Health Insurance ?

[Therapy]

Originally Posted by hellosailor

With medevac services, get a copy of the contract (a sample of what your policy will be) and look for gotchas between different companies. $ caps or exclusions. And once you've picked one, READ your actual policy to make sure that is the same thing as what they claim to sell you. (Ditto for any insurance, not just medevac.)

I have recently found that I am not really smart enough to read one of those things and be able to interpret it correctly.

[hellosailor]

Well, they DO spend a lot of money hiring experts in incomprehensibility in order to write and print them exactly the way they do.

I understand that one of the earmarks in the ObamaCare Bill calls for each insurer to supply an espresso machine, locked and loaded, along with each contract. (WEG)

[Extemporaneous]

If you think that you've understood me, obviously I've misspoke.

Extemp.

[bobfnbw]

As far as the idea of heath care in the US is concerned.
I have been in that biz for over 28 years, same as my wife too.
What I can tell you is that it is not health care really here. It is disease care. There are many reasons for it, I guess. But the truth is that there is a "LOT" of money to be made in it. And we all know that if you want to make money, come to america. It is the ultimate capitalist society. Now I don't have nothing bad to say about making a honest living. Its pretty important. But to make th OBCENE amounts that these corporations make, and that is the hospital, insurance, drug companies, etc that participate in it, along with all the so called leaders of this country that allow them to do it because they to get a piece of the pie... it is unconscietable. (sorry for the bad spelling, no spell check on this computer)

So what is a cruiser to do in this day and age?

My suguestions is first to arm yourself with knoweldge and a great med kit on board for emergencies. Make sure you can treat youself or others for the common types of medical emergencies you might encounter, and the knowledge of how to do it. Take a cpr course, a basic and advance first aid course, have good reference materials on board. And a lot of drugs, preferably purchased outside the US. Cause if you get them here, it will break you. Make sure you have prescriptions for the ones you need it for. Keep track of the expiraton dates are replace them as needed. Vacuum seal them. Same goes for bandage materials. Get a pelican case to put this stuff in as its the best for it. Keep it handy. No sense in having a ultimate med kit if it is unaccessable when you need it.

As previous posters have said, the best form of insurance is keeping yourself healthy. Do not smoke. Do not drink alcohol in excess. Exercise on a regular basis. Manage stress. Do not take unnecessary risks. The older you get the more time it takes to heal. Know your family history. If you know you have heart disease in your family, or diabetes, get checked more often. Get a automatic blood pressure machine. Check it often. Get a glucose machine if you have a tendency towards diabetes. Know what works and what doesn't with alternative medicine (that is almost impossible I agree because it's always changing but still keep up on it as much as possible.)
Do not go for medical proceedures that are not necessary. Do not get surgerys that you can avoid. If your knees are bad loose the weight first. Then if its still bad, get it done. Same goes for back surgery. In many instances its a more than a waste of time and money, it can make you worse. Hospitals are bad places to be unless you really need to be there.

When its time for things you cannot handle yourself, seek medical attention. You will find good quality care outside the US in many places for a lot less money than here. Insurance in most cases I believe is unnecessary. Its funny that at a time when many people are trying to get into the US, many americans are going overseas for medical treatments. Expensive surgery like heart bypass, laser eye surgery, and a host of others I am sure can be done at a lot less cost overseas.
And before you think, yea sure, until the complications set it... remember that you can be at the best hospital in the US, with the best medical team there is, and still have complications. Happens every day.
Sometimes there is not a easy answer. Its a shame in this country that we have a system that is profit driven, not heath driven. But that is what it is. It is up to each one of us to work with it.

I, when I get to go, will have my own insurance policy, say 10-25K, in a account that will be used for medical emergencies only. I will make sure my kit is fully stocked. I will try to exercise regulary, and drink lightly.
I will get my teeth either fixed or removed prior to leaving. (in Mexico)(can't have dental emergencies if you don't have any lol...)
Anything other than that is chance, and you cannot plan for that.

Bob

[Pelagic]

best advice yet

[bloodhunter]

My wife and I do local and coastal cruising but so far have not done any extended (six months+) cruises. However, we plan to change that situation in two years.
But we have one health problem -- my wife has type-one brittle diabetes. In type-one diabetes the body produces no insulin, brittle means that her blood sugar levels can spike or plummet for no apparent reason. She controls her blood sugar using an external insulin pump (she was just able to get one that is truly waterproof). The supplies for these pumps, including insulin, run about 10k a year. Otherwise we both are in very good shape physically and mentally.
Because of my wifes condition, we are unlikely to go on any long-distance cruises to remote areas (like the South Pacific) where the extended delay in getting medical service could be very dangerous. But we have coastal cruising, the entire Caribbean and Bermuda and exploring those areas should take us at least two lifetimes. Since we get her supplies on a quarterly basis and Animas, the company that makes her pump, tells me they can be shipped my question is two-fold:
1) is there a way we can set up something in advance so these shipments can be held on one of the islands --- say Nevis -- since we really like it there and plan to go back and 2) what are the facilities the we can count on if we have to deal with an emergency. Hoping some you folk who either live in Caribbean or have done extended cruising there will be able to answer
thanks
Azi

[bobfnbw]

Don't know the answer to your questions, but I am pretty sure that you can manage her diabetes pretty well no matter where you are.
As you probably know, diabetes is a treatable condition. She needs to monitor her blood glucose levels closely, and that means before every meal and at bedtime to check her sugars. and then adjust her insulin levels to keep her glucose levels with in normals, or between 70-110 or so. Some physicians will want her to keep them higher, but that is not the best way. Keep it lower. She needs to understand her own body and metabolism for it to work well for her.
Consistent diet is key, as is consistent exercise. That would be done by moderation. And knowing what foods are best for her to eat. Eating out is not a good idea until she knows how it all works for her. Once she is maintaining herself, then it should not be a issue, unless you run out of supplies. Don't let that happen. Also infection is very dificult for diabetic patients, so she needs to be hyper alert for that. Do not go into water without water shoes for instance. Watch the toenails. Etc.
As far as getting supplies sent to you, it should not be to much of a issue, just expensive. Get a phone number of marinas there. They should be able to accept a package for you. Just make sure it is sent around the time you are there. You don't want meds sitting in a hot office somewhere for months.

Hope that helps.
Bob

[bloodhunter]

Bob,
Thanks. Contacting the marinas is a good idea. Laura has had diabetes for 38 years following its sudden onset. Seems type-1 runs in her family. Because it's the brittle kind she tests 10-12 times a day. She's also part of a long-term test trying to determine how brittle diabetes works.

[hellosailor]

And remember, Bob, to keep a couple of chickens, pigs or sheep onboard. Because in some countries...they don't take American Express. Even the best doctors will haggle over how many chickens an annual visit is worth.

What's that? My copay is THREE chickens! that's outrageous!

[scallywag]

Very interesting posts--just remember what comes off the top of salary is not computed in Social Security Benefits or in Fl State Retirement Benefits. Watch the type of Health Savings Accounts. The one offered to me had a yearly limit of $3,000 and if you did not use it in that year, you lost all of your money in the account. I did not realize a blow to the teeth would cause the teeth to fall out 50 years later. The dental work was $4,000 in the states. I was not aware it could have been done cheaper in Mexico or Central America.
John

[Therapy]

Originally Posted by scallywag

The one offered to me had a yearly limit of $3,000 and if you did not use it in that year, you lost all of your money in the account.

Florida health savings accounts are different now.

You will no longer lose your money at the end of the year. It stays. And you can add the same amount (or whatever they determine is the max amount for that year will be) to the account.
Now it is truly a health "savings" account.

[Brent Swain]

Greece spends roughly $400 a year per capita on health care, Spain spends roughly $800. Both Greece and Spain have a higher life expectancy than the US. 40% of the diagnosis in the US are wrong. In 1976, when LA doctors went on strike , the death rate declined noticeably.

[sailorboy1]

Originally Posted by Brent Swain

In 1976, when LA doctors went on strike , the death rate declined noticeably.

Maybe just because no one was available to declare someone as dead.

[hellosailor]

From one of many similar web posts:

The Straight Dope: When doctors go on strike does the death rate go down?

" But the way this "fact" about doctors' strikes gets passed around suggests that a lot more people are a little more nuts than you'd want to imagine. ...

• One example often cited is that of a monthlong strike by Los Angeles County physicians in 1976, during which the mortality rate for patients was seen to drop by 18 percent. But a 1979 study in the American Journal of Public Health showed that the overall area death rate remained unchanged, as enough personnel remained on duty to handle the real emergencies. Any seeming benefit to patients' health likely resulted from about 11,000 fewer operations (presumably elective) being performed that month than was typical, meaning that an estimated 50 to 150 patients who could have been expected to die didn't."

Statistics are like water. They can kill you or save you, and if someone takes it at face value, they'll only get wet.

To analyze a statistic as far up the food chain as an overall death rate, you'd have to analyze everything that happened in LA in that month. Including heat waves, earthquakes, race riots, and the normal change in monthly birth rates and deaths, which have their own annual peaks and lows based on other things.

[YOGAO]

Originally Posted by bloodhunter

...But we have one health problem -- my wife has type-one brittle diabetes.

Every Type 1's diabetes is a little different, your wife's included.

FWIW, I am also a T1. I am living on a boat currently in the Eastern Caribbean, and have been away from a marina since 2006.

I use an insulin pump that is waterproof, plus I have a back-up pump designed to run for up to 6 months if my current pump dies (this happened last January in the USVI).

Supplies - Insulin - I was able to get a full year's supply of insulin (an insurance error in my favor) on a visit to the US over the summer, so as long as the refrigeration keeps working I'm OK there. Most of the islands will have the ability for you to purchase insulin since diabetics are everywhere.

Pump supplies - I got re-stocked with the various supplies for about 5 months in the summer. When we have friends or family visit, I have supplies shipped to them in advance. As an alternative, I can have the supplies shipped directly to a mailing address such as marinas or yacht clubs or local companies that specialize in receiving your mail/packages. They are generally happy to help; some may charge a nominal fee and you might be subject to duty in other countries, but you should be able to plan around this. I am sure you can do this in Nevis (heck, you can probably get HUD3 to receive the stuff for you).

Carry at least one extra meter that uses the same test strips as the current one.

Glucose tablets - go on-line and order in jars of 50. I normally get 10 at a time.

You can also now buy kits/meters to test your A1C.

$10K/year?? PM/email me if you like, because unless your wife is using a huge amount of insulin, that sounds way high!

Lastly, a bit of diabetic indignation - there is no such condition as "brittle" diabetes. Stop using this term!

Fair Winds,
Mike