Courtesy of FreeDigitalPhotos.net
EverywhereOnce isn’t a political blog, and this isn’t a political post. Health insurance, for us, isn’t a political matter but a practical one.
Of all the things we had to consider when preparing to hit the road full-time, how to manage health care costs was not only the most significant but also the most unpredictable.
In 2010, when we left behind our Mega Corp provided health insurance coverage and surrendered ourselves to the tender mercies of the individual insurance market, we couldn’t guarantee we’d even be sold an individual policy. Now that we have one, we can’t be sure it will actually be honored if ever we get expensively sick—despite paying hefty premiums each and every month.
We’ve written before about the special challenges we faced in trying to obtain health insurance without a physical address. We worried, and still worry, about our insurance company’s ability to declare our application fraudulent because we don’t actually live in our state of declared residency – or any state for that matter. Being citizens of the U.S. should be sufficient to buy a U.S. health insurance policy, but alas, it is not.
Total Recall?
We similarly worry that our insurer could cancel our policy if there are any errors or unintended omissions in the five years of medical history our insurance application required us to provide. And we were lucky. Many companies required 10 year histories.
It’s not clear to us how anyone could be confident in their ability to perfectly recall a decade’s worth of medical details. We therefore don’t know how anyone required to produce that information as a condition for an insurance policy can be confident in the reliability of that insurance. We know we aren’t.
These are not trivial concerns.
If we were to lose our health insurance after we got sick for these reasons, or any other, we’d most likely be unable to get a replacement policy under the existing system. Given the cost of U.S. care it is no exaggeration to say that hundreds of thousands of dollars potentially hang in the balance. And that is true even for people like us who are desperately trying to play by all the rules and do everything right.
Warts and All
For all of its warts, the Affordable Care Act (a.k.a. “ObamaCare”) fixes these concerns. Without the ability to deny coverage for pre-existing conditions our medical history is totally irrelevant. It even makes our state residency status mostly irrelevant, too. While our existing insurance company could still question the legitimacy of our legal address, starting in 2014 we’ll have no concern about getting a replacement policy.
ACA fixes other, smaller concerns of ours too. As explained in our How to Become a Global Citizen article, we became legal Texas residents when we started traveling full time. It was a practical decision made because Texas has special services and a legal history favorable to our vagabonding lifestyle. We have Texas driver’s licenses. It’s where we register our vehicles. We vote in Texas, and our health insurance is a Texas policy.
We don’t actually live in Texas, though. We don’t really live anywhere. Texas is just where our legal lives are domiciled. If we want to stop traveling some day, Texas isn’t necessarily where we’d choose to settle down. But if one of us develops a medical condition, we might not have any other choice.
Because health insurance is regulated at the state level, our Texas policy only covers us as long as we’re Texas residents. We have no right to maintain our existing policy if we move to a different state, even if our insurance company also operates in that state. In order to live where we want, we’d have to re-apply for a new policy in our new state. Absent the Affordable Care Act, that might mean foregoing coverage of pre-existing conditions we’ve developed or potentially not getting insurance at all.
Freedom of Movement
In other words, if one of us were to get chronically sick, we might not have any choice but to live in Texas. Under the Affordable Care Act, we can move to any state in the union and purchase a policy off an exchange.
For those who see this issue in terms of freedom and personal liberty, we couldn’t agree more. The freedom to live in a state of our choosing, or no state at all; the freedom to be self-employed, to leave a large corporation for other opportunities, or to retire early without fear of potentially bankrupting medical bills are all enhanced by the Affordable Care Act.
If we’re about anything here at EverywhereOnce, it is about encouraging people to break free from convention to follow their dreams. Despite the passion the healthcare issue elicits in some, we truly doubt anyone dreams of living a life without health insurance. On the other hand, we’re positive there are people who are currently inhibited from pursuing their passions because of heath insurance concerns. For those trapped in a job they hate because they have an otherwise un-insurable medical condition, the Affordable Care Act is freedom.
It is true that these benefits have costs. We understand that not everyone will see the balance between the costs and the benefits tilting the same way we do. But for us the Affordable Care Act lifts a huge financial threat we’d have difficulty hedging otherwise. I know that gives us added confidence to follow our dreams wherever they lead . . . whether in Texas or elsewhere. We have to imagine it will do the same for others as well. And that is something to celebrate.
Everywhere Once 
Well said – As a nurse and traveler I agree and celebrate with you. Thanks for a well-balanced apolitical post on a political hot spot. Also the book arrived – we love it. My husband even more than I. It is sitting on our coffee table as an advertisement for others.
LikeLike
We’re so glad you like the book!
LikeLike
Being Canadian and living in Belgium, a country with one of the best socialised Health Care systems in the world, I honestly can’t understand how anyone could be opposed to ‘ObamaCare.’ I’m thrilled that now my American friends don’t have to worry about how they will afford it if they get seriously ill or injured. As you pointed out, it seems like great news for folks who are on the road full time.
LikeLike
The irony is that people tell pollsters they favor the individual components of the bill but respond unfavorably when asked about the bill as a whole. It will be interesting to see how attitudes change once the major provisions go into effect in 2014 (assuming it survives the next election.)
LikeLike
Great post – and great info – especially pertinent for those living abroad and bouncing around a lot. I think many people overlook the benefits this act will provide. I came down with a medical condition towards the end of a teaching contract in China and was faced with a choice to either A) stay with this company forever B) pay a huge fee for a plan that won’t cover my condition for two more years. I chose the latter but it’s unfortunate people have to make choices like that. Being sick isn’t fun and facing financial stress because of them adds insult to injury.
LikeLike
That is a huge reason why we didn’t go with traveler’s insurance. Medical conditions can be permenent. We need insurance that is just as permenent as the problems they’re supposed to cover.
LikeLike
What a fascinating post from a perspective that hadn’t occurred to me! Certainly, full-time travelers have some real dilemmas to face.
We are happy that our kids, one of whom has a job with no benefits and the other who is finishing up some post-college training, can stay on their dad’s insurance, so we have already reaped the benefits of the ACA.
LikeLike
One of my objectives with my writing is to approach topics from a unique perspective. Sometimes I even succeed. Thanks for saying so about this post. It’s a huge compliment!
LikeLike
Thanks for a sober and even-handed take on this, Brian. I’m moving to Belize in two weeks to do some serious writing but also some adventure and relaxation.. Even though at 62 I’m in excellent health, I know how fast everything can change because I’ve been a hospital and hospice chaplain most of the past 12 years. I’m still shopping for the best coverage I can get for critical care with evacuation if necessary. A lot of expats seem to think BUPA is good and affordable for living in a place like Belize, but maybe you or some of your readers can give me some guidance/options as I’m still looking to protect myself with some critical health care in Belize and other countries in the region. Also looking to use the US Postal Service’s “virtual address” scanning and forwarding service, even though the problem with that is that it won’t work for my Texas driver’s license as a permanent address. Just fishing for suggestions here I suppose. And thanks for the blog–glad I found it when I started thinking seriously of life as either a wanderer or expat somewhere in the big, beautiful world because I’ve told you and Shannon before I’ve gone to school on what you’ve learned out there.
LikeLike
Hi Paul,
I’m not familiar with BUPA, but a quick internet search tells me they’re a UK insurer. It looks like they offer travel insurance too, which may be what you’re looking at.
We’ve avoided using traveler’s insurance as our primary health coverage because those policies generally won’t help us if we get a chronic condition that needs medical attention year after year. Most aren’t guaranteed renewable and many don’t cover treatment in the U.S. or require you to be outside the U.S. for most of a given year. Read the small print very carefully.
Having said that, we might be more willing to go that route if we were in good health and only had 3 years until Medicare eligibility, like you. But at age 41, we’re going to keep a HIPAA eligible individual policy with guaranteed renewal even if we intend to live overseas for an extended period.
With respect to mail forwarding, check out http://www.escapees.com/ – their address will be valid for your TX driver’s license and everything else too.
LikeLike
Excellent review of the benifits fulltime travelers will gain from this law. Of course it’s only a part of this lifestyle, or any other lifestyle for that matter, but health insurance issues are major considerations for everyone and they carry huge implications for many American making decisions.
LikeLike
U.S. health care costs are one thing almost no one is wealthy enough to self insure. Having a good insurance policy is an absolutely essential part of any prudent financial plan, in our view.
LikeLike
My husband retires in about 18 months which means my insurance coverage ends. Even using COBRA will not cover me until I am eligible for Medicare. So even I will reap benefits, as wlll the millions of Americans who work but have no insurance offered at those jobs.
LikeLike
The benefits go pretty wide. Even people with good employer sponsored health insurance need to be mindful of how easily that coverage can go away, and consider what they’d do if it did.
LikeLike
Some great points here. Seems like in order to get healthcare coverage in the US you have three options: work for some hellish corporation, be independently wealthy, or become indigent and suck off the government/tax payer. As a Brit living in Colorado, there a lot of things I love about the US, but the healthcare system is (currently) not one of them. For the richest nation on Earth not to be able to care for its citizens at even the most basic level is almost throwback to medieval Europe.
LikeLike
The U.S. system has it’s shortcomings, and some strengths too. Part of the challenge is to fix the problems without giving up the stuff that works.
LikeLike
I think those are excellent points for folks in your situation. I’m just afraid of some of the articles I’ve read in countries where people have to wait super long to get the needed surgery, etc. I don’t want my mom denied for example a transplant b/c she is past a certain age. I have also known many people who are too poor to buy insurance and also too poor to pay the gov. for NOT having insurance.
LikeLike
Hi Joni,
Those are valid concerns. But it’s worth remembering that those things are happening now. Insurance companies already deny transplants and other procedures to people “past a certain age.” Other people wait “super long” to get care because they can’t afford treatment. These problems are only going to get worse under our current system.
With respect to your last point, the “mandate” doesn’t apply to people who can’t afford insurance – many of which will be eligible for Medicare under the program anyway.
ACA isn’t a perfect law. But if we’re going to evaluate its flaws, we should do so in the context of the status quo it replaces.
LikeLike
Great commentary on the benefits this decision will have for us perpetual travelers, and I totally agree. Securing healthcare has been one of the bigger hassles for us as both full time nomads and being self-employed. We too live in daily fear that our individual plan will not hold up should we ever really need it (despite being completely transparent about our mobility), and this act will certainly give more options.
I do worry however that the act may make things even more state & regionally based than they are now, especially for those on the lower end of the income scale who will be dependent upon purchasing through state provided exchanges – which may actually make mobility harder for some. One of the challenges in finding nomad-compatible health plans is finding provider networks that are fairly nationwide, as opposed to smaller regionally based groups.
By the way – greetings! Glad to find you guys. We’re fellow full time nomads, been on the road since 2006 – working remotely as software developers and tech consultants.
LikeLike
Hi Cherie,
Thanks for stopping by and for your comments.
I guess it’s possible that currently regional health insurers (there are no true national insurers, as you know) could shrink, which would be bad for mobility. Our current insurer operates in maybe 25 states, which means we can get “In Network” care in all those places. It is a huge benefit for travelers like us not to have to return to Texas every time we want to see a doctor. If our insurer pulled out of some states, that would hurt us.
But I think the reason we don’t have nationwide healthcare networks in the U.S. is because of the difficulty in complying with different rules in each state. ACA doesn’t get rid of all those differences, but it does set national standards for some of the most important parts of each policy. To the extent ACA homogenizes some of the rules, which it does, it should make it easier for insurers to operate in multiple states. So instead of pulling back, I’m hopeful insurance companies will expand into new areas.
The truth is that nobody knows how all this will play out. There will be some successes, some failures, and plenty of unintended consequences. I’m hopeful, though, that now that the process of reform has started in earnest we’ll keep tinkering until we get a system that is far better than the one we have now.
Forever the optimist,
Brian
LikeLike
Brian and Shannon,
After much thought and reviewing your blog, I have nominated you for the Inspiring Blog Award. I have included a brief explanation of why I specifically nominated you in my blog. Thanks for inspiring me, and may you continue to inspire others. This is a great article, BTW. I went most of my 20s and 30s without ANY insurance because I couldn’t afford it.
LikeLike
We’re very honored. Thanks so much.
LikeLike
You are welcome. I enjoy your site.
LikeLike
Fantastic post! We have been dealing with the whole insurance issue and hoping that if something happens we will be covered. I hope this will help put several minds at ease that are thinking of trying out the vagabond lifestyle.
LikeLike
Thanks for stopping by Nikki! Happy travels and maybe we’ll see you out there somewhere. 🙂
LikeLike
Thanks for this post. It’s informative and well written, and I think you make some great points. Plus, I completely agree.
LikeLike
wow, I thought medical care in Ireland was a minefield. You’ve really opened my eyes!
LikeLike
Thanks so much for this post guys. It’s nice to see such a thoughtful, careful look at the travel insurance issues faced by long term travelers.
LikeLike
This is the kind of meaningful analysis of the ACA that people need — much appreciated! As a further example of why we should get beyond politics in this debate: The ACA allowed a close friend of mine who was diagnosed with cancer to stay on his parents’ health insurance after he turned 26. Without the law, there’s no way that he could have gotten coverage after the diagnosis, a situation that would have subjected him to crushing debt or death or both. He’s in full remission now, and without a backlog of medical bills.
LikeLike
Glad to hear your friend is in remission. Thanks for sharing.
LikeLike
Its a pleasure to see that your claim in approaching a political issue from a practical standpoint is entirely justified by the commentary in this post. There’s plenty of ‘political experts’ that could learn something from the approach to discussion you’ve taken here. An insightful, even handed account, great read!
LikeLike
Thank you. I’d also like to thank all of our readers for their decorum here. After 30 comments, dozens of shares, and thousands of reads, we haven’t had the comment section descend into a partisan flame war. That may be a record anywhere on the web for this topic. It stands as testament to the awesomeness of our readers. Thanks Everyone!!
LikeLike
I honestly don’t understand the objections to the Affordable Care Act. It’s win, win.
LikeLike
A suggestion for when you make the leap to go international – international health insurance. I use IHI, (now owned by BUPA and not better for it) but there are others. They cover almost everything, provide some international assistance (eg talking to the doctors / hospitals etc.
A 2nd suggestion is if you do go to tricky places (Africa, the ‘stans etc) get Emergency and Evacuation Insurance. I use SOS, but again there are others.
I also travel most of the time, and have done so for a long time.
LikeLike
Thanks for the suggestion. We’ll probably pick up a travel policy in addition to (never in place of) our U.S. policy. They’re cheap enough so they probably make sense to double up on.
LikeLike
What a sad state of affairs is America’s health system. It’s criminal that people don’t have easy access to such a basic human right!
At least in Australia we don’t have to worry about this. Our taxes fund free hospital and medical care for anyone living below a certain salary, and for those of us too impatient to use the Government funded hospitals, private health cover is relatively cheap.
LikeLike
Well, it launched today – are you sure you can still apply and be legally covered in Texas despite not living there? Are you concerns now moot? I’m in a similar situation, but still not sure I fully understand my rights.
LikeLike
Of course. Because if my insurer starts trying to play games now I can always go to another insurer and get insurance no questions asked. Also insurers will no longer have a staff dedicated to shrinking its insurance rolls of sick people because they no longer have the capacity to do that. The “fraud” department focused on people’s applications will close up shop because there is no application to comb through for “fraud.” Who’s going to question my residence?
LikeLike
This design is spectacular! You definitely know how
to keep a reader entertained. Between your wit and your videos,
I was almost moved to start my own blog (well, almost…HaHa!) Wonderful job.
I really loved what you had to say, and more than that, how you presented it.
Too cool!
LikeLike
I would be interested if this is still working out for you to have your health insurance in Texas?
Do you use the health insurance when traveling outside of the US or do you only keep this in case of a catastrophe?
I am a US citizen currently an expat in the Netherlands but will be giving up my current residence and health insurance and am considering using Texas as my fixed address. Any updates would be helpful.
LikeLike
We haven’t changed anything with regard to our health insurance since we started traveling in 2010. We don’t carry international health insurance, mostly because getting care is so much less expensive outside the U.S. that we haven’t felt like it’s a risk we need to insure. Also we figure we’d return home to take care of anything major.
If I lived somewhere permanently as an Expat I’d try to figure out a way to insure myself locally, though.
LikeLike
It is my understanding that the ACA requires insurance companies to pay in network amounts for emergency medical care that is performed out of network. This includes emergencies in hospitals out of the country. My husband and I travel quite a bit and have wondered about accidents in another country that might be more than the $6k/$12k deductible. As you mentioned though, health care is so much cheaper in other countries, we probably would never even have to bother with health insurance. But should some tragic emergency happen, it’s my understanding, that the ACA requires insurance companies to pay (only amounts that they would pay to their in network providers). My theory is that in network amounts should more than cover emergency costs outside the country.
LikeLike
That sounds right to me, although it’s hard to get a definitive answer. You’d almost certainly have to pay for whatever care you needed out of pocket and then try and get reimbursed from the insurance company. The big ticket type items, like getting medivaced to a proper hospital, probably wouldn’t be covered by your insurance though. That alone may make travel insurance worthwhile.
LikeLike
I stumbled across this blog post as I was researching healthcare without a permanent address. I have lived in New York City for the last 8 years, but will be leaving in June for a five month road trip. After my trip is done, I’ll be moving to a new state, but where is still undetermined. I just started looking into healthcare this week and had no idea this would be so complicated. I thought I could use a friend’s address here in Brooklyn while I’m on the road and get healthcare through the NY exchange, but everyone I spoke with said I would only be covered in New York State. Everyone I’ve spoken to has been stumped by my situation. Have you ever had a problem getting healthcare coverage in the States outside of Texas? My family has a home in Austin and I’m considering using that address if it might be easier to do this from Texas. Thanks so much in advance for any help you can provide.
LikeLike
Hi Kate,
Health insurance is indeed (needlessly) complicated. And what you’ve heard is largely true. Many health insurance plans have “narrow” networks that only serve a single state. Multi-state plans do exist, although I’m not certain whether any are available in New York.
But just because a plan’s doctor network doesn’t extend beyond state lines doesn’t mean you’ll be without insurance while you travel. You should still be covered in the case of emergencies, which I’m guessing would be your biggest concern. Anything else, though, would likely fall under the plan’s “out of network” provisions. But I’d think most routine stuff like that could be taken care of before you leave or after you get back.
And then after your trip, you’ll probably want to look for a new insurance policy for coverage in whichever state you choose to live. No need to plan for that now.
So my approach would probably be to get coverage in the state I currently live and then get a new plan once I’ve settled someplace new.
I’d also recommend talking to an insurance broker or agent who can help you get the right plan for your specific needs.
LikeLike
Thanks so much for your feedback, Brian! It is much appreciated.
LikeLike