One of the concerns of many cruisers (and their land-lubbing family and friends) is medical care and health insurance while cruising. After reading hundreds of blog posts I have come to the conclusion that there is no consensus, but rather a wide spectrum of ideas on what is the best and safest way to cruise. On one end of the spectrum are those that feel going without health insurance will surely bring about catastrophic results, both health-wise and financially. At the other end of the spectrum are those who think health insurance is an expensive ruse and would rather take their chances going without than spend a dollar for something they will probably (hopefully) never use. While these are the extremes, most cruisers seem to be somewhere in the middle of the spectrum, wanting some form of coverage for catastrophic health issues, but also not wanting to break the bank for comprehensive coverage.
While one can never know when a major illness will strike or an anaconda will bite off your arm, one’s health is a personal project that needs a reasonable amount of attention. Regular physicals with blood work, mammograms, colonoscopies, and other preventative care should be part of every cruiser’s itinerary. One must take responsibility for their own well-being, and monies should be earmarked for these procedures in every cruiser’s budget. On the same note, we should strive to eat a healthy diet and get in a fair amount of exercise. Not only do these things help the physical body, they also help alleviate stress, depression and other mental health issues.
There are many ways to insure that you will be covered in case you have a medical emergency on-board or in a foreign country, but you need to be sure that you understand the different types of policies and riders before you invest in a particular plan. In this post I will lay out a variety of options for dealing with medical costs, both planned and unplanned, while cruising. These options are geared for U.S. full-time, world cruisers rather than weekend sailors, as many policies require you to be away from the U.S. for a specific amount of time (generally 6 months) to guarantee coverage. Taking into account your own medical history and comfort level, as well as the availability of good (sometimes better) care in foreign countries at prices 40-90% cheaper than in the U.S., I hope that this post helps you navigate the available options.
Self-Insure – i.e. No Insurance: On the far end of the spectrum lies the folks who are true risk takers, gamblers if you will. These cruisers have decided, either by choice or by financial constraints, that they will not purchase any health insurance policies. Many cruisers in this category feel that they are young and healthy, with no pre-existing conditions. Health insurance, may seem, like a waste of money for some who see health care as much more affordable in locations outside of the U.S.. The self-insured usually have a pool of money set aside for minor medical expenses, though many realize that one large medical bill would end their dreams of cruising.
High Deductible Health Plans – A few cruisers mentioned specific HDHP’s to which they subscribe. Some cruisers believe it is important to keep continuous health care coverage while you cruise to avoid being placed in the high-risk pool. Hopefully this fear will be resolved with the Affordable Care Act. Others simply enjoy the security of knowing if they sustained an injury or illness that required long-term or complicated care, that they would be covered. These plans would require you to return to the states for care, which would not be helpful in a critical situation. Here are a few examples of plans discussed on cruiser boards:
Blue Cross Blue Shield – one couple mentioned their policy was $158 per month which covered them both and had a $8,000 deductible.
State Farm – one couple mentioned their policy was about $10000 a year with a $5000 deductible.
I was not able to find benefit information for travel and coverage outside of the USA for either of these insurers.
HSA – If you have a High Deductible Health Plan you could establish an HSA in the years before cruising. HDHP deductible must be $1250 for single coverage or $2,500 for a family. HSA accounts are set up for, and can only be used for, future health care costs (for you, your spouse or dependents). It is a great way for folks who typically do not have high medical bills to sock away funds with tax benefits (and anyone can contribute to this fund – put this on your x-mas wish list!). You can put in $3,250 per year as a single and $6,450 as a family (if you over 55 you can add an additional $1K). Monies roll over from year to year until you use them and the interest on the account is tax-free. Distributions for qualified medical expenses are tax-free and an HSA is portable, so it stays with you even if you change jobs or leave for cruising. An added bonus is that HSA funds can be used for anything after age 65. Many cruisers opt to use an HSA for minor medical expenses while counting on a high deductible insurance policy for catastrophic coverage.
Medical Evacuation Coverage – Many cruisers purchase a membership with the Divers Alert Network or DAN. While this is not a substitute for actual medical insurance, the $35 single / $55 family yearly membership does include $100K in medical evacuation coverage, which includes non-diving medical emergencies. Evacuation coverage begins when you travel at least 50 miles from home. This type of coverage would be used to get you or a family member back to the USA in the event that you have a very unusual or complicated medical issue that could not be treated locally. Your HDHP would then kick in to cover your medical care.
International Comprehensive Medical Coverage – these plans offer a variety of benefits, including medical, dental and vision as well as political evacuation and repatriation, mental health, maternity, and remote transportation coverage. The benefits vary according to the policy type, so be sure to check the fine print. Pre-existing conditions may be an issue for some of these plans. These plans must be purchased within a short time frame before you plan to depart, usually 45 days.
International Citizens Series Platinum Health Plan –
Below are a few examples of annual premiums for worldwide coverage-
Including the USA/Canada
40-44 $100 deductible M-$5,140 / F $8,855
40-44 $2,500 deductible M-$3,075 / F $5,186
Excluding the USA/Canada
40-44 $100 deductible M – $4, 019 / F $6,805
40-44 $2,500 deductible M-$2,453 / F $4,039
Click here for more premium info.
This plan offers $8M in coverage benefits, including medical, dental and vision, political evacuation and repatriation, mental health, maternity, and remote transportation coverage. According to the website “US Citizens have to plan to depart the USA within 30 days of their application and reside outside the USA for at least 6 months of the year, non-US citizens can purchase coverage for anywhere in the world.”
Lifeboat Medical Insurance World Health Insurance
– This is the plan that Larry and Lin Pardey bought back in 2002. Though they cruised for 35+ years without coverage, they decided to get insurance for their “golden years” (they were 58 and 62). You can check out Lin’s post about insurance here. With this policy, insured persons must reside outside the United States for at least 180 days out of any given 364 day policy period. Click here for more premium info.
Below are a few examples for annual premiums based on age and deductible:
Age 40-44 – $1000 deductible M-$1,185/ F-$1,341
Age 40-44 – $5000 deductible M-$853 / F-$965
Age 50-54 – $1000 deductible M-$1,598 / F-$1,685
Age 50-54 – $5000 deductible M-$1,146 / F-$1,210
This plan offers $5M in coverage benefits including medical, mental health, chiropractic, and dental accident.
GeoBlue – offered through US Sailing: Offers world-wide coverage with no lifetime maximums, 100% coverage outside of the US and 80% coverage in the US with in-network providers and a $5000 deductible. Below are examples of a few monthly premiums:
Single, under 30-$162
Single 30-49 – $251
Single 50-64 $485
Single + one – under 30 – $429
Single + one 30-49 – $725
For more premium info click here.
Benefits Summary available here:
International Marine Insurance Services – a collective of insurance providers, a few are listed below:
Meridian Basic and Enhanced Plans – worldwide coverage including US and Canada
Basic plan premium examples:
Age 40-44 $ 250 deductible M $1,166 / F $1,609
Age 40-44 $ 5,000 deductible M $526 / F $745
This plan offers a $2M Max Limit, wellness, prescriptions, medical evacuation, and ambulance benefits. They also have an enhanced plan that covers up to $5M plus vision, dental, and benefits.
For more info here.
Expatriate Medical: Global Citizen
The U.S. Department of State also offers a website with a listing of insurance companies who offer policies for international travelers here.