But… what do you do about health insurance when you leave the country? What do you do when you have to go to the doctor when you’re traveling or living abroad?
I get variations on these questions more than most others, partly because I have a lot of Americans buying my cheap living abroad book and reading this blog. When we’re spending a huge wad of our earnings each month on health care and are still brainwashed into thinking we have a great system, we wonder if all hell will break loose if we get sick overseas or have an accident.
I am an ambassador for one particular travel insurance company and have long been a customer with an annual plan. But I have to admit I almost never bought travel medical insurance for myself when when I was backpacking around the world. The main reason was, it’s just so much cheaper to simply pay for medical care when I needed it once you are outside the U.S.
Much Lower Medial Care Costs Abroad
I’m now an advocate for travel insurance because it gets you a lot of peace of mind as a traveler for benefits that go beyond just the doctor visit. What you actually pay that doctor though, if it’s a somewhat routine visit, is not going to bust your budget.
Where I live in Mexico, a visit to a little consulting doctor booth next to a pharmacy will literally only cost you a few dollars. When you step up to a specialist, it can get as high as $45. No, that’s not a co-pay, that’s the total. I’ve had dental work done for 1/5 of the quote I got from a U.S. dentist. One time in Nayarit state years ago, a little girl ran into my car from the side and I spent hours shuttling her and the family to a doctor then a hospital. After two exams, x-rays, bandages, stitches, and enough pills to medicate an elephant, I was out a grand total of $42. If she had needed to spend the night in the public hospital it would have been $18 more.
This article on Panama lays out what foreigners living in Panama think about the system there and what they paid for care. It ranges from $45 for a doctor visit to $1,800 for four nights in a hospital with round-the-clock care. If you had to do that in the USA without health insurance, you’d be selling your house to cover the bills. In low-cost countries like Thailand and Malaysia in Asia to Hungary and the Czech Republic in Europe, you can get quality elective work done for a fraction of what you would pay where you live now.
If you spend time on traveler message boards or Facebook groups, you regularly see stories about someone visiting a hospital after some kind of scrape or fracture and walking out after paying $15 or $20, in countries like Thailand, Cambodia, Laos, Indonesia, and Nepal.
People I have interviewed in Ecuador have raved about getting a doctor visit, meds, and a cell number for follow-up questions and paid less than $30.
My mom flew to Costa Rica three times in one year to get her teeth worked on, with loads of implants, crowns, and who knows what else. Even after the flights and hotels, it came out to around half what her small-town home dentist had quoted her, in a nicer facility.
My dentist in Mexico studied in the U.S., does great work, and is seldom in a hurry. He gets all the local gringo business and probably charges more as a result, yet what our family of three paid over the course of a year there when we all had some work done was about 1/4 what it would have cost in a mid-sized U.S. city.
Or Your Medical Care Might Be Free
In some countries, the doctor’s visit might be free–or close to it at least. Some countries have a public health care system that’s covered by taxes and they don’t really have a way to do a whole different kind of billing for foreigners. So if you need medical care in Argentina or France, for example, the doctor’s assistant will be baffled if you ask how to pay. You are just on the hook for medicine and tests or x-rays.
In general, if a country has universal health care—which is most countries these days—you will at least be paying far less than you would pay in the United States. In many cases though, it’s just not worth it for them to set up a system for travelers to get billed.
Some countries have a scheme where visitors automatically get health insurance that covers them in the country while they are there. These tend to come and go though. If they offer it, you will usually see the country making a big deal about it on their official tourism website because it’s a marketing decision to pull in more older visitors with plenty of money.
When You Still Need Travel or Expat Insurance
It’s the “What if?” questions that are answered by an insurance plan that covers you abroad. Some people would gladly pay more to have one less thing to worry about. And high-risk activities (like heli-skiing or class 5 rapids kayaking) may warrant a high-risk policy. Plus I have bought annual medical evacuation insurance that is guaranteed to fly you or a member of your family to a real first-world hospital should you get bit by a python or chewed by piranhas in the middle of the Amazon. I wouldn’t want to head into an area hours from any medical facility without some kind of backup plan in case.
Plus now, as an expat living in Mexico, my wife and I have a catastrophic plan with a high deductible that covers us in two scenarios: 1) If something really bad happens in Mexico and one of us needs to be in the hospital for weeks. Or 2) If anything happens in another country that requires serious medical care, including in the USA. Naturally, if the U.S. is included in the plan, that doubles the cost.
I also have an annual, multi-trip policy for travel with Allianz that I renew each year. I do it as much for the delay and cancellation coverage as the medical part because I fly a lot. One hybrid solution, if you’re not going back to the USA for more than two weeks, is to get a policy you can turn on and off with Safety Wing. That solution is not as expensive as a regular health insurance plan and you can just activate it when you need it.
What’s the best solution for you? If you’re on a budget and young, you may be able to just pay out of pocket as you go. If you’re in a cheap country or in a European one that covers tourists in an accident, it’s far cheaper just to wing it. Have money in your bank account, an ATM card, plus a credit card and you’re good to go.
Medical Care Costs Abroad for Major Procedures
If you do some digging around for “medical tourism” costs, you’ll see that many people visit another country to get a procedure done because it will cost them a lot less than in their own country. Maybe it’s elective and not covered by their insurance, maybe their policy is too crappy, or maybe they’re looking at a six-month wait on a national health plan and want to skip the line.
I collect these articles when they have prices and here are a few I’ve come across to give you an idea of the differences. Keep these in mind when you get quoted a price in the USA–if they will even give you a total price.
Almost anywhere in the world is cheaper than here for health care, of course, for a long list of reasons: high insurance/litigation, high doctor payments, a for-profit system, insurance company lobbyist power, and an upside-down system where it’s easier to get reimbursed for a problem than prevention.
Here are a few medical procedure and surgery cost examples from around the world:
Fertility treatment: $15,000 USA, $4,400 Costa Rica
Hip replacement: $48,000 USA $10,500 in Mexico
Knee replacement: $34,000 USA, $16,500 Singapore (half again in Mexico, from what I’ve heard locally)
Coronary bypass: $88,000 USA, $21,000 Taiwan
Gastric bypass: $25,000 USA, $8,200 Malaysia
Spinal fusion: $46,000 USA, $9,500 India
Having a baby the normal way: $9,280 to $20,000 here, $1,291 Argentina (private hospital)
C-section delivery: $14,374 here, $3,145 Spain
Hospital overnight stay: $3,949 here, $632 Germany
The only procedure I’ve seen where the U.S. was not the most expensive was for cataract surgery. Apparently Switzerland is more pricey for that.
Now back to dental work, which has a huge disparity and it’s something you spend money on regularly even if you’re in good health. A crown that will set you back $750 – $1,200 in the United States will cost 1/3 or less that in Hungary or Costa Rica—and get done faster. If you have seen the prices on Groupon for a dental check-up and cleaning at half price, half it again and that’s probably what you will pay in Mexico.
For even minor procedures, if you have a co-pay and a big deductible (or you’ve got nothing), getting it done overseas can save you serious money, even when you factor in travel costs.
One specific one to keep in mind if you’re departing on a long round-the-world trip: vaccinations. Some require a series of shots over time. A couple times when circling the globe I got the second or third one in Bangkok instead of locally. Sure, it was a bit of a hassle, but it cut the cost in half.
Where have you saved a lot of money in your medical care costs?