After deciding how to handle your housing situation, healthcare may be the largest hurdle to cross when deciding on an around the world trip. At least with selling or renting a home, you can estimate your costs. With healthcare there’s a huge unknown cost—nobody has any idea what healthcare services cost until they receive the bill a month or two later. Even then, with the breakdown between the initial charge, the insurance coverage, and what you pay, you still lack full comprehension of healthcare costs.
Healthcare is a major financial burden in the U.S., even if you have health insurance through your employer and are living debt free. I’ve always had a small fear of losing my job and living without health insurance for a few weeks, let alone a year or two without health insurance coverage while traveling.
I think the U.S. healthcare cost uncertainty is the primary reason why there are more Canadians, Europeans, and Australians traveling around the world. If you are 24 and don’t worry about the healthcare costs should you be diagnosed with a disease, it makes it easier to quit your job and travel for three months, six months, or a year at a time. If you are an American, you do not have the healthcare backstop that citizens of other first-world countries enjoy. Fortunately, there're a few healthcare basics that can reduce the fear before heading out on the road.
A few caveats:
Healthcare is a major financial burden in the U.S., even if you have health insurance through your employer and are living debt free. I’ve always had a small fear of losing my job and living without health insurance for a few weeks, let alone a year or two without health insurance coverage while traveling.
I think the U.S. healthcare cost uncertainty is the primary reason why there are more Canadians, Europeans, and Australians traveling around the world. If you are 24 and don’t worry about the healthcare costs should you be diagnosed with a disease, it makes it easier to quit your job and travel for three months, six months, or a year at a time. If you are an American, you do not have the healthcare backstop that citizens of other first-world countries enjoy. Fortunately, there're a few healthcare basics that can reduce the fear before heading out on the road.
A few caveats:
- I don’t know your health insurance or company plan specifics.
- I’ve been fortunate to enjoy a healthy life. I’m not an expert on any individual medical conditions and do not have anecdotes on how to cope with specific diseases while traveling. If you have a condition or a chronic disease, like diabetes, people have traveled around the world with these diseases and will have specific guidance on how to handle the disease while traveling.
- I address travel insurance in its own entry in The Buildup section.
HEALTHCARE ACTION BEFORE YOU LEAVE
The best healthcare is preventive action. Do not wait until the final few weeks before the trip to get a physical, dental cleaning or other annual health checkups. I addressed these healthcare activities six weeks prior to leaving to provide adequate time to address any potential conditions that would require follow-up work. I also had health and dental insurance that made incurring these costs more palatable. With insurance, a $200 teeth cleaning in California was only $20 out-of-pocket at the time of the visit. You don’t need dental insurance when you travel because dental services are cheaper outside of the U.S. and in countries like Singapore, South Korea, and Japan, of equal quality. Teeth cleanings in these countries cost less than $50. Find a dentist who understands English.
FLEXIBLE SPENDING ACCOUNTS
A quick comparison between the two primary healthcare bank accounts—Flexible Spending Accounts and Healthcare Savings Accounts. With a Flexible Spending Account your monthly contributions are pooled with other employees into a company-wide savings account. When you spend money, you need to submit a receipt to either validate the expense or claim reimbursement. A Healthcare Savings Account deposits money into your bank account with the requirement that the funds be spent on healthcare expenses. It’s your money.
If your company provides and you contribute to a Flexible Spending Account, it's wise to spend up to your contribution amount. The way this system works, is you lose the money you contributed but don't spend. The inverse is also true, that you may spend money which you haven't contributed. From a system-wide standpoint, the two extremes balance each other. From an individual standpoint, it’s better to address your medical concerns at the start of the year and leave for your trip in January or February rather than hitting the road in August or September with unspent funds. For example, if you have already purchased contact lenses in the current year and will need a new supply in the upcoming year for the around the world trip, electing to contribute to a Flexible Spending Account for the upcoming year will allow you to purchase another year supply of contacts at the start of the New Year—even though two weeks into the year, your actual contributions will not cover the purchase, you may still complete the transaction and be reimbursed for the entire purchase. If you already have enough contact lens, purchase a new pair of glasses. Follow a similar course for any medications—purchase a year supply in November or December, then purchase another year supply in January or February. You will have two years of supplies instead of one.
HEALTHCARE SAVINGS ACCOUNTS
Healthcare Savings Accounts operate differently than the Flexible Spending Accounts in that the money contributed is your money. It’s money in your bank account. It’s money you can take with you to a new employer or keep in your bank account while you are traveling. There’s no rush to spend the money for the sake of otherwise losing it. The money will be in your account when you return.
OVER-THE-COUNTER MEDICATIONS
Tylenol, Neosporin, and similar types of medication that are available over-the-counter in the U.S. may not available over-the-counter in foreign countries. If you have a strong preference for a brand or type of medication, purchase the item prior to departure.
RETURN TO THE U.S.
When you return to the U.S., you will likely qualify for Medicaid because you have no income and no savings. Effectively, you become a Canadian, European, or Australian. I provide more details on the Medicaid and healthcare options when you return to the U.S. in a later chapter.
EARLY RETIREMENT, THEN LIVE INTERNATIONALLY
Since returning home, I’ve given thought to retiring early and I run into the same issue I did when I was planning an around the world trip—how do I handle healthcare? There’s a higher risk I am diagnosed with cancer between the ages of 50 and 65 than when I was 33. Bloggers who have retired early and provide advice on how to follow their decision never fully explain their healthcare situation. I’ve spent hours Googling and am always left asking the same question—what are the specifics? People say it can be done. Tell me your healthcare company, tell me how much you pay for insurance per month, tell me your copays, tell me what services are covered, and tell me how this works if you have a wife and children. Would anyone who has figured this out be willing to share? Anybody?
My favorite article on how to handle your healthcare if you retire early came from Forbes. They listed four options:
If these don’t work Forbes recommended:
Looks like I’ll be working until I’m 67.
The best healthcare is preventive action. Do not wait until the final few weeks before the trip to get a physical, dental cleaning or other annual health checkups. I addressed these healthcare activities six weeks prior to leaving to provide adequate time to address any potential conditions that would require follow-up work. I also had health and dental insurance that made incurring these costs more palatable. With insurance, a $200 teeth cleaning in California was only $20 out-of-pocket at the time of the visit. You don’t need dental insurance when you travel because dental services are cheaper outside of the U.S. and in countries like Singapore, South Korea, and Japan, of equal quality. Teeth cleanings in these countries cost less than $50. Find a dentist who understands English.
FLEXIBLE SPENDING ACCOUNTS
A quick comparison between the two primary healthcare bank accounts—Flexible Spending Accounts and Healthcare Savings Accounts. With a Flexible Spending Account your monthly contributions are pooled with other employees into a company-wide savings account. When you spend money, you need to submit a receipt to either validate the expense or claim reimbursement. A Healthcare Savings Account deposits money into your bank account with the requirement that the funds be spent on healthcare expenses. It’s your money.
If your company provides and you contribute to a Flexible Spending Account, it's wise to spend up to your contribution amount. The way this system works, is you lose the money you contributed but don't spend. The inverse is also true, that you may spend money which you haven't contributed. From a system-wide standpoint, the two extremes balance each other. From an individual standpoint, it’s better to address your medical concerns at the start of the year and leave for your trip in January or February rather than hitting the road in August or September with unspent funds. For example, if you have already purchased contact lenses in the current year and will need a new supply in the upcoming year for the around the world trip, electing to contribute to a Flexible Spending Account for the upcoming year will allow you to purchase another year supply of contacts at the start of the New Year—even though two weeks into the year, your actual contributions will not cover the purchase, you may still complete the transaction and be reimbursed for the entire purchase. If you already have enough contact lens, purchase a new pair of glasses. Follow a similar course for any medications—purchase a year supply in November or December, then purchase another year supply in January or February. You will have two years of supplies instead of one.
HEALTHCARE SAVINGS ACCOUNTS
Healthcare Savings Accounts operate differently than the Flexible Spending Accounts in that the money contributed is your money. It’s money in your bank account. It’s money you can take with you to a new employer or keep in your bank account while you are traveling. There’s no rush to spend the money for the sake of otherwise losing it. The money will be in your account when you return.
OVER-THE-COUNTER MEDICATIONS
Tylenol, Neosporin, and similar types of medication that are available over-the-counter in the U.S. may not available over-the-counter in foreign countries. If you have a strong preference for a brand or type of medication, purchase the item prior to departure.
RETURN TO THE U.S.
When you return to the U.S., you will likely qualify for Medicaid because you have no income and no savings. Effectively, you become a Canadian, European, or Australian. I provide more details on the Medicaid and healthcare options when you return to the U.S. in a later chapter.
EARLY RETIREMENT, THEN LIVE INTERNATIONALLY
Since returning home, I’ve given thought to retiring early and I run into the same issue I did when I was planning an around the world trip—how do I handle healthcare? There’s a higher risk I am diagnosed with cancer between the ages of 50 and 65 than when I was 33. Bloggers who have retired early and provide advice on how to follow their decision never fully explain their healthcare situation. I’ve spent hours Googling and am always left asking the same question—what are the specifics? People say it can be done. Tell me your healthcare company, tell me how much you pay for insurance per month, tell me your copays, tell me what services are covered, and tell me how this works if you have a wife and children. Would anyone who has figured this out be willing to share? Anybody?
My favorite article on how to handle your healthcare if you retire early came from Forbes. They listed four options:
- Downshift, find a part-time job that offers healthcare; that’s not retiring early and what part-time job offers full benefits like healthcare?
- Go on your spouse’s insurance; I’d like my spouse to retire too
- Enroll in COBRA for 18 months; So I can retire 18 months early?
- Enroll in ACA; The only real option and it is being eliminated
If these don’t work Forbes recommended:
- Move states; Cool
- Move to a cheaper country; Isn’t America the Greatest Country…Ever? (This isn’t as easy as it seems because to obtain insurance you will need to have residency in a country, which means you’ll need to have a visa, which means you’ll need to be working in that country, which means you aren’t retired)
- Change citizenship; Now we are talking!
Looks like I’ll be working until I’m 67.