One of the questions friends and family asked Matt and me most often when we told them about our plans to become digital nomads was, ‘What about health insurance?’
Matt and I have been very lucky: we’ve always had great insurance through our employers. When I left Deloitte to start my own consulting company I was able to get on Matt’s corporate policy that is rightly defined as a ‘Cadillac plan’ because it is so generous.
We always heard about and understood that the cost of health care in the US is out of control but, like many Americans with good insurance through work, we never actually felt that ourselves.
So it was a good and a fair question: what about health insurance?
It was going to cost us $2100/month to continue our current plan via COBRA.
Other plans on the exchange, still with high deductibles, started at about $1100.
Knowing that we were not going to be in the US very much in the coming year, and knowing that we could affordably pay for quality healthcare most places in the world, a lot of research was in order.
We had heard and read that health care is cheaper just about everywhere else in the world. But what if one of us got really hurt, or really sick?
I did a lot of research and in the end I bought two insurance policies for us:
- An Allianz travel insurance policy. This policy cost $450 for both of us for one year and covers travel related mishaps like accidents, lost luggage and, if needed, emergency repatriation to the US. It also covers medical mishaps (with a lot of caveats) if you are more than 100 miles from home.
- A non-conforming short-term catastrophic health insurance policy from United Health Care. This policy has a deductible of $5,000 per person. After that it covers 100% in-network, but $0 out of network. This policy is basically to ensure that if we have an emergency in the US we won’t end up bankrupt. It cost us approximately $450 per month for the two of us.
How Well Does it Work?
This week that question, ‘what about health insurance?’ was put to the test.
Matt hurt his ankle a few weeks ago when we were in Southern California. It was our friend Martin’s birthday weekend and Matt decided that a dance party was in order. By the end of the evening he was limping badly and complaining about the pain the back of his left heel. That’s my Matty!
He’d been limping on it for about 3 weeks and, given the fact that he had to have his right Achilles surgically repaired about 15 years ago, he finally decided today to go to the Chaingmai Ram hospital here in Chiang Mai to have it checked out.
Walking to the hospital I was filled with a sense of dread. The irony that we had lost our amazing health insurance so recently and were now heading to the hospital was not lost on me. However, my research had all clearly shown that we should have no issue self-paying in much of the world, including Thailand.
Bearing in mind that Chaingmai Ram is the ‘expensive’ international hospital in town, here is our experience with the Thai healthcare system:
4:29 pm – walked in door. Immediately greeted and asked why we are here. Given form to fill out
4:34 pm – Matt is still filling out form but is ushered to new patient registration (which I should add is a very civilized desk area with comfy seats, not a standing counter behind a screen)
4:43 pm – registration complete, he is taken to the ‘vital sign room’ for blood pressure etc
4:53 pm – sent to (comfortable, quiet) waiting lounge
4:56 pm – nurse collects Matt and takes him back to see doctor
5:02 pm – Matt is finished seeing doctor. Diagnosis is Tendinopathy – good news: no tear, just inflamed and needs time and some anti-inflammatory meds to heal – Doctor says he can go get an MRI if he wants and bring it back for the doc to look at but that it would be a waste of money (an MRI would have cost ~$250-$300US vs. the average cost of an MRI in the U.S. which is ~$2,600).
5:05 pm – nurse collects Matt again to take to cashier department for prescription and to pay
5:09 pm – Matt pays the fee of 1506 Thai Baht – approximately $49 – in cash and we leave. Still time for our afternoon pool visit!
Breakdown of cost: $16 for ‘total doctor fee’, $28 for 2 medications, $4.50 nurse/hospital fees
40 minutes and $49 dollars in a pleasant, calm, state of the art hospital.
The next day I submitted the $49 claim to our Allianz travel insurance policy. A day later I got an email saying the claim would be paid directly to my checking account.
So there is the answer to ‘What about health insurance?’: so far so good.
I still have some angst because until now I felt covered no matter the situation thanks to our employer-issued healthcare, but I do feel that we have the correct level of coverage for us.
We will self-pay through much of the world where it is simply less expensive than in the US. And we have enough coverage to ensure that treatment in the US would not be catastrophic to our finances.
PS, Matt made fun of me for having such detailed time records of the visit…all I can say is that I was just so amazed at how quickly it went from the start that I decided to keep track.
PPS, when they took Matt’s blood pressure I was thrilled to see that it was 112/78. He’s been slightly hypertensive for about a decade and takes a low dose of meds to keep it in check. Apparently this new lifestyle suits his stress level and blood pressure!!!