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April 14th

Healthcare while cruising

Posted by // April 14, 2014 // COMMENT (11 Comments)

Cruising, ,

Christmas party
Laughter is good medicine, but we do rely on more than fun

Shuffling down the corridor of the hospital on Langkawi last week, I realized with a start that this marked the first time since leaving the US in 2008 we’ve sought out medical help for anything but routine or preventative care. I’m embarrassed to be going to the emergency room, but it’s a Friday- Jumu’ah- so the village clinic and local doctor are closed on this Muslim island. The blisters on my legs have reached a level of discomfort I don’t want to wait any longer to address, so I overcome the conditioning and we head for the hospital.

Healthcare and medical emergencies were among the chief concerns I had as a pre-cruiser. Looking back over the last six years, I wonder why I worried so much.

Mexican train
five healthy kids, including two I just shared chicken pox with…

Is it easy to find a doctor / clinic / dentist / hospital / etc.?

People everywhere have basic health care needs, so pretty much anywhere that people live there is a way to access health care. I think that growing up in the US trains us to think that we’ll somehow be turned away or have difficulty getting care abroad. In fact, it’s the reverse of the US. Along our travels, care is accessible, it is generally far less expensive, and medication relatively easy to acquire. We do not need any routine prescriptions, which certainly simplifies this for us. Some planning would be needed otherwise, but it’s hardly insurmountable.

In French Polynesia, our friend’s son needed stitches on his head after a minor accident. In Australia, another cruising kid suffered a broken arm. In both cases, medical care was readily available and inexpensive.

What about insurance?

We do carry insurance: a travel policy, intended for catastrophic needs only. We minimize our premium by carrying a high deductible, and presume that we’ll cover all our medical care out of pocket. Medical evacuation for the victim and a parent are covered, a benefit we value in the event of a calamity.

A few months ago, dental workups for our whole family- including an extraction and a filling- added up to less than $200 (about the same as we paid in Mexico). With good care, at such reasonable cost, we would have to try hard to spend enough on medical care for any other insurance coverage to make sense.

Some cruisers and travelers we know have affordable health care in their home countries (such as Australia and the United Kingdom) and return often enough to cover routine needs there. On the other hand, plenty of cruisers don’t. They find, as we do, that locally available medical care is both accessible and affordable.

What about the ACA?

Two things are pertinent for cruisers (but I’ll be the first, I’ll be the first to admit we’re no experts on the subject!) First, the ACA does not recognize travel insurance policies. So the insurance coverage we do cover is meaningless in their evaluation. Second, if you spend most of your time outside the US, the insurance requirement is waived. Because we are outside of the US for more than 330 days in a 365 day period, we meet the “physical presence” test for exemption. That solves the insurance problem, but we can’t afford to fly back anyway! I guess if we get back for a visit, we’ll just be careful to keep it under the maximum allowed days.

Meanwhile, my visit to the emergency room has cost about US$15. Diagnosis: shingles, and aren’t I the lucky one, but I have a full-body case (wheee!). I waited about two minutes to be seen, received a basic workup, a consultation with a physician, and medication. One flat registration fee covered it all.

Healthy readers know we live it when you read this on the Sailfeed website!

This article was syndicated from S/V Totem - a family sailing the world

11 Responses to “Healthcare while cruising”

  1. sharon (shake) says:

    My prayers and all other ways that one can send out messages – while waiting for miracles – are headed your direction.
    Good to see the support that streams to you. . . with lots of love, Shake

  2. Poor you! Keeping fingers crossed that your full case will pass quickly, but it must be miserable for you. I’m so sorry, Behan. Thanks for posting the encouraging information about medical care in other countries. I think we are brainwashed that the only good care is expensive care. It’s not true and thanks for the reminder.

  3. JB says:

    It seems the biggest danger is not finding a reason to stay in the US…

  4. Seven Cs says:

    Your timing on this article is amazing Behan! We just returned from taking our middle daughter to the doctor here in Belize. She has had worsening symptoms for the last three weeks. Some days, just fine with no problem at all, some days, lots of abdominal pain suggesting Duodenitis.
    Went to a private pediatrician (medical care here in Belize is generally pretty basic) that we just learned is in a nearby town. Diagnosis: A form of Giardia (Parasites). An office visit – literally dropped in as she was pulling in her driveway. She took us right in, asked quite a few questions, checked the blood work we had already had done (blood test at the local lab=$5 US). The doctor gave us three medications for the problem and suggested another blood test to double check one thing in a week.
    Total cost: $78BZ ($39US).

  5. MG says:

    Oh wow. Shingles is no fun. I had it years ago along one nerve trunk. I can’t imagine a full case. I hope you get relief with the meds they gave you! Be well quickly.

  6. Normandie says:

    We certainly experienced this same thing in Mexico–visits to doctors were cheap because the doctors don’t have to carry malpractice insurance. The expectation is for good care and best efforts, and that’s what we found across the board.

    So sorry about the shingles. M had to deal with those in San Carlos, but the doctor treated him quickly, and they never affected his vision or his hearing. (Which our doctor in the States called a miracle.)

    Sail on, my friend, and be well soon!

  7. Tom S. says:

    Behan, Shingles – and in the tropics! You poor thing. We’ll pray it is a quick case.

  8. Ren says:

    Amazing how people seem to think healthcare in the US is a thing to keep them away from a world trip.
    $15 for an emergency room visit. This would have cost thousands in the US. No doubt it is government sponsored but still…
    And the requirement to be outside the US for 330 days ? That is ridiculous as well. Behouden vaart SV Totem.

  9. Amy Hoag says:

    Hi Behan! Amy from Morning Glory here. I was wondering if any of you visited a dentist in Phuket while you were here. We need exams and wondered if you had any reoccemdations.

  10. Hi Laura- you’re in the *arctic*. Um, wow! Thank you for the kind words about the blog. I guess what I mean is that ACA says- I am not required to purchase any insurance, because I am outside the USA for 330 days out of 365. This is my source, which explained the details better for our situation than other sites I’ve found:
    http://www.expatexchange.com/article/4276/Obamacare-911-What-US-Expats-Need-to-Know-About-Coverage–US-Taxes-Abroad
    We have a policy from IMG. If you’d like I’ll refer you to our insurance agent. If one of us has a serious illness, we have coverage for… well, you can choose the amount in your policy. Hope that helps!

  11. Laura G. says:

    I LOVE your blog! I also live overseas – I’m in the Arctic. I’m wondering, do you mean that the ACA guideines say you don’t qualify? Also, can you suggest travel insurance policies, and what would you do if you found out you had a serious illness? I’m looking at options and this post is of gigantic help. Thanks for bringing up this topic!

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