Early retirees often fill their early years in retirement with lots of travel. There is even a vibrant community of nomadic early retirees who travel long-term.
But what do you do about health insurance, especially if you’re American? Unlike in most other industrialized countries that have universal health insurance, American health insurance is generally tied to your employer, at least before you’re old enough to qualify for Medicare. That means if you don’t have a job, you generally don’t have health insurance. For early retirees, that’s a problem.
What are the health insurance options for early retirees, especially those who plan to travel significantly in retirement?
This week, I chat about early retirement health insurance options with Tracy Winters, Director of Individual Insurance at Good Neighbor Insurance, an Arizona-based health insurance brokerage that specializes in health insurance consulting for long-term travelers, expats, and traveling early retirees.
- The big picture for how traveling early retirees should think about their health insurance options
- When it makes sense to simply self-insure
- Tracy’s observations on which countries offer both high-quality and affordable healthcare
- Tracy’s health insurance recommendations for early retirees who wish to travel abroad 100% vs. 90% vs. 50% vs. 25% of the time
- ACA marketplace health insurance options to consider for early retirees
- How Medicare coverage is impacted when you travel long-term
- When it’s worth repatriating to the US vs. staying in-country to get medical care, plus what kind of insurance plans provide repatriation services
If you’re early retired, what do you do for health insurance?
How do you handle health insurance when traveling as an early retiree?
If you’re planning to early retire in the future, how important is health insurance coverage to your decision of timing when to early retiree?
Let me know by leaving a comment.
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Andrew Chen 01:22
My guest today is Tracy Winters. Since 2016, she’s been the Director of Individual Insurance at Good Neighbor Insurance, an Arizona-based health insurance brokerage firm founded in 1997 that specializes in health insurance advisory and consulting for nomadic travelers, long-term travelers, expats, and traveling early retirees.
I learned about Tracy and Good Neighbor Insurance from an active Facebook group on nomadic early retirement that I’m a member of. And I asked a question in that group about how other early retirees, particularly long-term traveling early retirees, deal with health insurance, because getting good, affordable health coverage is a real challenge for Americans in particular because in America, health insurance tends to be tied to your job.
And if you don’t have a job anymore because you’re early retired, then you probably don’t have employer-sponsored health insurance. So, what do you do for healthcare coverage as an early retiree, especially if you’ve got a long way to go before you’re covered under Medicare, which itself does not cover you much if you’re internationally nomadic?
Anyway, most other industrialized countries don’t have to deal with this problem because they have national health insurance schemes, or a single payer system, or some other way that’s not tied to an employer. But if you’re an American (like I am), like a lot of listeners I’m sure are, then you have to solve healthcare in order to have peace of mind and actually enjoy early retirement.
So, when I got recommended to Tracy, I reached out to her to see if she could share any tips and advice for HYW podcast listeners about how to think about health insurance coverage as a traveling early retiree. So, I’m really glad I was able to get her on the show to share her insight on this. So, without further ado, let’s jump into it!
I guess I just wanted to first start by understanding: what exactly is the nature of your role at Good Neighbor Insurance?
Tracy Winters 04:02
What I do here is I work with individuals, either individual people or families, to help them find either short-term or long-term plans for their international needs. And it doesn’t necessarily have to be a U.S. citizen going out. It could be for anybody from any country.
And there’s so many different needs as far as budget or why you’re going, where you’re going. And since Good Neighbor Insurance is a brokerage, we work with quite a few different insurance companies, so we’re able to tailor our recommendations to what each person or family needs.
We also have an employer group department, like what you’re used to in the U.S., if you work for a large company and you have employer group coverage. And that’s for US-based companies that work overseas, that have employers overseas. But that’s a different department; I usually just help the individual families.
Andrew Chen 05:06
Excellent. I’d love to get a little bit more insight in terms of, personally, how did you get into health insurance advisory work? And for listeners on the podcast who are interested in this topic, and they know how important the topic of health insurance is, why might listeners want to pay attention to what you have to say about health insurance coverage for long-term traveling early retirees?
Tracy Winters 05:28
It’s really about financial protection. The way I got into it, I fell into it. I did a lot of admin work, and I actually worked in a hotel for 16 years, so I was used to travelers and what they need there.
But 10 years ago, I decided hotel management was not really my forte. So, I found Good Neighbor Insurance. I was just looking for something new.
They didn’t require a lot of insurance background, which was fine, but I got to work with people traveling all over the U.S., especially for humanitarianism, social good, people going overseas to adopt children, and just those who want to visit other cultures. And the more I talked to people, it’s exciting, and someday I can’t wait to retire and travel the globe too.
But it really has been so great to work with a company like Good Neighbor just because I do feel like I’m helping, and we do help find the best fit, especially those that maybe have preexisting conditions that can’t get covered other ways. At least, if we can’t help, we know which way to go for each one of our clients.
Andrew Chen 07:00
Excellent. So, to just frame the discussion, to help listeners get into the right headspace, what is the mindset or the mental framework for how a potential nomadic retiree should think about health insurance coverage?
For example, one philosophy might be to just buy enough insurance coverage to prevent a surprise medical bill from bankrupting you or forcing you to go back into the workforce? Maybe that means very limited coverage or really high deductibles, or whatever the case may be. But I’m curious if you have any framework or right mindset that you think a potential nomadic retiree should have as they think about their post-retirement health insurance options?
Tracy Winters 07:46
There’s a lot of different ways to begin the discussion when you first start planning your trip overseas or your move or your journey. What we’ll want to know from a client first is “What is your current or past medical history?”
If you have a lot of different preexisting conditions or something recent, and you’re going over long term, expat insurance plans, the long-term renewable plans require medical underwriting. So, the coverage isn’t automatically accepted, so we need to know what needs to be covered, or we need to know upfront, are you going to be covered?
Plans that may cover a preexisting condition would have a higher premium, so that’s something to keep in mind. We have clients that have diabetes that need regular insulin, which could be expensive in the U.S. but maybe not in other countries. So, that’s something to keep in mind when you’re trying to start your budget.
And that’s another thing that we want to know upfront. Do you have a budget? Is there some frame of your finances that you want to set aside just for the premium?
And if you do want a high deductible, that’s great. Some of our plans go even up to $25,000. The long-term plans go up to a $5000 deductible; some offer $10,000-$25,000.
Another thing that we’ll need to know upfront is: Do you want coverage in the U.S.? This is advisable. If something happens and you do get a more serious illness, do you want to be able to come back to the U.S.?
So, those are just the frame of it.
Andrew Chen 09:51
You mentioned a moment ago that all the long-term plans have a deductible: $5000, can be higher, maybe $10,000. Did you mean that those are the lowest deductibles, or are those more like the upper bound?
Tracy Winters 10:08
For all of our plans, there will be deductible options. Some of our long-term plans will go as low as a $250 deductible for a year, whereas you can have a $5000 deductible.
And typically, it’s per person, not a family deductible. So, if you want a $5000 deductible per person, there’s that option. There’s going to be many options when you get quotes for coverage.
Andrew Chen 10:41
Interesting. So, it sounds like you can pay more premium to get a lower deductible.
Tracy Winters 10:50
Andrew Chen 10:51
And did I also hear correctly that the option to get care in the U.S. is not automatic, it’s like an add-on? Is that the right way to think about it?
Tracy Winters 11:00
It’s a choice. You can choose on most plans to exclude coverage in the U.S., which would bring your premiums down significantly. But yeah, it is an option for the international long-term plans.
Andrew Chen 11:18
And you mentioned medical underwriting. All the international plans, I think I heard you say, require medical underwriting.
Tracy Winters 11:24
Andrew Chen 11:25
Can you share any insight on what does that entail and what are they looking for?
Tracy Winters 11:33
They’re looking to keep their risk level low. Like the example before, for those that have a condition like diabetes, we’re limited on which companies will accept that person.
So, they’re going to look at that individual person. How much are they going to look at claims for this person if they take this risk on? Will we have to charge a little bit more in premium to cover this preexisting condition?
Another one that’s pretty common is those that are on high blood pressure medication. A lot of the low-cost budget plans can offer coverage but may exclude cardiac, which means anything to do with high blood pressure, heart. You can get your insurance, but it’s not going to cover that.
So, if you want something that can cover that preexisting condition, the insurance companies, the underwriters, are going to take a look at what is your actual risk, like what’s your dosage, or have you had a heart attack in the past? So, they want to look at your medical history a little bit closer, if you are on a maintenance medication.
So, essentially, underwriting is just the insurance company evaluating their risk in covering a person with preexisting conditions.
Andrew Chen 13:07
So, fair to say that your chronic conditions are probably going to have less options? Maybe if you had an acute condition some time ago but is no longer there, less concerning?
Tracy Winters 13:18
Yes, that’s correct. So, if you were on high blood pressure medication, and if your diet and exercise got off of it two years ago, you may not have any exclusions going forward. So, it’s really a case-by-case basis.
And the more you tell us, within limits, because we still want to stay HIPAA-compliant. You share what is relevant, but we don’t share any medical history unless you give us permission to go to the insurance company on your behalf.
Andrew Chen 14:01
It’s a requirement, though, right? So, I guess if you don’t share it, then they will just say, “Sorry, we’re not going to cover you”?
Tracy Winters 14:08
To apply for an insurance coverage, you do have to supply your medical history. If you don’t provide your medical history, or you don’t disclose certain conditions or any condition, they can actually cancel your coverage if they found that you were essentially fraudulent on an application.
So, applications are completely confidential between a client and the insurance company, and they’re not shared with anyone else.
Andrew Chen 14:47
I remember when I did life insurance, somebody came in and took my blood and had me do a urine test. Is there any of that stuff involved, or is it just a questionnaire?
Tracy Winters 14:57
It’s just a questionnaire for the most part. We have one insurance company that if you’re over the age of 55, they’re going to want to see your last blood test. They want to know that you’ve had a physical in the last six months.
But most other plans will not ask for any other kind of medical records, and nobody will come to your house.
Andrew Chen 15:25
A lot of countries outside the U.S. have quite good quality healthcare provider service. You have the good quality care for very affordable prices. So, sometimes a legit strategy might be to just plan to pay out of pocket for most routine or even most non-emergency care, because a lot of countries outside the U.S. have pretty good healthcare for affordable prices.
I’m curious if you have any thoughts about when it might make sense for a traveling retiree or an early retiree to simply say, “You know what, I’ll self-insure. I’ll just pay out of pocket if I need care, and I won’t bother with paying for health insurance.”
Are there circumstances where you might advise that as a good, viable strategy?
Tracy Winters 16:18
That’s a good time to really research the country that you’re going to stay in for a significant amount of time, because country by country, even hospital by hospital, it’s very fluid. It can change all the time.
Whereas, a few years ago, we had a client in Kenya in a motorcycle accident, and she had two or three surgeries and only paid $600 out of pocket. And I know Italy right now is very open to visitors and tourists. Many hospitals in Italy don’t charge, or will charge just a small fee for any kind of emergency medical care, but that’s also hospital by hospital in Italy.
So, it’s good to do the research on the countries you’re going to or staying in for a longer period of time.
Andrew Chen 17:25
I guess on that note, I know you said hospital by hospital, but maybe there are patterns, at least at the country level. What countries do you think provide good quality care for cheap?
Because sometimes the care is cheap, but it’s not very good. Other times, it’s good but not very cheap. And in some cases, it’s both cheap and also good.
So, I’m curious if you have any insight on what places in the world or countries in the world have both, based on all the traveling expats you’ve advised over the years.
Tracy Winters 17:54
From what I’ve heard recently, countries especially in Europe are pretty good right now. Spain, Portugal, and Italy are probably top three to have the best healthcare. Spain and Portugal may not be the cheapest, but a lot of countries in Europe right now are probably some of the best places to go for healthcare.
As far as low cost, that could change daily.
Andrew Chen 18:32
I wonder if you might talk a little bit about the range or the type of health insurance options that you might recommend for different profiles of travelers. I had four profiles in mind.
From one end of the spectrum to the other, someone who wants to be abroad all the time, 100% of the time. And then the next rung over would be somebody who wants to be abroad the vast majority of the time, but they want to come home sometimes. So, maybe they’re abroad 90% of the time, but they want to come home for a couple of weeks a year, a few weeks a year for major holidays, for Christmas, things like that.
And then moving over to the next rung, somebody who wants to split their time pretty evenly abroad versus in the U.S. And then finally, on the other extreme, somebody who wants to spend most of their time in the U.S. and basically just take long vacations maybe a quarter of the year or 25% of the year.
I’m curious if there are differences in health insurance options that you would recommend given this range of profiles.
Tracy Winters 19:40
Absolutely. For somebody who is only going to be outside of the country, outside of the U.S. for only 25% of the time, say three or four months, it’s best to stay on your U.S. health insurance, on an ACA-compliant plan, and then just use short-term travel insurance.
We’ve got a myriad amount of short-term travel options, and that will just cover new injuries, new illnesses, and medical evacuation while you’re outside of the country. And you can get that per trip.
We have multi-trips, so if you go for a month here, come back, and a month there, and then come back. Annual multi-trips are usually a lot more cost-effective.
All of our long-term expat plans that are renewable have up to six months of U.S. coverage. So, if you are going to be outside of the U.S. for at least six months out of the year, that’s when you are going to be eligible to be on a long-term expat plan. So, where you’re only going to be six months, that’s when you definitely have to have that U.S. coverage, like we talked about before.
So, you do want to add that U.S. coverage, because usually international health insurance plans are going to be lower cost and like a U.S. domestic individual ACA-compliant plan. And then, when you get into 90% or 100% outside of the U.S. every year, that’s where you want to consider maybe excluding the U.S. if you know that’s where you’re going to be, especially for 2, 5, 10 years. That’s definitely your goal: to be outside of the U.S.
We do have short-term travel plans back to the U.S. So, if you know you’re only going to be back for a couple of weeks at a time, you can do a travel plan back to the U.S. if your international plan excludes the U.S.
Just keep in mind that if you get a short-term travel plan back to the U.S., it’s only going to cover you for emergencies while you’re back, so you can’t come back to the U.S. to seek treatment. But it is something to keep the cost down if you’re going to be outside of the U.S. 100%, 90% of the time. Just have an as-needed backup plan for U.S. coverage, just for trips back home for Christmastime, Thanksgiving.
Andrew Chen 22:30
But those would only be for, like, if you got hit by a motorcycle, and not if you discovered a tumor or something like that, right?
Tracy Winters 22:39
Correct. It would be any new injuries, new illnesses. So, if you came back to the U.S. and got COVID while you were back in the U.S., the short-term travel plans would cover you if you need a treatment for COVID, or if you had food poisoning, or broke a leg, broke an arm.
It’s just any new injury, new illness. But if you did come back and find a tumor, that’s when you want to go outside of the U.S. if your coverage is outside of the U.S., especially if you’re in a country like Spain that has amazing healthcare.
You can go back to Spain, you can go back to the UK, or whichever country you would come from. I know Singapore has incredible healthcare coverage. There’s plenty of places that you can get treatment.
If you do come back to the U.S., something like that happens, you find it. And if you do want to stay in the U.S. for treatment, you’ll have to get on a U.S. domestic insurance plan. And U.S. domestic insurance plans will cover preexisting conditions from day one.
So, if you want to stay back in the U.S. for treatment, that’s what you would have to do, if you excluded U.S. from your expat plan.
Andrew Chen 24:11
Is it the case that if you did find yourself in that unfortunate situation, you’re like, “I need to switch back to a U.S. plan,” U.S. plans cannot include preexisting conditions if they’re ACA plans, or just all of them? Just all plans now cannot?
Tracy Winters 24:26
If it’s an ACA-compliant plan or Obamacare plan, they cannot exclude preexisting conditions.
Andrew Chen 24:37
I think that you mentioned that if you’re spending the vast majority of your time abroad, or even all of your time abroad, the long-term international health plans tend to be a lot cheaper. I was wondering if you could comment on why that is. Is that just because the cost of care is lower in other countries?
Tracy Winters 24:56
Yes, for most countries. I do have one plan that’s going to exclude countries like Singapore and China and Taiwan, just because their medical costs are so much higher. They’re comparable to the costs in the U.S.
But most plans, as long as you exclude the U.S. (it’s just the U.S. and Canada sometimes), it’s just because the cost in the U.S. is so much higher.
Andrew Chen 25:31
So, does the premium amount depend on where you’re going, such that you actually have to stay in those countries? You can’t just be truly nomadic? Or are they more plans that cover everywhere, maybe with a few country exclusions?
What’s the right way to think about that?
Tracy Winters 25:52
When you apply for a long-term coverage, you do have to have a destination in mind. Even if it’s a temporary destination, even if you’re just going to be in New Zealand for a couple of weeks and you have an Airbnb address, you do have to have that. And some plans do base their rates on what country you’re going to.
But for the most part, once you’re started, you can be anywhere in the world, unless you’re back in the U.S. That’s the only time that that’s an issue or that the insurance company needs to know. Once you come back to the U.S. and you plan on staying in the U.S., then you actually wouldn’t be eligible for an international plan any longer.
But you can be truly nomadic. You just have to have a start country.
Andrew Chen 26:46
Then how is that not totally hackable? Because if a lot of plans will exclude something like Singapore or Taiwan or something, and then you have your Airbnb address in New Zealand, you go there for a month…
And actually, let’s remove hacking intent, but let’s say you went there for a month and you’re like, “You know what, I haven’t figured out what my next destination is,” but Week 4 rolls around, you’re like, “Singapore sounds nice. Why don’t I go there?” even though you would not have been able to buy an insurance plan for Singapore had you started out there.
Surely, insurance companies know that. How is that allowed if you can be truly nomadic?
Tracy Winters 27:30
Unless the country is actually excluded, like the one plan that we have that does exclude, if you exclude the U.S., you exclude Singapore, you exclude China. That’s the only plan that if you do decide to go to Singapore, you’re just not going to have coverage.
So, with the insurance companies, it’s worldwide coverage, unless you exclude the U.S. It’s going to be worldwide, no matter where you go.
So, it’s not an issue whatsoever. You can be anywhere in the world. They’re just going to base the rate on the address that you provide.
A lot of people use a friend or family member that’s based in Spain, and that’s completely fine. And we’ve double-checked because that’s what we do as a brokerage. We double-check to make sure everything is copacetic with the insurance companies.
But they’ve all confirmed, as long as you have an address outside of the U.S., you can be anywhere in the U.S. and have coverage, as long as that country is not excluded from the start.
Andrew Chen 28:42
So, I think what I understood is that it’s not really hackable because the plan will just specify in the terms which countries are excluded. And if it’s just written out that it’s excluded, you just can’t go there and be covered. Is that right?
Tracy Winters 28:57
Andrew Chen 29:01
I was also curious, how does the claims process work in that globally there could be millions and millions of providers? There’s no way that the insurance company has relationships with everybody in the world, especially when it’s global.
So, is the patient meant to always just pay out of pocket first and then try to get a reimbursement later? Or are there direct relationships with some providers and not others? How does that work?
Tracy Winters 29:32
That is a great question. For the most part, if it’s something minor, say it’s a medical treatment that’s under $1000, most international insurance companies will want you to pay out of pocket and then submit a claim for reimbursement, of course less whatever your deductible is.
If it’s anything emergent or something major, you have to have surgery, you have to be hospitalized overnight, and it looks like your medical bills could be quite high, over $1000, you or a family member, or even staff at the hospital, they get in contact with the 24-hour emergency number for the insurance company. The insurance company can then set up a promise to pay that hospital directly, if needed.
Our three major insurance companies that we work with actually do have direct billing with quite a few international hospitals, because we do work with a company like GeoBlue. BlueCross and BlueShield are what we’re used to here in the U.S., but GeoBlue is very global.
We also work with Cigna Global. Those are the top two international insurance companies, and they do have direct billing with major hospitals.
But if you go in for an earache, you just pay out of pocket and submit the claim. Most claims are done digitally, so you can do it by email, and a lot of insurance plans have member portals that you would be able to download any documents.
I always recommend getting an itemized medical receipt. It’s just line by line, what you got the treatment for. If you can get any medical records while you’re there, because if you’re traveling, especially if you’re nomadic, it will be hard to try to go back if you’re already in the next country that you’re planning on going to, to try to get medical records after the fact.
So, you just make sure you got everything. But yes, when in doubt, call the 24-hour insurance emergency number.
Andrew Chen 31:59
So, to ask them, “I want to get this surgery done. Can I set up a direct billing?” Call them to ask that type of question?
Tracy Winters 32:09
Yeah, you can actually pre-certify. And pre-certification is really just for the insurance company to know that it’s medically necessary, that you’re not just going in for some kind of elective surgery.
You don’t have to pre-certify with every single company, but if you’re scheduled to have surgery, it is best to have that set up. You can have the insurance company contact the hospital directly. They can work that out prior to.
And some companies will also provide a letter saying “This is covered.” But yeah, the insurance company will work that out.
Andrew Chen 32:58
How can the patient know in advance which hospitals have that relationship? Because I can imagine, let’s say you’re traveling in the UK, and I think not all the hospitals have billing departments, and there’s like “Where’s your NHS card? What are you talking about, billing?”
Can patients log into the insurance website to find a list by country of all the relationships they have and maybe do some planning that way? How does that work?
Tracy Winters 33:30
Yes, most of the companies that we work with have a provider search. It’s not necessarily like a preferred provider search in the U.S., although it’s on there too. So, if you’re looking for a PPO in the U.S. for a doctor in your city, it’s something to that effect.
But the three major ones (IMG, GeoBlue, and Cigna) all have international provider searches, so you can find the hospital that already has a direct billing relationship.
Andrew Chen 34:08
I think you were alluding to this a moment ago, but is there a concept of in-network versus out-of-network, or is it just all one?
Tracy Winters 34:15
Outside of the U.S., it’s all one. Any hospital, any licensed physician you can go to.
Andrew Chen 34:25
I was also curious, the insurance companies that issue international policies, are these, for the most part, American companies, or do they tend to be companies that have foreign headquarters that are just doing business in the U.S.?
Tracy Winters 34:40
GeoBlue, IMG, and another company that we work with, Azimuth, they are all US-based. Cigna Global is actually out of the UK.
Andrew Chen 34:54
I want to shift a little bit and talk ACA plans. And I was just curious if you have any insight. This might be orthogonal, but I just don’t have a good way to think about it.
What coverage options do ACA marketplace plans provide, if you were going to be a nomadic retiree? I’m sure it probably depends a lot on what state you’re domiciled in, but are there any general insights you have for listeners on whether they can’t even utilize an ACA marketplace plan for health insurance as a traveling retiree, and if so, how?
Tracy Winters 25:29
That’s where cost is going to come into play, especially if you have a preexisting condition and you can’t get on an international plan. So, it is state by state. And most ACA-compliant plans, as long as you’re paying the premium, you can keep your coverage, even though you’re outside of the U.S. for a certain amount of time.
So, the only time I would recommend it is if you’re going to be within the U.S. six months or more, you’ll want to keep an ACA-compliant plan. Or if you have preexisting conditions that you want to come back. But yeah, it is state by state, and you really have to know your cost.
And just keep in mind, open enrolment is only at the end of the year for January 1st. There are special enrolment periods if you change your address. So, if you’ve been outside of the U.S. for six months or more, and you’ve moved back, as long as it’s been within 62 days…
Or say you’ve been outside of the U.S. and you’ve been on an expat plan, and your coverage ends June 1st, and you’ve moved back to the U.S., you’re losing your health insurance, so you would be eligible for a special enrolment period because you’ve lost your insurance and you need to get back on.
Andrew Chen 37:06
But just to be clear, as a general matter, can ACA plans actually be used for care outside the U.S., or no?
Tracy Winters 37:17
Andrew Chen 37:18
So, you would still have to anyway. I think you were saying then, you can buy the ACA plan, but probably only worthwhile if you’re here at least half of the year, and the other half you would just have to buy a supplement?
Tracy Winters 37:29
Correct. And you can have an ACA-compliant plan and then just use the travel medical plans. That would cover new injuries, new illnesses while you’re outside of the U.S. and also include the medical evacuation.
And we do have medical evaluation-only plans. That’s something where you just want to go and want to make sure that you can be evacuated directly back to the U.S., to your hospital of choice, we can help with that too.
Andrew Chen 38:00
Medicare. For seniors who are already on Medicare, how should they think about Medicare coverage if they also want to be nomadic or at least long-term traveling? And in what ways is your Medicare coverage impacted by spending large portions of your time abroad?
Tracy Winters 38:23
Part A and Part B, which are the ones that you automatically want to enroll in when you turn 65, those are not affected at all. So, if you’re outside of the U.S., nothing is affected by that because those are federal. You don’t have to stay.
If you do have Part C, which would cover anything not Part A and Part B (Part A is hospitalization; Part B is outpatient, your labs, and things like that; Part C covers everything else), the Part C is state by state.
So, if you do have Part C and your home state finds out that you’ve been outside your state for 3-6 months at a time, that’s when they can cancel that. That’s really the only Medicare part that would really be affected if you’re outside of the U.S. for an extended period of time.
But if you do plan on keeping Part A and B, you can maybe just do the emergency coverage or just a medical evacuation coverage. We do have quite a few of our clients that have opted for that: to just have a medical evacuation coverage so they can come back to the U.S. and get treated here in the U.S. where their Medicare is going to take care of them.
There is a plan under Part C if they’re just traveling, and they’re not going to be affected by being outside of the U.S. because they’re only traveling short term. There is a plan that you can choose that covers international travel, but this plan that does cover the international travel in Medicare only covers up to $50,000 lifetime, has a 20% call insurance and a $250 deductible, which means it’s really one and done.
So, if you choose to get that plan under Part C for the international and you go to the Caribbean on a cruise, and you have to go to the hospital because you have to have surgery on the leg, that’s all you’re ever going to use, and now you’re out of pocket $10,000 because you have that deductible. But we have short-term travel plans that can compensate, to be a little bit additional coverage for those short term, especially for seniors.
Andrew Chen 41:02
So, I guess for Part C then, is basic strategy if I know I’m going to spend three-quarters of my year abroad to just not buy a normal Part C supplement, and instead do Part A, Part B, and then just go to you, for example, and buy an international plan, then that’s the extent of it?
Tracy Winters 41:22
That would be advisable. And this is really not in my wheelhouse, so medicare.gov is really the best website. It’s a really good website for a government website to get more information on this.
But Part A, Part B, and also Part D are not affected. And you can keep that coverage, and then if you want something supplemental while you’re outside of the U.S., that’s when you want to get the expat plans or travel plan. That doesn’t cover the U.S., so you’re not paying the additional premium.
Andrew Chen 42:07
So, if it was my first year of Medicare and I’m like, “Go, go, go,” I want to travel, and I buy international insurance to cover my Part C, and then, after a few years, I’m like, “You know what, I’m tired, I’m ready to plunk down and just play golf all day in my home state,” then I could still do open enrolment and get a normal Part C plan, I think, right?
Tracy Winters 42:32
I believe so, but I’m not the best person to ask that.
Andrew Chen 42:37
Tracy Winters 42:38
But yeah, I think you’d have to check within your home state to see what’s available for Part C.
Andrew Chen 42:47
Can I ever use my Part A and B abroad, or is that only if I’m inside of the U.S.?
Tracy Winters 42:51
Only inside the U.S.
Andrew Chen 42:57
Interesting. So, it’s not affected, but it also doesn’t do me much good outside.
Tracy Winters 43:02
Correct. You still have to pay for Part B or Part D while you’re outside of the U.S., but it’s not affected. You keep it forever as long as you’re paying.
Part A is automatic, and there’s no charge for the Part A. It’s already paid for. But Part B and Part D (D is prescriptions), there is that additional charge that you have to pay.
Andrew Chen 43:35
I wanted to talk a bit about repatriation. How should folks think about when it’s worthwhile to repatriate back to the U.S. to get medical care versus staying in-country and getting it abroad?
Tracy Winters 43:51
It really will depend on the situation. And repatriation and evacuation is something that’s very important for our brokerage here, Good Neighbor, that every single policy that we have includes evacuation and repatriation.
Now, with evacuation, this is covered when it’s a life or limb-threatening situation, you’re in a hospital, maybe you’re in an area that doesn’t have the best coverage, maybe you’re in Luxembourg and they want to take you to France. That’s when the insurance company in the hospital will work on getting you across borders to get you to the best and nearest hospital for treatment. And most evacuations are always going to take you there.
So, if you do have to have a medical evacuation, every single one of our insurance plans, once you’re released from the hospital that you’re evacuated to, you will then have the choice to either go back home to the U.S., if you want to keep recovering in the U.S., or you can go back to where you were evacuated from.
If it’s something that’s not immediately life-threatening, but if you do get an unfortunate diagnosis and do want to come back to the U.S. for treatment, that would be your own responsibility to go home if you did want to repatriate. And a lot of times, people do want to have that emotional support of family and friends here in the U.S., so that’s when you want to come back to the U.S.
But again, that would be your own responsibility if it’s not a life or limb-threatening situation.
Andrew Chen 45:46
I want to circle back to life or limb in a moment. But are evac and repatriation different benefits, or are they one and the same in the eyes of insurance companies?
Tracy Winters 45:54
They are different benefits. The evacuation is going to be when you’re in a hospital that is not going to give you the care that you need, or they’re not able to provide the care that you need.
I like to compare it often to if you’re in a car accident here in the U.S., and say you’re a block away from a hospital, but that hospital doesn’t have a trauma center. The ambulance isn’t going to take you to that hospital because it’s not going to be the best one. Or maybe they’d take you there just to get you stable, but then they’re going to transfer you to the hospital that’s going to be the best for you.
So, that’s how evacuation will work. If you’re in a hospital that does not have the services that you need, that’s when the insurance company and the hospital are going to work together to say, “Yes, we’re going to get you evacuated.”
Most medical evacuations can take place within 24-48 hours. They will get you to where you need to go. Repatriation is usually after the fact.
So, if you’re medically evacuated, and you got the treatment, and the hospital is going to take care of you, then the repatriation sometimes is included in the evacuation coverage, but sometimes it’s a different benefit. It just depends on the plan.
But either way, the repatriation is covered. The policy [47:27 inaudible] is going to be a little bit different plan to plan, but it’s always going to be included.
Andrew Chen 47:34
Is the simpleton way to think about repatriation basically then that “Once you’re stable, we’ll buy you an airplane ticket home”? Is that right?
Tracy Winters 47:43
Andrew Chen 47:44
So, if you were really life or limb, and you actually make use of the repatriation benefit, and you only had long-term international insurance because you were living abroad most of the year, they drop you off on the doorstep in the U.S. but you don’t have health insurance coverage here, so what happens next?
Tracy Winters 48:09
If you’ve chosen not to have the U.S. coverage, then that’s when you’ll have to get on an ACA-compliant plan just as quickly as you can. And that’s also why the insurance companies give you the choice to go back to where you came from.
So, if you were in Luxembourg and went to France, they say, “Do you want to go back to the U.S. or do you want to go back to where you were?” That’s why they give you the choice.
Andrew Chen 48:38
And then you mentioned life or limb conditions. That may sound like it’s very obvious, but I can squint my eyes and think of some scenarios where it’s maybe not so obvious. So, I was curious if you could shed some more light on what qualifies and what doesn’t.
Tracy Winters 49:01
A lot of times, it’s case by case. I know we had a client that was in, I believe, South Africa, and the insurance company decided that they wanted to bring them back to the U.S. But it was a spinal injury.
They did evacuate that person back to the U.S. So, it was not necessarily life-threatening, but if it’s urgent and very serious medical care, they’re going to do the evacuation.
But we’ve also had people that maybe broke their leg, and they could have lost their leg if they didn’t get the correct orthopedic surgery. And then they’ll get evacuated to the nearest and best hospital that would cover that surgery.
So, it’s really going to be a case-by-case basis, and the insurance company will work directly with the hospital to make sure that that person is getting the care that they need.
Andrew Chen 50:14
Interesting. Sorry, this may sound really naïve. I don’t mean to be melodramatic, but you have to be conscious to make the evacuation election, right?
If you were hit in a car crash, and now you’re in a coma, then you’re just up to the good Samaritan graces of whoever found you. I think that’s probably right, right?
Tracy Winters 50:39
To a point. Just like the pre-certification, the emergency contact, somebody from the hospital can call the insurance company, as long as they have your information. Or if you’re a couple and it’s your husband, then the wife can call on the husband’s behalf.
So, you don’t have to do that yourself. As long as the hospital has the insurance company’s information, they can take care of that for you.
Andrew Chen 51:15
And then lastly, you said that all the plans that you guys offer in your brokerage have evac and repatriation. Is it generally included in most expat long-term traveler health insurance plans, or just the ones that you guys work with happen to all have it, but if you go to the broader marketplace, it might be hit or miss? Which of the two is it?
Tracy Winters 51:38
I think for the most part, a lot of them are going to include it now. I believe Cigna is the only one that’s optional that we work with, so you can choose to not have it. If we quote Cigna, we are always going to quote it with the medical evacuation coverage.
Andrew Chen 51:59
Tracy, I think that’s all I have. Where can people find out more about you and your work and services?
Tracy Winters 52:05
If you look up Good Neighbor Insurance, you can email us at [email protected] We’re here Monday through Friday, and then info will come to me and also come to my partner Gaby here. She can answer any of your expat or individual insurance questions that you may have.
Andrew Chen 52:30
All right. Thanks so much, Tracy. I look forward to sharing this out with our listeners.
Tracy Winters 52:34
Okay. Thank you so much, Andrew.