This is the second most common question I am asked about our lifestyle of cruising on a small sailboat. (After, “What do you actually DO all day?”) Short answer is – It’s complicated! We aren’t old enough to be covered by Medicare. And I’m not daring enough to go uninsured, especially because we still spend several months in the USA each year. I worry that one car accident and the resulting hospital stay could bankrupt us if we don’t have insurance for the US. So I’ve spent countless hours researching options that provide the right balance of cost and coverage for two fairly healthy folks in our 40’s.

When we first quit our jobs in September 2017, we were given the option to continue our Cigna health insurance by paying for it ourselves via COBRA. But that was CRAZY expensive – on the order of $1500 per month for two people. So I didn’t even consider it. Instead, I went on the Healthcare.gov web site and signed up for a high-deductible ACA bronze plan through Florida Blue. And every month that we were in the US, I walked into a CVS and paid in person, because that’s the only method that allowed me to pay via credit card and earn cash back. Outside the US, I paid on-line. Since I hadn’t set up automatic payments, I really noticed how much money I was spending each month on something that provided very little value and that I hoped I never had to use. In 2017 this bronze plan cost about $750 per month, and in 2018 in increased to about $850 per month. Because of the high deductible, I had no intention of going to the doctor unless it was a real emergency. But I’m grateful to my friend Uta who is pursuing an degree in healthcare policy for reminding me of the various preventive procedures covered at no cost by an ACA plan. Once I figured that out, I made sure that Capt. Mike and I got our money’s worth. I researched my insurance company’s preferred (lowest cost) provider and made appointments for both of us to get annual exams including a thorough set of blood tests, and our cancer screenings. I take two prescription medications; one for thyroid, and one for arthritis pain relief. Both are available as generics, and I learned that it’s cheaper to pay out of pocket at Walmart for generic prescriptions than to use prescription insurance – almost half the cost. As an added bonus, the pharmacy will fill all of your refills at once if you pay out of pocket, rather than only a 90-day supply using prescription insurance.

But in 2019 the cost of my bronze plan went up significantly, and I could no longer justify the cost. Back to the internet to research other options! Travel insurance wouldn’t work, because it’s designed to treat the emergency wherever it occurs, but then to get you back to your home as soon as possible for the bulk of your medical care. And since I wouldn’t have US medical insurance, getting sent “home” wouldn’t help. So instead, I signed up for an international medical insurance policy with IMG. To qualify, we needed to live outside the US for at least six months of the year. No problem! It’s an underwritten policy, which means I had to fill out a detailed health history form and the provider decides whether to issue us a policy, based on level of risk. It’s also not an ACA plan, so it doesn’t cover all preventative care or pre-existing conditions (my arthritic knees) but it DOES cover accidents and illness both inside and outside the US. And it’s a renewable policy. So if one of us gets diagnosed with cancer while we are insured, that’s not considered a pre-existing condition, and we won’t be denied coverage as long as we keep renewing the policy. IMG provides an advise nurse, and a health concierge, and several other handy services, and does provide expatriation in case we ever have an accident someplace that doesn’t have adequate health care facilities. I could afford to choose a much lower deductible than under my old ACA plan – With a $1000 deductible, we now pay $2500 per year to cover both of us. That’s a huge difference in premium cost! And when I do need to get those darn knees taken care of, I’ll pay out of pocket in a country like Thailand that specializes in medical tourism using the money I’ve saved from lower premiums. I still hope not to need this insurance, but I’m not longer sick at heart every month when the bill comes due.

What about dental? Well for the past two years, I’ve bought a Groupon for new patient cleaning and x-rays for less than $50 per person. Last year they even threw in teeth whitening strips! I’m pretty sure I’ll need a crown replaced soon, so I’ve researched a dental discount plan that negotiates 25% to 50% discounts on dental work when you pay out of pocket rather than filing for insurance. I found a plan that allows you to pay for a month at a time and cancel at any time rather than signing up for a whole year. For medications that don’t come in as generics, I’ve learned that there are prescription discount plans and that some drug manufacturers even offer coupons right on their websites. And of course, there’s always Mexico.

Vision? Another discount plan that charges $50 for an eye exam. And then I get my prescription glasses and sunglasses through Warby Parker. They are MUCH cheaper than glasses from an optometrist’s office, and the quality, style, and customer service are fantastic.

Did I mention that we donated blood for the snacks, and for enough Walmart gift cards to buy a set of Mexican train dominos? Ok, I might have lost a few of you there.So basically, I’ve learned to be my own advocate and to research the cost of EVERYTHING before making an appointment. It’s eye opening to realize how much the cost of every procedure varies between regions of the country and between providers.

Boat insurance? Now that’s a topic for another looooong blog post!