to send you back to your home country where it (usually) expects your regular insurance to kick in. That’s why it’s so affordable! It often includes trip interruption and baggage delay insurance and a few other travel-related coverage — just don’t confuse it with travel insurance, which usually doesn’t have a medical component. 

Expat/international/global health insurance is much more comprehensive, is typically meant to be your only health plan, and to address ongoing needs. However, “international” or “global” health care COULD be a misnomer, as oftentimes, many policies will exclude coverage in countries where healthcare is extremely expensive. Oftentimes, you can select the areas of coverage to suit your needs.

The way I see it, there are several ways non-insured nomads, frequent travelers, or expats can approach healthcare — and it really depends on what your coverage needs are, where and for how long you’re traveling, and how easy or complicated you want it. Here’s a little table that might help (and this assumes you WILL be in the U.S. a least a little bit of the year. If you aren’t, that simplifies things!). If I’m missing any scenarios, please let me know!

Options	Considerations
A truly global (no country restrictions) expat plan	– One stop shopping – Possibly more expensive or basic/emergency coverage only, unless you want to upgrade for $$ – Probably for people who are spending a lot of time in countries with expensive health care (but be sure to check the length of time restrictions!)
A U.S. plan, and travel medical insurance for the periods and places when you’re outside of the U.S.	– Assumes you can obtain affordable U.S. coverage or ACA, which varies A LOT by state of residence (and sometimes, only applies in your state of residence!) – If you’re traveling a lot, multiple policies (and local addressees) may be hard to keep track of (although some you can bundle) – Do the math — are two (or more!) policies more affordable than a blanket one?
A non-U.S. global or country-specific expat plan, and travel medical insurance for the U.S., for the short periods you’re in the U.S.	– For people who will probably not spend a lot of time in the U.S. and more time in affordable-health-care countries – If an accident happens outside the U.S., are you prepared to stay to receive medical attention (because you don’t have regular U.S. coverage)? – More affordable, but the travel medical part is really not for preventative or ongoing care
A U.S. plan and pay out-of-pocket when outside the U.S.	– While emergency medical is cheaper in a lot of other countries, it is still probably a good idea not to risk going without – …but for wellness, routine tests, and SOME emergency medical, it may STILL be cheaper than paying premiums to pay out-of-pocket should the need arise

My experience so far: After a little research, I picked a health insurance plan geared towards expats for 2022

I wasn’t totally sure what my 2022 would bring, so in late 2021, I decided to go with IMGlobal, or IMG, and I paid $1,884 for the year when I purchased the “Silver” plan in December 2021. This plan is truly worldwide, including the U.S., as long as I’m there for no more than 6 months a year — well, no problem there. 

I’m not great at understanding health insurance policies (who is?!), so I picked the Silver plan because it included in-network coverage to the tune of $70 per visit/examination with specialists and physicians. I selected this plan because I wanted to be able to see my gynecologist for yearly preventive care, and I was also a little over-cautious because of my accident-ridden experience the year before (and I tend to have chiropractic needs). Well, little did I realize in the fine print, well-woman exams with specialists do not qualify as an exam with a specialist. Hmm. Alrighty then! It would’ve been great if the customer service guy had told me that on the phone when I called to authorize care, but he assured me my doctor was in-network and that wellness was covered. Unfortunately, he was wrong, meaning a denied claim and hundreds of dollars in out-of-pocket clinic and lab fees. Lesson learned. 

To play devil’s advocate, if I take the cost of my yearly well-woman visit (which was negotiated down by 30%) and add it to the cost of my yearly policy, I paid $2,192 for healthcare in 2022. In the grand scheme of things, not SO much, but definitely more than I like to pay.

More research: Cost comparisons for next year

These days, when I input my info into the IMGlobal website with the same specifications and a $1,000 deductible (aside from being one year older), I was quoted $205 per month, or $2,465. Again, that includes exams with specialists, but not gynecological and woman’s-health-oriented specialists, apparently. When I exclude the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan, the price for this policy becomes $154 per month, and if I drop the coverage to the “Bronze” level, it becomes $133.30 per month ($177.50 per month, when adding back in the U.S.).

An alternative that I’ll consider next year is William Russell. I ran the numbers on their comparative global plan, also called “Silver,” and I was quoted $2,293 for the year for worldwide coverage. However, that includes everywhere but the United States. If I do plan to visit the U.S., I can add cover for trips up to 45 days and up to 90 days — but it’s not cheap. Kinda makes you want to avoid the U.S., right? 

After the U.S., if I exclude “certain countries where the cost of private healthcare is high” on William Russell’s quote-building engine — that list includes the UK, the European Union, Japan, Singapore, Australia, New Zealand, the Caribbean and others — the annual price for me becomes $1,834. If I add preventative health and wellbeing (to include my annual well-woman exam and other various screenings — which would have to take place in a country not on the list above) the yearly cost increases to $1,944. Hmm. Not that much more.

What I’m going to do for healthcare in 2023

As you can see, it’s a good idea to have a good idea of where you’re going to be while you’re nomading (especially if you’re on a budget), to avoid over- or under-insuring and to avoid overpaying for coverage you don’t actually need. (Or, you can keep it simple and streamlined — it’s up to you!)

So, what am I going to do? I’m not totally sure yet. I still have a few months to figure it out, as my current coverage doesn’t expire until January 2023. I do plan to spend a fair amount of time in Mexico and probably South America in 2023, and I’ll probably limit my time in the U.S. to less than two months over the course of the year. 

So the question I’ll be chewing on is… do I really need so much U.S. coverage?

As a pretty healthy 37-year-old who IS watching her budget, I might go for something that’s a little more barebones (and plan to pay out-of-pocket for what else I might need, whether inside or outside of the states), I might mix-and-match on policies (option #3 above), and I might also reach out to an insurance broker for some additional guidance. I know a LOT more this year than I did last year… but healthcare, especially for the emerging nomadic market, is still pretty mystifying. 

If you’ve had positive or negative experiences with any global or expat-oriented carriers, please leave a comment!

Mentioned in this blog: IMGlobal and William Russell (this is an affiliate link)

UPDATE (JAN. 4, 2023) – In 2023, I am on an Affordable Care Act plan which covers me in the United States (it will cover emergencies, preventative care, and chiropractic medicine) and, due to the fact I’m low income/under-employed, it is subsidized by the government (I pay $4/month). When I travel, I will take out travel insurance policies specific to the countries or regions I visit (which tend to be a few dollars per day or less). I will, of course, update everyone on how this went for me later on in the year!