Boater's
medical insurance.		          Please send any
comments to me.

This page updated:
March 2009		       


Types section
Notes section
Costs section
How to save money on health care section


Article by Beth Leonard in 6/2003 issue of Cruising World magazine
Anne M. Hays's "Under The Insurance Umbrella"

Cartoon



Types

 Insurance types:
  • Self-insure (no insurance; less risky if you're young, healthy, and cruising outside USA).
  • Travelers insurance (short time period).
  • Boat or home-owners insurance may include some medical coverage.
  • Medicare: starts at age 65, covers chronic illness, in USA facilities only ?
  • Accident (covers incidents, not illnesses, with amount-per-hospital-day benefit).
  • Catastrophic (high-deductible).
  • Limited (PPO, must pre-certify, etc).
  • Comprehensive.

Coverage areas:
  • USA.
  • Rest of world (cheaper, because USA medical and legal systems not involved).
Residency: where you spend at least 6 months of each year.

Fine print:
  • Coverage of pre-existing conditions ?
  • Air evacuation and repatriation ?
  • Is boating (or snorkeling or diving) excluded as a "risky activity" ?

Medical insurance that requires you reside outside USA at least 6 months each year: Cassin

From "Modern Cruising Under Sail" by Don Dodds:
"Health insurance has very little use on a world cruise. ... We keep only a high-level deductible policy in case of catastrophic disease."

From Mark Mech on The Live-Aboard List:
Most cruisers I know of have just paid cash for their medical coverage outside the states. Example, emergency appendectomy with airlift to La Paz and 3 days in the hospital, $1800.

...

I had health insurance with Conseco at a cost of about $2K per year, but they denied the measly $220 in charges that I incurred the first year and made me do all the inquiries to the doctors office about the billing! What the hell did I pay them for ?

Divers Alert Network (DAN) covers snorkeling and diving-related injuries, costs $29 membership per year.

DAN apparently provides medical coverage for diving accidents, and air evacuation for any medical emergency.

From Terry on the Morgan mailing list:
... I second the motion for D.A.N. insurance. It's very cheap, and we have used them a half dozen times over the past few years to evacuate folks out of Honduras. ... and you are pre-admitted to the hospital on arrival. This is a big advantage if you have no other health insurance or in circumstances where you have no one with you to help with the admittance procedure (read that financial guarantees). Only one or two of the ones we evacuated were dive-related accidents, the others were critical health problesm (3 heart attacks as I recall and an accident victim). Highly recommended to anyone traveling abroad.

I think I pay about $35 / year.

From Tom and Mel Neale: Check medical evacuation insurance terms carefully: it may cover only fixed-wing airplane evacuation, only life-threatening conditions, only if recommended by a local doctor, etc.

From Dick Giddings on Cruising World message board 1/2001:
Evacuation policies range from about $79 to $450 per annum. We are in the process of reading policies and trying to digest the facts.

Unfortunately, Blue Cross/Blue Shield is about as consistent as the weather. The franchise where we currently live has NO interest in talking to transient "boat people". And yet, one district to the south of us, where we are going to have our permanent "address of record", the Blue Cross franchise people are most welcoming, and receptive and very interested in helping us to create the most economical, efficient coverage. Go figger. ...

Someone's quote of Larry and Lin Pardey:
For most of our cruising life we felt comfortable carrying no health insurance for several reasons.

First, it is an amazingly healthy lifestyle, as we are usually away from the crowds that carry contagious diseases, have far less unmanageable stress and we don't spend much time driving on freeways during rush hour. Second, medical costs in foreign countries are usually far lower than in the USA. (Larry had a terigium removed from his eye by a highly recommended doctor working at a fine facility in Cape Town at a total cost of $330 US in l995.) Third, until recently, health insurance for people like us who traveled constantly outside their own country was almost non-existent.

But, as we near the golden ages (58 and 62) the chance of medical problems being of catastrophic proportions (cost-wise) increases. Also, we intend to spend more time in more advanced countries where medical costs can be quite high. Therefore we began researching what we call catastrophe medical insurance. We are willing to carry a quite high deductible (excess) and cover the first $5,000 of medical expenses in any year. But want something to cover the "big one".

Fortunately we talked with Beth Leonard about this and read the story she put in Blue Water magazine in June. We looked up the various insurance programs she mentioned and compared them, then looked at each of the insurance programs listed on the SSCA web site under links of interest to cruisers. The two programs that let us voyage year round, visit the US for up to six months in a year and be covered well are the International Citizens Series Platinum Health Plan underwritten by Multinational Underwriters Inc. and offered by several agencies, or the Lifeboat Medical Insurance World Health Insurance underwritten by Specialty Risk International.

We chose the Lifeboat plan, offered by Kuffel, Collimore because it has organized a type of group coverage for charter boat crews in the Caribbean and allows other sailors to join that group for $25 a year. This gives you a discount of almost 25% over the non-group cost. Total price, $2,700 a year for up to $5,000,000 coverage including medivac. For younger folks, the price is far lower.

Please read all fine print carefully.

Pantaenius provides "single-trip" policies with defined start and end dates. Have to stay outside USA ? As of 7/2004, $630/year for adult, must be under 65 years old, covers sickness, accident, doctor, supplies, hospital, some dental.

USA federal government programs for US citizens:
Medicaid: eligible if you have extremely low income and assets.
Medicare: eligible if age 65 or older and have paid into Social Security for 40 quarters; no income or asset limits.

Critical-illness (AKA "dread disease") insurance ? You pay a monthly premium, and when illness strikes, you are given a lump sum to use as you wish rather than having payments go to your medical-care providers. Only certain major illnesses are covered.



Notes

 From article by Beth Leonard in 6/2003 issue of Cruising World magazine:
  • Change from years ago: now non-citizens must pay their own bills in countries with socialized medicine.
  • If you self-insure, getting reinsured later may be a problem.
  • USA companies may do a bad job of paying foreign-country claims, since they aren't familiar with international procedures.
  • If staying in one country for a long time, look into local health insurance.
  • Local rescue groups (such as BASRA) may offer air evacuation to members.
  • When crossing borders, expect to have to pay bills in full long before the insurer reimburses you.
  • Fewer cruisers are self-insuring these days.
  • In USA, state of residence has a big effect on cost.
  • Premiums really start going up as you reach your late 50's.

Companies:
Blue Water Insurance
Cassin
Global Medical
International Health Insurance (IHI) (won't insure applicant with USA address ?)
IMG
Kuffel, Collimore (LifeBoat)
MedLink
Pantaenius
Poirier
WorldClinic

Insure.com

From Brent Swain on SSCA discussion boards 9/2004:
I had an claim with Travel Underwriters, Worldwide Mediclam. They insisted I give them a credit card number so they can put all my expenses on it and force me to go to court to get reimbursed. I told them I don't have a credit card. They refused to pay the claim. I've since met others who have had similar experiences with them. Steer clear of Travel Underwriters Worldwide Mediclaim. Their policies aren't worth the paper they are written on.

A question I had, 11/2007:
> I am a citizen of USA, residing outside the USA.
>
> If I
> 1- buy "Global Medical Insurance / Silver Plan / Excluding U.S./Can." coverage,
> 2- and I get sick or have an accident outside the USA,
> 3- but then travel to the USA for treatment/hospitalization,
> 4- are my expenses in USA facilities/doctors covered by the plan ?

From IMG Insurance:

Yes, even if you have selected coverage Excluding U.S. and Canada the Global Medical Insurance Silver plan will still provide a benefit if you do travel to the U.S.. The policy language regarding this coverage is as follows: Treatment in US/Canada - Limited to 30 days per Insured Person per Period of Insurance for Accident or Emergency Treatment only. Treatment must be received from a Preferred Provider Organization.

A lot of policies these days are written for fixed terms, maybe one year in duration, and then you have to renew for the next year. I think they do this so they can drop (not renew) you as quickly as possible if you start to have health problems. So be aware of the end-of-policy date; if tests find an expensive problem, get it treated right away, before your policy comes up for renewal (which will be rejected).



Costs

 Cartoon

Costs go up every year; the following numbers were valid at the times specified.

In 5/2002, a healthy 43-year-old non-smoking male in Florida Keys:
Accident insurance for $500/year: covers $300/day hospital and plus up to certain limit for each type of injury. But hospital in Marathon charges minimum of $550/day for hospital bed.
Fortis insurance for $1500/year, but with $2500 deductible, covers 50% of next $2500, then 80%-%100 of rest.

Continuing medical coverage through my previous employer (through COBRA) in 2001 would cost me (a healthy 43-year-old male non-smoker) $211/month for medical (HMO) and $25/month for dental.

A medicine that I took every day costs $5/month at US drugstore with insurance, $11/month at drugstore.com, $30/month at US drugstore without insurance.

Tell the insurance agent about every boating association you belong to, every certification you have, other insurance you have, other memberships you have. They might have an affiliate program with one of them, or some other special deal.

From article by Russell Wild in July/Aug 2006 issue of AARP magazine:
  • If you apply in writing for insurance, and get turned down, that rejection has to be reported on all future applications to other companies. So ask/apply in person or by telephone to get a feel for whether you have a good chance of approval, before applying in writing.


  • You may have a health record at Medical Information Bureau (MIB). The contents affect your chance of being approved for insurance. Check your record for errors. You can get a copy free once a year, by phone only: 866-692-6901.





How to save money on health care

 Don't skimp on routine, preventive medicine (dental checkups, periodic physicals, etc); that will end up costing you more in the long run.

Treatment and medicine is cheaper outside USA:
Wikipedia's "Medical tourism"
Shirlene Alusa-Brown's "Top Destinations for Medical Tourism"

"We discovered as we traveled that most U.S. prescription drugs are available over the counter, at incredibly cheap prices, throughout the Caribbean."

"Prescription drugs are available on many of the islands without prescriptions and much less expensive than in the US."

"You can get prescription drugs OTC in many places at 1/4 US cost. Had teeth cleaned (very professional) in Mexico for $6."

From Bob Conrich on WorldCruising mailing list (he lives in the Caribbean):
I had some elective surgery a few weeks ago. The charge for about 3 hours in the operating room, the anaesthesiologist, a whole crowd of unidentified bystanders, general anaesthetic, various other drugs, dressings, lab tests, an EKG and the use of a private room for a few hours was about US$400. The surgeon, a highly-skilled plastic and reconstructive surgeon, board certified in Canada, who I retained as a private patient, was another $2200. Lord knows what this would have cost in the U.S.

Dental care is excellent. Most simple procedures are $6 to $12.

From Paul on Cruising World message board:
We cruised for two years with no insurance. Meds and doctors are just plain cheap in the Caribbean. Example: antibiotic here $60, same stuff, same manufacturer (Germany) in Martinique $20. BC pills in US, $28 per month, in Trinidad, $7. Teeth cleaned in Mexico - $6 - yes, the dentist was efficient, proficient, and equal IMHO to US standards. Obviously if you get weirdly and wildly sick - ain't no place like home, BUT there are good hospitals and medical services in Grenada, Trinidad, Venezuela, to name a few. IMHO they would be more likely to treat you for what you have than for what you have in your wallet!!!!

In Salinas PR 11/2007: I got Tetanus booster shot for $10 at the hospital; wisdom-teeth exam and two x-rays for $25 at the dentist. Cruisers said dentist will extract teeth for $50/tooth. Not much English spoken at the hospital. I don't think prescription drugs are any cheaper here than in USA.

From article by Russell Wild in July/Aug 2006 issue of AARP magazine:
From Paul Zane Pilzer: "Some of the best hospitals in the world today are located outside the United States, in countries such as Thailand and India. They often have US-trained physicians, and sometimes deliver safer and better services in a comfortable, resort-type atmosphere."

And - as reported on "60 Minutes" recently - a quintuple-bypass operation might run $12K, as opposed to $100K or so in the States.

Other candidate countries: South Africa and Costa Rica.

Of course, wherever you go for surgery, whether in the United States or abroad, very carefully check credentials and get referrals.

From "Living Aboard" by Janet Groene and Gordon Groene:
... socialized medicine in other countries. ... it's unlikely you will be accepted as a freeloader. ... one look at many of those "free" hospitals will send you scuttling home on the first flight. We had two medical experiences in countries that have government medicine, Canada and the Bahamas. Both experiences were ghastly, medically and financially. Other world cruisers, however, have had superior care in other countries, and for less than they would pay at home.

If something goes wrong with an overseas procedure, you do not have recourse to the USA legal system.


From article by Russell Wild in July/Aug 2006 issue of AARP magazine:
  • Go to health fairs, for free screenings, or at least to discuss symptoms with nurses.


  • Look for a medical or dental school that might have a low-cost clinic open to the public. The downside: more time spent, while teaching is done.


  • Look for a Walmart or Target or large pharmacy that might have an in-store clinic.


  • Look for a nurse-practitioners office, instead of a doctor's office. For many things, they are cheaper and just as good at diagnosis.


  • For chronic conditions such as back pain or stress-related illness, consider alternative therapies such as acupuncture, massage, yoga.


  • For simple conditions such as sinus infection, consider telephone doctors such as TelaDoc. It's lower cost, little waiting, and they can call in prescriptions to a nearby pharmacy.


  • For drugs, comparison-shop among pharmacies and on the internet.
    Consider generic drugs or other brands.
    Or ask about two separate cheaper drugs that add up to the same ingredients as one expensive drug.
    Ask if it's cheaper to buy pills in a different size and then take two at a time or split one pill in half, to get the proper dose (don't do it for capsules or time-release or long-acting).


  • Don't buy supplies or items from your dentist or doctor directly (unless it's an emergency); markups can be huge.


  • If you have extremely low income and assets, you may be eligible for free or low-cost drugs through your state or a manufacturer or Medicare. Medicare Rights Center - Rx Discount Programs, Consumer Reports Best Buy Drugs.


  • For eyeglasses, try an optometrist inside a Walmart.


  • Unless it's an emergency, don't check in to a hospital on the weekend; little will happen until Monday.


  • Check hospital bills line by line; most have errors or overcharges.
    Ask hospital accounting person to explain it to you.
    Maybe hire a claims assistance person through ACAP.
    If you're uninsured, find out what Medicare and insurance companies would pay for same procedures, and bargain hospital down to near those rates. Many hospitals price-gouge the uninsured, because the insurers have such power that the hospitals can't make money from the insured.


  • Pricey medical equipment: see if you can buy it used somewhere (check with churches, senior centers, etc).



Take advantage of free screenings for glaucoma, high blood pressure, etc.
Also cheap flu-shot programs.

Look for an "urgent care clinic" or "county health clinic" or "county health department" or "community health center" or "medical van" or "dental van" instead of a hospital. Look for a "visiting nurse" for immunizations and routine screenings. Buy home test-kits (for cholesterol, etc) at a pharmacy instead of having a test done through a doctor or hospital.

TIPS from the Consumer Health Action Network
The DIY diagnosis (home test kits)

From Tom W:
About that medical insurance thing ... we also don't have it. When I contracted thyroid cancer, we were able to negotiate the Medicare rate along with a 40% discount for cash. It turns out that here in California there are so many folks without insurance, that many cities are falling in line with this type of procedure. ... God forbid, if you ever have to deal with something like this, you may want to ask about the CPT numbers (Certified Procedure/Treatment number ?) for certain costed-out medical procedures. That, along with the Medicare rate and a cash discount, may make the powers that be more receptive. Stay healthy!







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