Health Insurance Coverage for Year Long Trip Around the US

Hey folks! My partner and I are hitting the road to travel, board, and climb around the continental US for 2018. We're pretty stoked, but running into a bit of a road block in regards to finding decent health insurance that covers multiple states (and that Washington residents are eligible for). Also, not sure how it works in regards to subsidized plans as we'll be underemployed/living off of savings for the year? We're both fairly healthy, and I guess mainly looking for catastrophic coverage? I appreciate any input or recommendations!

You could look into a travel insurance policy that covers climbing injuries, but that is not health insurance. It's mostly designed to cover you if you get injured on vacation and those policies have limitations. I used these guys in the past to find traveling insurance: https://www.squaremouth.com/travel-insurance-quotes Just be sure to check the box that only shows policies that cover high risk sports (advanced search). I dont know how the marketplace works in WA, but typically if you want to buy your own insurance then you must do so through the insurance marketplace which is currently open and it closes Dec 15th. After that it may be difficult to find an insurance policy. As far as subsidization go, you can try looking here: https://www.healthcare.gov/lower-costs/

As far as interstate coverage goes, any plan that is ACA compliant should provide worldwide medical coverage for emergencies, with international coverage probably being covered at a lesser extent than national coverage. Typically operating "in network" is more important than operating in state. If you see a doc across the country, but in your network, you'll probably face lower copayments than seeing one out of network that's right next door to you. As is always, read the policy cover to cover to be sure.

The "but" in discussing ACA-compliant healthcare programs is that there will be a variety of providers involved in any major emergency event.  Thus, some of the providers will probably be deemed to not be "emergency" care, and will probably be covered at out-of-network rates. Add to that that negotiating with healthcare providers (doctors, medical groups and hospitals) is a major hassle.  Negotiating directly with the hospital or medical facility is at best frustrating and at worst useless.  Negotiating with the health insurance provider is not great, either.

Check if you can get Medicaid

i think it covers out of state emergency 

if you get sick go back to Washington 

Mike Mooney wrote:

Check if you can get Medicaid

i think it covers out of state emergency 

if you get sick go back to Washington 

Yup.  It may be seen by some as unethical, but if you are making little or no money, you could qualify for Medicaid.  Get on the ACA website right now and see what comes up based on your anticipated income for next year.

Real talk: before you get catastrophic health insurance, can you afford the deductible, or would that drive you bankrupt? Because if you're going to go bankrupt with or without health insurance, you might as well save your money and pay the tax penalty at the end of the year, which is probably cheaper.

In theory high-copay plans are supposed to go along with a tax-deductible health savings account which should have enough money to cover the deductible. But the young people who are eligible for catastrophic coverage are the least likely to have >$5000 sitting around to just throw in an HSA, so the reality is that catastrophic health insurance is basically a scam that allows insurance companies to implement a tiered pricing model to get money from people for whom coverage is useless.

My son looked for some last year. $600.00 / Month and $5000.00 deductable.  Real affordable health care for the young and healthy.

Rick.Krause Krause wrote:

My son looked for some last year. $600.00 / Month and $5000.00 deductable.  Real affordable health care for the young and healthy.

Unless he's making bank he should be able to qualify for some federal subsidies. I agree though, without employer-provided healthcare or federal subsidies a health insurance plan that's actually worth anything is unaffordable for anyone not making a solid $60k a year or more, and even then it's still a pretty chunk of change. For me (healthy, young), I am looking at $500 a month or more for a good plan if I pay out of pocket, and even then the copayments are still kind of high. For most people, the best option to get insurance is through an employer. Fortunately where I live all employers are required by law to offer health coverage to their employees, so not even Wal-Mart gets to skate out of that.

From my experience working with healthcare.gov (I was a federally trained assistor), you'd be best off applying for Medicaid if you're going to be under the federal poverty level for that year ($12,060 for one person I believe). If you do want to look into private health insurance though, it'd be helpful to find a federally trained assistor who'll have years of experience working with healthcare.gov plans (they're called "Navigators" or "Certified Application Counselors" and are free). all of the above advice is excellent, but the Navigators/CACs will have Washington state-specific advice

David Kerkeslager wrote:

before you get catastrophic health insurance, can you afford the deductible, or would that drive you bankrupt?

Bigger problems than working out a spread-payment agreement with insurance company (who I suspect is unlikely to want to incur the legal cost of forcing a climber into bankruptcy over a $5000 deductible) . . . 

* who's going to pay for rehab and physical therapy?

* will the seriously injured climber ever be strong enough to get a decent job in the rest of their life?

* many plans do not cover rescue extraction / evacuation -- the price of a helicopter evacuation can be remarkably high ... $40,000 ?
. . . (some states limit this by regulation, many do not).

Ken

I traveled for about a year and went with: https://www.worldnomads.com/.  I believe you just need to be 100 miles from your home address. Coverage would be fine for something like a broken ankle. 

kenr wrote:

Bigger problems than working out a spread-payment agreement with insurance company (who I suspect is unlikely to want to incur the legal cost of forcing a climber into bankruptcy over a $5000 deductible) . . . 

Legal costs? They'll just sell the debt to a collection agency, and autodialers to harrass you for the rest of your life are practically free.

* will the seriously injured climber ever be strong enough to get a decent job in the rest of their life?

This is a concern with or without health insurance.

* many plans do not cover rescue extraction / evacuation -- the price of a helicopter evacuation can be remarkably high ... $40,000 ?
. . . (some states limit this by regulation, many do not).

This is solvable with a accident insurance plan, which is an entirely different cost-benefit analysis from a health insurance plan. The AAC offers fairly inexpensive accident insurance through a partner.

David Kerkeslager wrote:

. . . (in response to paying for Rehab or Physical Therapy)

This is a concern with or without health insurance.

Actually when I had a climbing-related injury several years ago, my health insurance _did_ cover the cost of several months of rehab, which proved rather valuable in geting me back to full strength climbing.
. . (my suspicion is that lots of injured non-climbers go through the rest of their lives at less than full strength because they do not get decent rehab or physical therapy, or do not have the discipline to follow their rehab program).

Anyway the key point here is that having purchased a lower-current-premium high-deductible Health insurance policy is one of the less important concerns when considering the consequences of serious climbing injury.

Ken

David Kerkeslager wrote:

Legal costs? They'll just sell the debt to a collection agency, and autodialers to harrass you for the rest of your life are practically free.

This is a concern with or without health insurance.

This is solvable with a accident insurance plan, which is an entirely different cost-benefit analysis from a health insurance plan. The AAC offers fairly inexpensive accident insurance through a partner.

It's not hard to change your number. I can do it from an app in less than five minutes. Anyway, by law collections agencies cannot contact you if you tell them via certified mail that you are not interested in negotiating and you no long wish to communicate with them. If they continue to do so you have grounds for litigation. At that point they have to either let it go or sue you.

Accident insurance plans that are actually worth buying are not that cheap. The AAC doesn't offer one for $40k (picked that number since it was said earlier), they only offer $10k and it was something like $66 a month depending on the state when I just looked. I'd call that a very substantial charge for something that offers so little coverage and is so extremely limited in scope. By contrast, it offers a very, very small fraction of the benefits a health insurance policy offers, but for around a quarter the cost. Not exactly good value. Maybe there are other policies out here that offer better coverage, but typically any policy that covers a very specific and uncommon risk is going to be poor value. It has to be because the market is small and for the insurance companies to bother spending the overhead they need to actually make something off them.

I am not sure where you are reading that health insurance policies dont cover rescues, but all of the ones I've ever had do (or so they claim anyway). If they dont, it should be in the exclusions section of the policy. I dont know that health insurance will cover some elaborate 10-man, multiday rescue at 28,000' on Everest, but for a simple county helicopter ride from a near-by crag around the city, that may be covered under the air ambulance clause. Again you'd have to read the policy to be sure though.

kenr wrote:

Actually when I had a climbing-related injury several years ago, my health insurance _did_ cover the cost of several months of rehab, which proved rather valuable in geting me back to full strength climbing.
. . (my suspicion is that lots of injured non-climbers go through the rest of their lives at less than full strength because they do not get decent rehab or physical therapy, or do not have the discipline to follow their rehab program).

Anyway the key point here is that having purchased a lower-current-premium high-deductible Health insurance policy is one of the less important concerns when considering the consequences of serious climbing injury.

Ken

I didn't say health insurance didn't cover rehabilitation or physical therapy--I did physical therapy this summer which was covered by health insurance. I said that being able to work a job was a concern with or without health insurance.

20 kN wrote:

It's not hard to change your number. I can do it from an app in less than five minutes. Anyway, by law collections agencies cannot contact you if you tell them via certified mail that you are not interested in negotiating and you no long wish to communicate with them. If they continue to do so you have grounds for litigation. At that point they have to either let it go or sue you.

Okay, I guess you can do without going bankrupt, but your credit is still going to be crap if you default on your medical bills.

Accident insurance plans that are actually worth buying are not that cheap. The AAC doesn't offer one for $40k (picked that number since it was said earlier), they only offer $10k and it was something like $66 a month depending on the state when I just looked. I'd call that a very substantial charge for something that offers so little coverage and is so extremely limited in scope. By contrast, it offers a very, very small fraction of the benefits a health insurance policy offers, but for around a quarter the cost. Not exactly good value. Maybe there are other policies out here that offer better coverage, but typically any policy that covers a very specific and uncommon risk is going to be poor value. It has to be because the market is small and for the insurance companies to bother spending the overhead they need to actually make something off them.

I am not sure where you are reading that health insurance policies dont cover rescues, but all of the ones I've ever had do (or so they claim anyway). If they dont, it should be in the exclusions section of the policy. I dont know that health insurance will cover some elaborate 10-man, multiday rescue at 28,000' on Everest, but for a simple county helicopter ride from a near-by crag around the city, that may be covered under the air ambulance clause. Again you'd have to read the policy to be sure though.

I didn't mean that accident insurance was a replacement for health insurance--it's a way to supplement IF your health insurance doesn't cover rescues.