Health Insurance

[osirissail]

Actually they usually have up to a half dozen different "levels" of coverage with significantly different premiums. Amongst the "international" medical insurance companies the "fine print" is extremely important to read. One company with more economical premiums had a not so obvious clause where you were not covered for the first year for a pre-existing condition. Another company did not have that restriction but had slightly higher premiums. It took a month or more to dig through all the different levels of coverage and conditions and find the best company for our needs.

[goboatingnow]

In europe, where there is a private health insurance market, ( not all countries) its possible to get overseas medical coverage , including the US and most include medical repatriation ( our health system actually pays to send citizens to the US for treatment from time to time!). However the cover is usually limited to three months, so its needs a bit of trickery to keep it in place. ( they dont have any real way of determining what time you spent out of your own country anyway).

Dave

[Madwand]

In my case, I plan to leave the U.S. for good when I retire, at least until I either die onboard, or am too feeble to sail any more. When I leave, my awesome medical insurance will not cover me anywhere outside the country, unless I opt for ridiculously priced international coverage. Stupid since medical care outside the country will be so cheap. So my option seems to be to jus do without and seek private reasonably priced care at my own expense and drop my coverage. But if I do this, I cannot resume my group coverage at a later date. So it seems once I leave the country, I cannot return when I am old and in need of care. The insurance company's view is that if I am not contributing to the kitty for the 10-20 years I am cruising, I am not entitled to participate any more.

So it seems I will need to scout a nice place in some third world country to wait to die. Is this the same scenario for other retired American cruisers who cannot self insure in America?

[s/v Moondancer]

International healthcare plans | Bupa International

[osirissail]

Originally Posted by Madwand

In my case, I plan to leave the U.S. for good when I retire, at least until I either die onboard, or am too feeble to sail any more. When I leave, my awesome medical insurance will not cover me anywhere outside the country, unless I opt for ridiculously priced international coverage. Stupid since medical care outside the country will be so cheap. So my option seems to be to jus do without and seek private reasonably priced care at my own expense and drop my coverage. But if I do this, I cannot resume my group coverage at a later date. So it seems once I leave the country, I cannot return when I am old and in need of care.. . . So it seems I will need to scout a nice place in some third world country to wait to die. Is this the same scenario for other retired American cruisers who cannot self insure in America?

It isn't all that bad. But, yes, the USA internal medical insurance rarely, if ever, covers you when you are outside the USA for more than a short time - like a month or two.
- - Reasonable international medical insurance is available from the sources other posters have mentioned and through I.M.I.S. My wife's policy costs US$1500 per year for major medical coverage.
- - In the really 3rd world countries like in Central/South America and a few of the Caribbean Islands the local clinics will treat you for free or free with donation - or minor charge. But in the more modern European "out-island" territories good medical care is available but you will find steeper charges for services or even no services without international medical coverage for non-emergency problems. Also most countries have two levels of medical care - first the local clinic and general hospitals that treat the locals in basic, raw, and rarely hygenic facilities with good simple care doctors or even medical practicioners (sort of- doctors, not real ones). Then there is the "private" medical systems with modern clean facilities and the best of the island's doctors. Of course, you have to pay for this level of care. This is really what the international medical insurance policies are designed to cover.
- - Cruising without any medical insurance coverage and also letting your home country coverage lapse is quite common but not necessarily a very good idea - unless - you are a single hander and prepared to die from something that might be easily taken care of back in your home country.
- - Local medical clinics/hospitals are set up to handle and serve the local medical needs of the local population. They are not set up for the more exotic or advanced-age medical needs that are seen in major western countries like the USA, etc. So if you have medical needs for anything like advanced cancer or cardiac/vascular problems - a simple thing to care for back in your home country - you can kiss your ass goodbye. These are things the locals do not experience either because the die before they get to that stage of life or their lifestyle does not promote those types of medical conditions. It is amazing how healthy you can be when you are not subject to the paranoid stress and insanities of modern 1st world life. Also eating natural rather then manufactured, chemically or genetically altered foods really promotes good body health.
- - *But* - if you have a significant other, like a wife, and she gets sick (or vice versa) are you willing to sit on a bench in the clinic and watch her die from something easily taken care of back in your home country? I have seen this happen to cruising couples down here in the Caribbean. All of a sudden all that "saved" money from not paying to continue your home country medical insurance disappears as you can do nothing to "save" your spouse like returning home and getting advanced medical care. It becomes a whole different set of moral principles/considerations when it is not only you that is going to die due to lack of advanced medical care - but your life-long partner.

[Madwand]

That "saved" money is $30,000 over 20 years. It's not an insignificant amount. That's a pretty steep price to pay for the privilege of keeping a policy I've already paid into for 30 years. And that is just me.

My partner is currently uninsured, never has had insurance. But at least she wouldn't have to pay $30,000 just to have insurance when we got back. At least that money could go to real insurance for her.

[Doodles]

Originally Posted by Madwand

That "saved" money is $30,000 over 20 years. It's not an insignificant amount. That's a pretty steep price to pay for the privilege of keeping a policy I've already paid into for 30 years. And that is just me.

My partner is currently uninsured, never has had insurance. But at least she wouldn't have to pay $30,000 just to have insurance when we got back. At least that money could go to real insurance for her.

I may be missing something and I'm not trying to defend the insurance companies, but the $30,000 ($1,500 x 20 yrs) is for a policy different from what you have been paying into. I doubt you can get you current policy for $1,500 a year and if you can I'd jump on it.

[rebel heart]

I don't know if anyone has entertained the idea of the medical evacuation insurance plans (they normally have a picture of a rescue chopper or the inside of a small well appointed medical jet), but if you read the reviews they are horrible. To date I've yet to see a single positive experience by anyone who's actually needed to use medjet or any other similar service.

[Madwand]

Originally Posted by Doodles

I may be missing something and I'm not trying to defend the insurance companies, but the $30,000 ($1,500 x 20 yrs) is for a policy different from what you have been paying into. I doubt you can get you current policy for $1,500 a year and if you can I'd jump on it.

No, the $1500 a year is what my major medical through work costs and will cost me after I retire, somewhere around that number, if my policy even exists any more in the next ten years after the politicians are done jerking me around. That is the amount I will have to continue to pay while out of the country, even though I won't be able to use that policy outside America. I will have to pay that money in order to still be in the system IN CASE I ever come back and want to be insure here after I stop cruising.

That's all in addition to any policy that I will find that will cover me outside the states. So, in effect, I will have to have two full insurance policies on myself the entire time I am cruising. Or just not have any and rely on 3rd world medicine.

[Doodles]

Originally Posted by Madwand

No, the $1500 a year is what my major medical through work costs and will cost me after I retire, somewhere around that number, if my policy even exists any more in the next ten years after the politicians are done jerking me around. That is the amount I will have to continue to pay while out of the country, even though I won't be able to use that policy outside America. I will have to pay that money in order to still be in the system IN CASE I ever come back and want to be insure here after I stop cruising.

That's all in addition to any policy that I will find that will cover me outside the states. So, in effect, I will have to have two full insurance policies on myself the entire time I am cruising. Or just not have any and rely on 3rd world medicine.

That's a great deal and I'd hang onto it for the US coverage alone. I've got a high-deductible policy through I.M.I.S like orisisail and pay about $2,000 a year. It covers me worldwide but I need to be out of the US for a least 6 months of the year. If I need good medical services I can go to the US but I doubt the coverage is as good as what you have with your existing policy. Its all a crap shoot of course, but $1,500/year seems like an awfully good deal to me.

[Madwand]

I'm sure it's a good deal if I live in the U.S., actually, only if I live in Louisiana, but I will not be living in the U.S. I will be living all over the globe. If I have a medical emergency, I won't be travelling back to the U.S. to fix it. I'll be doing it in whatever country I'm currently living. The $1500 a year is merely a placeholder in the event I ever return to the U.S.

[hellosailor]

"That is the amount I will have to continue to pay while out of the country, even though I won't be able to use that policy outside America."
Madwand, i would be surprised if that was the case. It is most unusual for medical policies to provide coverage OUT OF YOUR AREA, forget about outside the US. If your plan in in Louisiana, you are probably "out of network" if you go to California, NY, AK, or Chicago. And "out of network" is probably the same thing as "France, China, or Istanbul".

Most insurers in the US are now writing their policies basically as HMOs do, with regional coverage only. Even Blue Cross/Blue Shield is broken down to regions, and if you step outside your region (or get hit by a bus while on vacation) you're "Out of network".

For $1500 a year, you may have no "out of network" coverage, or a $10,000 deductible if you do have it. And "major medical" is generally referred to as just that, not to be confused with full "health insurance" coverage.

[John A]

Originally Posted by Doodles

That's a great deal and I'd hang onto it for the US coverage alone. I've got a high-deductible policy through I.M.I.S like orisisail and pay about $2,000 a year. It covers me worldwide but I need to be out of the US for a least 6 months of the year. If I need good medical services I can go to the US but I doubt the coverage is as good as what you have with your existing policy. Its all a crap shoot of course, but $1,500/year seems like an awfully good deal to me.

As I've posted on other threads, the devil is in the details. I used I.M.I.S and experienced an increase each year in the $100's as I grew older. I had cancer removed from the inside of my bladder while in Trinidad opting to not pay to return to the US to pay the inflated medical costs where the deductable would equal the total cost of the surgery in Trinidad, plus storage of my boat etc, etc.
At age 63 I paid $3700 for a years medical insurance and optained approval from the insurance company for the surgery that was performed in Trinidad. Three days in a private room, surgery, and all the extras came to $5200 total. I submitted a $5000 pre-approved claim to I.M.I.S. and received a check for $1800.
The next year the premium would have been $4200, so I cancelled and went without insurance for a year. Doing so after the surgery was a hard choice but it worked out ok.
By then I'd started Social Security while cruising and as I turned 65 I started Medicare, which is payable in the USVI.s and Puerto Rico.

Always keep in mind that Insurance Companies are a for profit business.

[Madwand]

Originally Posted by hellosailor

"That is the amount I will have to continue to pay while out of the country, even though I won't be able to use that policy outside America."
Madwand, i would be surprised if that was the case. It is most unusual for medical policies to provide coverage OUT OF YOUR AREA, forget about outside the US. If your plan in in Louisiana, you are probably "out of network" if you go to California, NY, AK, or Chicago. And "out of network" is probably the same thing as "France, China, or Istanbul".

Most insurers in the US are now writing their policies basically as HMOs do, with regional coverage only. Even Blue Cross/Blue Shield is broken down to regions, and if you step outside your region (or get hit by a bus while on vacation) you're "Out of network".

For $1500 a year, you may have no "out of network" coverage, or a $10,000 deductible if you do have it. And "major medical" is generally referred to as just that, not to be confused with full "health insurance" coverage.

I don't get your point. You repeated everything I said and then told me I was wrong. I said my policy will not cover me out of Louisiana. It is a Blue Cross policy, it is a $5,000,000 medical policy, and it is useless as long as I am out of the country. But I still have to pay for it for an indeterminate time if I ever want to live in the U.S. again. I still don't get your point.

[osirissail]

Originally Posted by Madwand

. . . If I have a medical emergency, I won't be travelling back to the U.S. to fix it.

I'll be doing it in whatever country I'm currently living.

The $1500 a year is merely a placeholder in the event I ever return to the U.S.

Whether you travel back to the USA for treatment really has to do most with what the medical problem is. If it is a common problem that is also common to the local population, the local medical care system will suffice just fine. But you need to spend some time in these "other" countries to really see what they consider "adequate/normal" health-care and health-care facilities. It can be a real eye-opener.
- - That leads into the situation of only having the medical problem treated locally in the clinics. As I mentioned, most countries have virtually free medical care for their citizens as all are considered "equal." However, in all the countries there are citizens who think/believe they are "more equal" and thusly, the second tier private medical care system has evolved. This tier has very superior (to the local clinics/hospitals) medical service and costs money. This is where I mentioned the International Medical Insurance comes into play.
- - Finally - you are absolutely, completely accurate that the $1500/year is a place-holder. Be it medical insurance or automobile insurance or boat insurance, once you terminate an existing coverage and drop out of the system - getting back in again puts you first into the "high-risk, high premium" pools. That is if you can even get coverage. (We will have to wait more than a few years to see how the new insurance reform laws play out. Nobody knows now how that will evolve.)
- - And basically in the USA at age 65 all "private/company" medical coverage terminates and you transfer into Medicare. Depending upon your finances you pay for that privilege and then have to fork up significantly more money to buy the "supplemental coverages." Failure to do so - I believe - forfeits your ability to get into Medicare later in life. And no private insurance company will touch you at the advanced age. This is where living outside the USA is almost mandatory if you want to have any access to medical care if you opted out of Medicare.
- - Again, the basic tenet of the cruising lifestyle is that you are totally in charge of your existence - life or death and the path between is "captained" by you. But what about your spouse/life-partner? Are you comfortable telling her she will just have to die because you will not maintain a "place-holder" that includes her? (This supposes the spouse/life partner is also of your nationality and was in the past eligible or had medical coverage.)