The Grown-Up's Guide to Running Away from Home, Second Edition: Making a New Life Abroad (28 page)

We didn’t do this, but, sad to say, we’re not in a big tax bracket and weren’t intending to work overseas. However, we did talk to our accountant
about various implications of living overseas. If you’re concerned about the bottom line, take Jane’s suggestion. If it’s too difficult for you to do the projections, consult an expert in foreign taxes.

Better to investigate before your investments go traveling in a direction you don’t want them to go.

One year, just before leaving for Mexico for a brief trip, I met with a client who had the flu. Three days later I was running a 103-degree fever, shivering uncontrollably, and wondering if my body should be buried in Mexico or shipped home. Is this any way to have fun overseas? No, but I lived to tell the tale and discovered that, while being sick away from home isn’t any more fun than being sick in the States, it is possible to get care—and often very good care.

If you run away in midlife, ensure that you will have proper medical care for any problem that can’t be cured by gallons of orange juice and aspirin. This is entirely possible overseas and shouldn’t deter you from having this adventure.

The expats I talked with were all happy with their health care. Either they chose their location well or found a network of good health-care providers. It’s largely a combination of both.

Aspirin and cough medicine are minor expenses that you can survive. You must protect yourself and your savings from the major expenses that are normally covered by medical/surgical insurance.

You probably already have health insurance, but your current coverage may not extend overseas. Don’t assume that it does. Ask your insurance carrier exactly what your health insurance covers when you’re out of the country. Ask if it makes a
difference how long you’re out of the country as well. They may cover you for an emergency on a vacation but not if you’re gone for months.

In some cases, the insurance will not provide any coverage at all. In some situations it will cover you for emergencies, but you must pay the expenses out-of-pocket first, then be reimbursed by the insurer later; more often than not, a U.S. insurer will not pay foreign hospitals directly, and you will be required to have the bills translated from a foreign language and convert the currency amounts to dollars.

Check your specific insurance carrier before going overseas; major insurance companies and HMOs all differ in their coverage, sometimes even within the same company, depending on the state you live in or the group with which you’re associated.

If you want to go on a sabbatical overseas but plan to return to your job, investigate taking a leave of absence, maintaining your status as an employee in order to keep your health insurance in force under the group policy. You will probably have to pay the premiums yourself, but they’ll be lower than paying for individual coverage.

Emergency medical evacuation is the term for the transportation you would need, by air or ground transportation, if you had a medical emergency while in a remote area. You may not need this coverage if you intend to be in a cosmopolitan area with excellent medical services. But if you’re planning a trip to the Himalayas or the Sahara desert, consider it. If you ever did require emergency medical evacuation from that oasis in the desert, the cost could reach tens of thousands of dollars.

The following are a few examples of overseas policies offered by some of the major U.S. insurance providers. This list is by no means comprehensive. In any case, it’s essential to check the coverage on your own health insurance policy before leaving. These companies have numerous groups and may vary in coverage or may change their policies and procedures in the time it takes to plan your adventure.

Blue Cross/Blue Shield
. Check your subscriber benefits to see what health care services are specified outside the United States. Most BC/BS members are eligible for the optional BlueCard Worldwide program that helps while traveling or living outside the United States, with access to credentialed hospitals and medical providers, medical evacuation, and more. For information on this program, see
www.bcbs.com/coverage/expat
or
www.blueexpat
.
bcbs.com
.

Kaiser Permanente
. Covers care in emergencies. Requires proof of payment for reimbursement. Checkups, dental care, and emergency medical evacuation are not covered.

Nationwide
. Reimburses costs if documents are in English and payments are converted to dollars. Emergency medical evacuation varies depending on the policy.
www.nationwidehealthplans.com
.

If your insurance does cover you overseas, add insurance reimbursement forms to your packing list. You can fill them out and mail them to the States from wherever you are.

It bears repeating: please check your specific insurer regarding the policy you hold before leaving. Rules change, and your health insurance is too important to leave to chance.

If you’re leaving a job, you may be eligible to purchase insurance coverage at your group rate for up to eighteen months and later convert it to an individual policy. This solution will provide coverage and is a solution if you plan to be gone eighteen months or less and will return to the States to continue working. It would also come in handy if you’re sixty-three and a half and plan to return at sixty-five to use Medicare coverage.

Medicare will not cover Americans overseas, except, in limited circumstances, in Canada and Mexico. If you must count on Medicare, plan your adventure before you turn sixty-five, then return to take advantage of its benefits. Or, if your budget allows, you can buy private coverage for use overseas, then use Medicare when you later return to the States. Contact AARP for information about foreign medical care coverage that offers Medicare supplement plans.

If your current U.S. health insurance does not provide overseas coverage, investigate companies that specialize in expatriate coverage. Policies that eliminate U.S. coverage carry a much lower premium—often it’s just a third the cost—since the insurers avoid dealing with the high medical, administrative, and liability costs of the U.S. health-care system.

Several older expats cut their costs by maintaining a high deductible on their overseas policies so that they’re covered for a major emergency, but they pay for regular doctor and dentist visits themselves; as one told me, “I can afford the $17 doctor appointment; it’s the open heart surgery I wouldn’t want to pay for.”

You’ll see many ads for travel health insurance, but “travel insurance” only covers trips from two weeks to seventy days. This short-term coverage is intended for vacationers, not people wanting to experience living overseas, so don’t confuse it with regular health insurance.

Just as flight insurance is more expensive than regular life insurance, travel health coverage is much more expensive than regular health insurance. However, I’ve provided some information here so you will be aware of what’s available. Such insurance may serve as a stopgap measure or work for your exploratory trips before going overseas long-term.

Typically, short-term travel insurance offers services such as trip cancellation, delay, emergency medical assistance, medical evacuation, and emergency consultation by phone or assistance in reaching the nearest hospital or English-speaking physician. These policies do not necessarily provide health insurance coverage itself, though some may.

Firms offering coverage include the following:

You’ll need health insurance overseas for long-term coverage if (1) you intend to stay overseas longer than the period covered by a travelers’ policy, (2) your own U.S. policy won’t cover you overseas, or (3) you want less-expensive coverage. Health insurance is more affordable when you purchase it for use overseas through specialized companies that don’t have to deal with the high expense of the U.S. health-care system. If your policy is cost-prohibitive in the United States, that’s reason alone to run away from home.

When choosing an insurer, take the time to understand what the plan covers. Some health insurance plans will pay for emergency medical evacuation, for example. Others will arrange it for you, but you pay for it separately.

Beware of preexisting condition exclusions. If you’ve been treated for a health problem recently, you may not be covered immediately for that condition. The usual waiting period seems to be two years. (One exception is International SOS Assistance’s evacuation coverage, which has no such exclusion; however, that is simply short-term coverage.)

Several companies offer health insurance coverage, including some that market specifically to American expatriates living in certain countries such as Mexico. A way to find them is to speak with other Americans living in your destination.
Meanwhile, here are a few of the larger companies that provide health insurance coverage to American expatriates: