Healthcare and Cruising By Michael

Several of the responses to my guest post on Get Rich Slowly (mostly an audience without a knowledge or understanding of the cruising community) asked simply, "What about health insurance?" As our departure date approaches, we are crossing one thing after another off our list(s). But one thing we haven't yet resolved is whether or not to buy health insurance (and not having health insurance does not mean not having health care).

Windy bandaged up and listening to her instructor at NOLS



In the United States, the cost of health care rightly leaves folks feeling like health insurance is an imperative. The employer-based nature of our health insurance industry leaves many folks feeling like maintaining a relationship with an employer who will make you a de facto member of a group policy, is an imperative. Furthermore, switching employers severs ties to that group and can leave you unable to join another group, should you have any pre-existing condition. Because illness and corresponding health care expenses are one path to personal bankruptcy in the U.S., it is understandable that the first mental roadblock when contemplating an adventure like ours is, "What about health insurance."

Well, we've already decided to leave the employer-based system and the only question that remains is whether or not to purchase insurance on our own, and if we do, what kind?
As I see it, there are three non-employer-based health insurance options for the U.S.-based cruiser:

• A traditional policy through a U.S.-based company like Blue Cross/Blue Shield. This can be either a policy akin to what most folks get from their employer (in terms of coverage and deductible limits) or it can be a high-deductible ($5,000 to $10,000) policy that includes defined lifetime caps.


• A traditional policy through a company based in the country we happen to be in for an extended period of time. These policies are used by cruisers who spend many months, or years, in one country. Mexico is the example I am most familiar with. In several ports of call, there are cruisers who have obtained FM3s, or long-term non-immigrant visas. They often carry insurance through Instituto Mexicano del Seguro Social (IMSS) and/or a private carrier. In both cases the costs are almost negligible.


• An international policy that provides coverage in any country. These policies are underwritten by non-U.S. companies and intended for long-term international travelers and feature high-deductibles. Not surprisingly, they universally limit to six months per calendar year the amount of time that can be spent in the U.S..

I've looked into the first option and the cost is prohibitive (roughly $7,000 per year for our family), even with a large deductible ($5,000). Even if costs were within our budget, coverage is not designed for folks who receive care outside of the U.S.. For us, this option is not really an option.

The second option, buying into the Mexican system for the time we are there, and perhaps supplementing this with a private carrier, is attractive, for the time we are in Mexico. I've read numerous accounts by cruisers in Mexico who have received excellent care, for everything from routine dental work to complicated surgeries. I have no reservations about Mexican health care for us and the total costs are comparable to what we pay in co-pays and deductibles in the U.S.. I've read that the annual cost of IMSS is $250 per person.

The third option is a popular one. I read last year on Lin and Larry Pardey's blog about their 2002 research leading them to purchase health insurance through Lifeboat Medical Insurance. Another company I read good things about is Seven Corners and their Reside plan. (Note: Seven Corners happens to also be the administrator of the Lifeboat plan, though I think the underwriters are different, and the rates for Lifeboat seem to be a bit lower, but require membership in the Charter Yacht Society, only $25) I received quotes from both companies for our family at roughly $1,800 per year (Reside) and $1,500 per year (Lifeboat), with a $5K deductible. These companies are attuned to the needs of folks of all nationalities living and travelling all over the world.

Just based on blogs I've read, I suspect there are cruisers, and even cruising families, who do not carry health care insurance of any kind. For all of my adult life it would have seemed an insane proposition: considering whether or not to maintain health insurance. Even in the early stages of planning for this lifestyle change, we assumed we'd budget for the premiums of high-deductible private health insurance (often referred to in the industry as a catastrophic plan).

But I am no longer certain we will purchase conventional health insurance, perhaps at least not right away, perhaps not for the time we are in Mexico and have access to excellent care for very low cost. What we may decide to do is to remain uninsured while in Mexico, and purchase high-deductible international coverage when we leave. (The only hitch I imagine is whether a gap in coverage will present a problem when re-entering the market.)

Too, cruisers are a self-sufficient lot, often because we have to be. If you are anchored on a remote spot in the Sea of Cortez, you will address a whole range of injuries yourself that you would not think to address in a land-based U.S. life, simply because neither an ambulance nor a drive to the hospital is an option. Windy completed a comprehensive National Outdoor Leadership School (NOLS) First Responder course last year and she is busy putting together a comprehensive medical kit, complete with prescription antibiotics and painkillers.

Additional thoughts on addressing health care as we prepare to move aboard:

• Another consideration is the period of time between quitting my job and crossing the border into Mexico. During that time, we will be doing a lot of driving and I may be able to increase the coverage for accident medical insurance on our auto policy.



http://www.diversalertnetwork.org/



• What also warrants mention is the emergency medical evacuation insurance that Divers Alert Network (DAN) provides for a nominal annual fee ($55 per year for a family). They have a stellar reputation for repatriating insureds in the event of medical trauma (emergency medical evacuation). Joining this network is on our list of things to do before we leave.


• While advances in health care technology and knowledge in the United States are impressive, I think that the system under which that technology and knowledge are administered is messed up. First, for lack of tort reform in this country, the threat of litigation forces doctors to increase the number of interventions. No matter how advanced those interventions are, they are often generally counterproductive when they are unnecessary. In 2007, I wrote about this phenomenon (that is not me in the picture) in Mothering magazine with respect to pregnancy and our decision to home birth our girls. Furthermore, unnecessary interventions increase the cost of health care, along with the high cost of premiums doctors pay to insure themselves against litigation. These self-perpetuating factors are the reason our health care costs are the highest in the world. And because they are the highest in the world, all non-U.S. based companies that provide coverage throughout the globe, restrict access to care in only one country: ours.

--MR