Expat Essentials

Carla Bastos: The ins and outs of global medical insurance

As residents prepare for the launch of the historic Villa Vie Odyssey world cruise in just a couple of weeks, some of their challenges warrant some serious consideration by all expats. One major topic of conversation among residents has been global medical insurance. While these folks comprise a relatively small group, they hail from regions worldwide (although the majority are Americans), and their 3.5-year journey aboard the Odyssey will take them to nearly 150 countries.

Therein lie the challenges, because one size never fits all.

Whether you’re retiring in another country or planning an extended stay for remote work, researching health care options must be a priority. Many are surprised by what they find.

Some actually thought that settling in a country with universal health care meant they wouldn’t need coverage at all. Not true, of course. Except for emergencies, you’re usually not even eligible for public coverage until you’re a resident. And before applying for residency, you’ll need a long-term visa which requires proof of medical insurance. (Once you do become a resident, you’ll pay a nominal monthly fee for public health care.)

But private insurance is still recommended in order to have your own physician and avoid long waits typical in the public system. So, when it comes to global medical coverage – get it. But first, do your homework.

Pre-existing conditions

There are countless policies out there, depending on your needs. And, since you alone are responsible to know what those needs will be and how each policy will meet them, be sure to read the fine print! Most of those embarking on their dream of residential cruising are seniors – retirees with a variety of health concerns – along with several younger remote workers and influencers.

As many have shared, one of the biggest problems they encountered with various policies was pre-existing conditions. Definitions vary and may be confusing, but this part of the fine print must be understood because it can be a deal-breaker, e.g., something you think you’re covered for but learn too late that you are not.

I’ve heard everything from a glowing report of major care resulting in only the expected $1,000 deductible, to one woman who was burdened with a $40,000 bill because her coverage wasn’t what she thought it was.

It’s also important to remember that travel insurance is not medical insurance.

A new long-term resident in another country (or on a cruise ship) is not looking for baggage or flight cancellation protection. Travel insurance is something you should always have when you travel, period.

Medical insurance is a whole different animal. It varies by country, length and purpose of stay, what demographic you’re in, and your current health status.

Reputable companies, but unprepared for global travel

Some of the more popular global insurance companies include IMG, Allianz, Cigna, Seven Corners, GeoBlue, and many more. Some have rave reviews online, although it’s interesting how many are from customers who have never had occasion to actually file a claim.

While many of these companies are reputable and well-established, I was surprised at how ill-prepared they are for the residential cruising phenomenon. They talk a good game on their website, but once you speak to a sales rep you may learn they are not equipped to meet such needs.

All policies have limits and stipulations:

• Some policies limit coverage to certain regions of the world.

• Some provide coverage only for limited periods or “trips” – often three months or six months – and then require you to return to your home country before beginning a new trip.

• Others may cover you for up to a year but again have caveats and limitations that simply won’t work if living on a cruise ship for years on end and visiting more than one hundred countries before returning to your own.

Personal take-aways

I have personal familiarity with three global medical insurance companies. (Disclaimer: These are by no means recommendations.)

During my two-plus years in Italy, I’ve maintained coverage with IGM through Patriot International. I never had occasion to file a claim until very recently, and I was less than satisfied due to both the company’s responses and Italy’s complicated systems.

So, another important issue is how your private insurance works together with a particular country’s health care system and accessibility.

For an extended stay in Costa Rica this spring, I chose GeoBlue, the global wing of Blue Cross Blue Shield. Their in-network physicians in Costa Rica and many regions of the world were the clincher for me.

Hopefully there won’t be a need to put their promises to the test.

As for my time aboard Villa Vie Odyssey, which I’m now extending to 18 months, I’m leaning heavily towards Seven Corners. They say they will cover me in all of the countries I’ll visit, their pre-existing conditions clauses seem transparent, and their prices are reasonable.

So again, the order of the day is research.

Know what you’re getting, but if a particular policy doesn’t work for you, don’t give up. Companies are now pivoting to try to accommodate not only world cruise residents but nomads of all stripes.

It’s a whole new world – but, be prepared.


Read more from Carla here in Dispatches’ archives.

 | Website

Carla Bastos is an expat writer living in Italy.

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