Let’s face it: shit happens. When we’re traveling or living abroad as expats or digital nomads, anything can happen, from a global pandemic (hello coronavirus) to stolen credit cards to motorcycle accidents. We can’t stop these things from happening, but we can prepare for them by getting international health insurance.
So I thought I would get into the [potentially boring] practicality of comparing and choosing the best health insurance plan for expats or digital nomads.
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My healthcare experiences and needs as a digital nomad
I forewent health and travel insurance altogether for the first 2 years I spent living and working abroad. Outside the US, I accessed healthcare in Thailand, Sri Lanka, and Vietnam and was generally pleased with both the quality of care I received and the cost of care. I paid out-of-pocket fees for any appointments I had while visiting family in the States. (Including a routine checkup, vision checkup and new contact lenses, blood tests for my prescriptions, etc.)
But this year I signed up for international health insurance with Cigna Global. My health needs grew to a point where I felt the cost of the premium was worth it for me. And boy oh boy am I really grateful to have insurance now since everything escalated with the coronavirus pandemic!
Moving forward, I will likely switch to World Nomads travel insurance, which includes catastrophic health coverage.
Should YOU get health insurance as a digital nomad? Everything to know while making the decision
Travel insurance vs. health insurance for digital nomads
There are a few options out there if you’re looking for health insurance to cover you while living and traveling around the world. The very first thing you should know is health insurance is different from travel insurance.
“Travel insurance is designed for holidaymakers to cover cancellations, personal belongings, and emergency medical treatment, whereas international health insurance is designed to cover inpatient treatment check-ups and continuing treatment of chronic conditions abroad.” (Cigna Global)
Travel insurance like the oft-recommended World Nomads or SafetyWing plans only offers health coverage for emergency medical treatment, not for everyday stuff. It is mostly made for travel-related issues like assault, stolen belongings, or trip cancellation for a natural disaster or something like that.
Pros and cons of getting international health insurance as a digital nomad
- You can go to the doctor without worrying about the costs, in America and abroad (according to the plan you choose)
- You don’t have to worry about getting treatment if you become sick or injured in emergencies or accidents
- Premiums can be really expensive and you may not even end up needing the plan in the end
- Self-pay prices for treatment may be more affordable than paying a health insurance premium depending on the country you’re seeking treatment in
- Dealing with insurance companies and filing claims is exhausting and may take more effort than it’s worth, especially if you have a high deductible and end up paying a lot out of pocket for treatment anyways
Comparing the best international health insurance plans for expats and digital nomads
I’ve narrowed it down to the global health insurance companies that offer plans with US coverage options. Do note if you don’t care about being covered during visits home, there are other options available to you outside the ones below (and they are also probably cheaper).
How much will global health insurance cost me?
Insurance companies are notoriously shady about providing information upfront. You usually have to get in touch with a salesperson to get any real quotes, and all quotes will usually depend on
- The tier of the plan you choose
- The deductible you choose
- Your age
- Your preexisting conditions
- Your nationality
- The regions where you want coverage (In the USA or not essentially)
When I was shopping around, I encountered premiums of $300-$400 a month for a global health insurance plan that included at least some coverage in the USA, the lowest deductible option available for outpatient visits ($0 if possible), and vision and/or dental.
If you are looking for just travel insurance, you can probably find something from $30-$100 a month for your premium with a deductible of a couple hundred dollars or more.
You’ve probably heard of World Nomads; they are very popular in the travel blogger space. They offer travel medical insurance, meaning they do not cover primary health needs but just medical emergencies. You can get covered for short trips or a longer time abroad for up to 180 days at a time.
- They are backed by Nomadic Matt and Lonely Planet.
- When coronavirus became a pandemic, they sent out an email saying they may cover pandemics (depending on what you are making a claim for). Meanwhile, their competitor SafetyWing said they would not cover pandemics.
- They cover injuries sustained from motorcycling and a bunch of other adventure sports. If you want to have lots of adventurous travel fun, this is the travel insurance for you.
- You can get coverage in the US but must be at least 100 miles from your home. This doesn’t bode well if you want coverage for visits home.
- You are asked to pay for the entire term upfront.
SafetyWing offers two main types of plans: they have a Nomad Plan aimed at individuals and a Remote Health plan for groups (small businesses or startups with remote workers). The Nomad Plan is catastrophic health coverage + travel insurance while the Remote Health plan offers more health coverage like wellness visits and outpatient visits (however it still has a lot of exclusions e.g. mental health, STI’s, chronic conditions, and more).
They are offering the Remote Plan to individuals at the moment with the coronavirus pandemic in full swing, but I’m not sure if this will change down the line. It doesn’t have exclusions for pandemic coverage while the Nomad Plan does (excuse me but what kind of catastrophic plan doesn’t cover pandemics??? Is that normal?).
- Their website is more transparent with pricing and WAY more intuitive and easier to navigate than the others. They were super easy to contact through the chat function on the website.
- You can pay monthly instead of for the entire term upfront (like World Nomads). There’s no annual contract.
- You can upgrade to the Remote Plan which has more health coverage than the Nomad Plan for situations like the coronavirus pandemic.
- If you’re American, you can only get coverage in the States for 15 days at a time in any 90-day period.
- The Nomad Plan only covers emergency medical care – they do not cover preventive care, routine care, or pre-existing conditions.
- Looks like you’re looking at a deductible of at least $250 on the Nomad Plan.
Cigna Global – The best global health insurance for those who don’t want to commit for a long period of time
Cigna Global offers international primary health insurance for people who travel a lot or live abroad. They have different tiers offering different levels of coverage, including primary, preventive, and outpatient care in addition to emergency inpatient care. This is not travel insurance, but rather international health insurance.
- It is fairly easy to contact them – You can just call or email them and you do get a real person on the other end though you can end up on hold for a while first.
- You’re billed monthly and can cancel at any time. No annual commitment.
- In the USA, they cover providers in the Cigna network. This is an enormous network including most American providers.
- You can seek treatment in the US within a 180-day period out of the year
- They cover up to 15 visits a year for Acupuncture, Homeopathy, and Chinese medicine
- They offer at least $250 towards vaccinations
- They offer something called a Life Management Assistance Programme, which is 5 in-person or telephonic counseling sessions a year.
- There is a 3-month waiting period before you can claim certain benefits, like those for dental.
- It’s highly recommended you get pre-approval every time before seeking treatment.
- Some things are really unclear even after you sign up, and it may take a lot of touchpoints with their staff to accomplish something as simple as filing a claim.
- American providers have no idea how to check your benefits and you might end up paying upfront and filing for reimbursement often when seeking care in the States.
Integra Global offer two international health insurance plans for expats or digital nomads called yourLife and PremierLife.
- You can get a plan that covers the USA and Canada for up to 180 days out of the year.
- They cover some outpatient mental health treatment
- Within the USA, they do direct billing through United Healthcare, who have a fairly extensive network of providers.
- They offer plans starting at $0 deductible.
- They offer something called the Expatriate Assistance Programme, which is voice or text counseling to help with mental health issues related to travel like culture shock, work relocation stress, anxiety and depression, loneliness, and more.
- You can claim benefits for chronic conditions.
- The plans are annual terms so you are committed for a whole year, though you can choose to pay quarterly, semi-annually, or annually.
- There is a 6-month waiting period before you can claim benefits for preventive, wellness, and vision care (unless you pay annually).
- Outside the USA, you have to pay for all outpatient services upfront and then make a claim for reimbursement.
- They only cover out-of-network providers in the US at 70% and costs do not go towards your out-of-pocket maximum (though it is unlikely you will be out-of-network since UHC is a comprehensive network).
Geoblue offers a few different types of plans, including those for expats, crew members, missionaries, and educators abroad, among others. For the purposes of this post, I looked into their Xplorer plan which is made for expats. The plan is a primary health insurance plan so they cover preventive and primary care.
The Xlplorer Essential plan offers only emergency medical coverage for three nonconsecutive visits a year to the US of up to 21 days each. Their Xplorer Premier plan offers full health coverage in the US for up to 9 months.
- Their network inside the US is BlueCross BlueShield PPO which is a very extensive network accepted by many American providers.
- They partially cover mental health outpatient visits.
- They cover scuba diving and adventure sports, including scooters/motorcycles.
- You might be able to get coverage for a pre-existing condition.
- You can choose to pay, monthly, quarterly, semi-annually, or annually.
- While they do offer plans with $0 deductible, they have a sort of complicated coinsurance and copay situation (especially for any appointments within the US) that I find to be a complete mindfuck.
- The minimum enrolment period is 6 months.
Similar to Geoblue, IMG offers plans for crew members and missionaries, as well as general expats and “global citizens”. Their expat plan is called Global Medical Insurance.
- Some levels of the plan may cover pre-existing conditions.
- They cover you in the US up to 6 months out of the year.
- They are in-network for any United HealthCare provider in the US, a very big insurance company with a large network.
- You can choose to pay monthly, quarterly, semi-annually, or annually and cancel anytime.
- They have Healthy Travel Preventive coverage: $250 for vaccinations or prescriptions needed before travel.
- There’s no $0 deductible option; deductibles start at $100 and most are $250 at least.
- Some levels of the plan cover outpatient mental health visits but only after a 12-month waiting period.
- You’re responsible for a 20% coinsurance if you visit an out-of-network provider in the US.
They offer Worldwide, Worldwide excluding the USA, and Africa Only coverage plans.
- You can get $70 towards a digital health app of your choice after a 6 month waiting period.
- They have a plan especially made for families.
- Most serious/expensive procedures require pre-approval to get benefits.
- You will probably have to pay 10% or more of any outpatient specialist fees.
- Most of their plans don’t cover prescriptions??
- You have to make an annual commitment.
Aetna offers two tiers of the Mobile Healthcare Plan (MHP): MHP Classic and MHP Exclusive. As long as you live outside the US for 6 months or more out of the year, you can get 182 days of coverage within the States.
- They offer something called vHealth where you can do telephonic or video consultations with doctors through their app.
- Their US network is Aetna, which is a large and very popular network.
- It’s an annual contract, though you can choose to pay at shorter intervals.
- You only get $250 towards routine checkups and any payment are not subject to your deductible.
But Michelle, what do you recommend I do??
It depends. If you are…
Risk-averse: A primary health insurance plan (see options above) + World Nomads
To get the most coverage for both primary healthcare needs, health emergencies, and travel emergencies, I recommend choosing one of the primary health insurance plans and adding World Nomads or SafetyWing travel insurance on top of it.
Moderately risk-tolerant: World Nomads OR a catastrophic-only international health insurance plan (see options above)
If you just want travel insurance and medical emergencies covered, go for World Nomads. Note this means any primary, outpatient, or preventive care you seek will not be covered. But any travel mishaps like accidents, lost luggage, or stolen items will be covered.
Alternatively, you could get one of the international health insurance plans at the lowest level of coverage (catastrophic only) if you also want some coverage while in the States. This is probably what I’m going to do.
Risk tolerant: Fly solo baby
I mean listen: I didn’t have any health or travel insurance the first 2 years of my digital nomad journey and I felt okay about it because I was in countries where healthcare was affordable.
There are more factors that you should weigh in your decision than just your risk profile. Ultimately, you should make the decision based on…
- Your comfort with risk
- Which countries you plan to spend your time in – Will you be in countries with affordable (out-of-pocket) and quality healthcare options (e.g. Thailand)?
- Your level of health-seeking – Do you have a lot of ongoing health problems or prescriptions that you need to manage?
- If you want to be covered in the US at all
- If you plan to seek [non-emergency] healthcare in the States – Are there certain things you know you only want attended to in America? (For me, this is dentistry and dermatology. Sorry but America wins for me in these categories)
Whatever you choose to do, stay safe out there guys! The pandemic will pass and we *will* be able to travel again. When we do, it will be a good reminder for us to be prepared for anything.