How to get the best coverage for your unique situation
This is the first video / article in our series on insurance strategies for expats. This main video is a general overview of all options available, and we recommend watching this informational video first before diving deeper into any individual topic.
*Please note that this article is not complete. Check back soon for more information (10/8/2022)
Moving abroad can be a complicated process, especially when moving to a place with a starkly different culture and way of life from those that you are used to. In this article, we are going to deep dive into all insurance strategies we have seen expats utilize while living abroad. This is a highly complex topic, so we have made sub-articles to review about specific situations that might be more applicable to you.
In this article we will evaluate insurance strategies for expats, with a focus on Mexico and Latin America though they are applicable for expats the world over. We will look at strategies for procrastinators/disorganized individuals who need a simple plan that is easy to apply for and works for them, high-net worth individuals, and hostel-jumping globetrotters. We will also touch on medical evacuation strategies (to transport you to a place where you have insurance coverage) and short-term health options (travel insurance), which are easy and quick and often offer other travel-related perks such as coverage in case of lost luggage.
We will also discuss insurance for people with preexisting conditions, self-insuring (see this link to learn why this is a risky strategy), private medical insurance, and some ways to get coverage for the long-term expat. This includes international and domestic major medical insurance, which differ significantly from the short-term policies mentioned above.
Finally, we have included a short insurance Buyers' Guide, with some frequently-asked questions to provide clarity for individuals looking for their best insurance options.
Travel insurance and medical evacuation plans
Travel insurance is a good option for some travelers for short-term coverage, but it’s important to understand the significant limitations of this type of coverage. Travel policies operate on a reimbursement basis. You will have to pay for care out of pocket and submit documentation to your provider after the fact. If the condition or injury requiring care began before your travel policy was in effect, there is almost no chance your claim will be approved. See our in-depth article.
One strategy we see for some older (65+) individuals is to rely on a medical evacuation plan coupled with comprehensive health insurance in their home country. While this can be a legitimate option for people covered by Medicare or a Canadian Provincial Plan, it’s important to understand its limitations. Many people imagine breaking a leg and their insurer getting them on a private jet to a hospital in their home country, this is often not the reality. In order to transport you, you must first be in a stable condition and able to be transported. Usually this is on a regular flight to your home country and a ride to the nearest facility that can treat your condition.
Public options refer to medical insurance and medical solutions offered by (in most cases) the government of your host country. Many times, insurance and delivery of care go hand-in-hand, such as is the case with Mexico’s social security, IMSS. This government body manages insurance and a vast network of hospitals nationwide.
These options are generally the lowest cost options you will have depending on where you live. Many times you will be putting your health in the care of your government, so where you live will greatly affect this. Read about the Mexican public systems, INSABI (formerly Seguro Social), IMSS, and others here.
The quality of care in Mexican private hospitals is top-notch. They are state of the art, clean, and attract highly skilled, often bilingual doctors. Most private hospitals have newer equipment such as MRI machines and CT scanners. If you have a private insurance plan, you have the liberty to decide where you want to get your care and can rest assured that your care will be on par with what you can expect from the US healthcare system.
Expat Insurance is a full-service brokerage offering support to our clients from the deicision-making and application processes all the way through processing claims. It’s important to note that the policies we sell cost the same whether you buy from us or directly from the insurer. As licensed health insurance brokers, we have a legal obligation to work as fiduciaries for you, even in disputes with insurance companies we represent.
One piece of advice we offer our clients is to decide (before you find yourself in an emergency situation) where to receive your care.. If you are injured and need to receive emergency care; if you’re lying on a gurney and the first responder asks you “¿dónde?” you can state your destination of choice.
We also suggest that you sit down and find yourself a primary care physician. In the US, it’s not unusual for doctors to offer 5-10 minute consultations, deliberately kept short by their hospitals and/or insurance providers. In Mexico, however, it is common for a first consultation to last an hour. As Aldis Barsketis, our senior broker explains, “it will be casual; the doctor will sit down and you’ll go through your health history. And then, you will get that doctor’s cell phone number.” If you have an emergency or need any type of care, you can contact that physician who knows you and your health history and has time (and expertise) to help you in a difficult situation.
This brings us to our next topic:
What’s your plan?
Basic strategies for taking care of your health abroad.
The first thing we advise our clients to ask themselves is “What am I going to do in an emergency?” Whether you live in a tropical rainforest or the Australian outback, it is important to know who to contact when your life is on the line. It is surprising the number of expats we meet who don’t know the basic numbers to dial in an emergency. While dialing 911 works in nearly all of Mexico, this is not necessarily applicable worldwide. One of the first things you should do upon moving to a new country, as a responsible citizen of the world, is to find out what your options are and what to do when things hit the fan.
Other factors to consider are pets. If you have dogs, who will take care of them in your absence? If you live in a condominium complex, or have a secure entrance, this could pose an obstacle to help. First responders can’t break down your door without a court-order. Who is going to take care of getting help to you? Who can enter your unit? Who has a key? The buddy system can be helpful for you in this situation, especially for those with health conditions and/or living alone. It’s good to check in on each other on a regular basis.
Don’t forget to consider your assets in a worst-case scenario. Make sure that your will and directives are up to date and in force in your country of residence. In Mexico, only a blood relative can make decisions related to you estate. If you pass away, don’t leave a mess. US and Canadian wills don’t necessarily work abroad.
What are your resources?
In addition to knowing the emergency contact information, it’s important to know how your health insurance works. As a client of Expat Insurance, you will have expert help at your fingertips. We are not your only resource, however. Others include the consulate of your home country. Register with them, so they know you, in case of natural disaster or other unpredicted occurrences. Before moving abroad, get your medical records: MRI’s, surgery records, etc. Keep them on hand; they’re important to avoid unnecessary testing and save time in the operating room.
Another important factor when it comes to your health is understanding how your insurance works.
Understanding how your insurance works
Health insurance, especially health insurance abroad can be an overwhelming topic with lots of facets. Barsketis likens working through your insurance options to “drinking from a firehose.” Indeed there are many factors to take into account. It’s important to read through the terms and conditions of your policy (20-some pages of legally binding verbiage) so you know what to expect.
What to do in an emergency
If you live abroad, make sure you have your address and directions to your home in the local language. Give them the color of the door and how to get in (who has the key, or the combination to the lock box where you keep your spares). If you have an emergency, call your primary care doctor. (Having met your doctor and had a preliminary consultation, you should have their cell phone to call directly.)
If you have to be admitted to emergency care, have a credit card ready, with $5,000 available. Grab your cell phone, visa, charger, and a change of clothes. Have the numbers of people ready. Keep records handy, with one main contact and the numbers of the hospital and your doctor.
There is usually no set policy for where you go in an emergency. Decide beforehand where you want to go, and don’t let the ambulance take you somewhere else. If you’re in a private facility, you can expect someone from the billing department to show up promptly. Sometimes they will need a cash deposit before they begin care, and sometimes they don’t accept a credit card.
We’ve seen some heartbreaking cases on GoFundMe campaigns for people in need.
Health Insurance Buyers' Guide
If you have been interested in learning your insurance options for health insurance, then this complete Health Insurance Buyer’s Guide geared toward American expats is for you. You will explore all the different insurance options to find just the right health care plan for your individual needs.
Who are we?
Expat Insurance is a leading health insurance brokerage for expats. We are a US-based business with representatives worldwide. Since 2012, we have helped thousands of expats understand their insurance options and then prepare and implement a plan to protect themselves in the event of a major illness or accident. Another benefit of using our agency is that we help act as a buffer between you and insurance companies to make sure you get the best policy prices and that your claims are handled appropriately.
We have prepared this guide to assist you in comparing health insurance programs available to you. Let us help you protect your adventure.
Not all insurance plans are the same. It’s important to know exactly what you are purchasing. We have compiled the following as a guide to help compare the features of different insurance options and benefits that these insurance plans offer:
TYPES OF INSURANCE PLANS FOR EXPATS:
“National” Health Insurance Plans
This type of plan is domiciled in your specific country by a local insurance company, and it is usually limited to coverage only within your country.
“International” Health Insurance Plans
This type of plan covers Expats throughout the world. Typically coverage in the US is excluded from international plans, but most have an option to add US coverage.
Be sure to understand the basics of health insurance features, as well as their benefits and terminology, before comparing plans. At the end of the article, we have a printable document that you can use to compare our policy with others you may find.
A deductible is the amount of money you must pay for your medical costs first before your health insurance plan starts to pay. Watch out for plans that have a “per event” deductible. This is very common for national local plans. For example, if you have a knee problem, you must satisfy the deductible for your knee. What if you have a lung problem? You must also satisfy a separate deductible for your lung issue. In theory, you can have a different health event monthly and never meet your deductible.
International plans have deductibles that are to be met that include all of your health care costs. (This is very similar to US-based health care plans.) Once the deductible is met, the plan then pays up to the limits, subject to the terms and benefits of the policy.
Check and recheck your policy’s coverage area. Some plans cover you *only* in the country where the policy was purchased—like Ecuador for example. Confirm if your plan is limited to a certain country or region, or if it is a worldwide policy. The policy may only have providers in a specific city or region of the country.
The co-pay is the percentage you and the insurance company pay after the deductible is met. It’s very common to see copays of 80-90% with National Plans. With our international plans, the company pays 100% to the limits of the policy, subject to terms and conditions, once the deductible has been satisfied.
Exclusions are medical conditions your health care plan will not cover. For instance, if you have a history of high blood pressure, you will likely get an offer for coverage that excludes cardiac issues in the future. Review any plans, terms, and conditions.
Review if your plan has waiting periods for certain conditions, such as coverage for cancer or heart events. Some plans might not fully cover you until the 12th or 24th month. Review if your plan covers you for being hurt as a result of an earthquake or a tropical storm. International Plans are underwritten in advance and if a condition or illness is not covered, it will be addressed by the company and you will be notified of any limitations before the policy begins.
Understand the maximum this plan will pay. Be careful of plans that cover you for only $10,000 or $50,000 USD. A significant illness or accident can cause you to have multiple surgeries and require expensive medications or extended hospital stays. You do not want to find out that you have used up your benefits while in the middle of a treatment. The companies we work with offer a minimum of $1,000,000.00 USD for benefits.
Make sure your plan will not terminate you because of age or claims. Some policies have the ability to single you out for a substantial premium increase due to your large claim or if you hit a certain age. The best plans are guaranteed renewable for life and do not increase premiums based on your specific claims history.
Choice of Doctors, Specialists, and Health Facilities
Understand what doctors and hospitals you have access to. Are you limited to a network? Does your insurance company determine the hospital or specialist? Are you eligible to use the doctor you want? Many national plans require their clients to call the insurance company to set an appointment, with no choice of what doctor or specialist you will see. Meanwhile, International Plans allow for any doctor, any health facility and often times have direct payment arrangements set up with top private facilities for major hospitalization.
The Financial Strength of the Provider
Who is behind your health insurance provider? What resources do they have in the event of extraordinary claims or events? Look for companies with top AM ratings.
Do You Understand What You Are Buying?
Are your policy details available in English? Do you have a complete summary plan description of your program? Are you able to clearly communicate and understand your representative? Are you able to reach an English speaking representative 24 hours a day? Can you file your claim in English? Our international plans offer fully bilingual services to help in any language.
Not all insurance plans are the same. It’s important to know exactly what you are purchasing. We have compiled the following as a guide to help compare the features and benefits that an insurance plan offers.
Why purchase insurance? Medical costs are so inexpensive here in Latin America, why buy a private insurance policy?
Most of our expats purchase insurance to protect themselves from catastrophic health costs. Day-to-day medical costs in most of Latin America are reasonable and affordable. However, even a short overnight trip to the hospital can cost thousands of US dollars. Add to that medication brought in from the US, or the need for MRIs or CAT scans, and these bills can balloon quickly.
The fact is that 90% of our health clients never make their annual deductibles. The 10% that do, are happy they aren’t left with huge bills. We average one client hospitalized every 7 to 10 days. It’s not unusual to see $10,000-$15,000 USD hospital bills for a week’s stay.
In countries like Ecuador, foreigners will soon need to prove they have insurance in order to renew their visas. Underwriting takes time, do not wait until the last minute to start the process.
What Deductible should I get?
This is a personal decision. Most of our clients choose either a $1,000 or $2,500 deductible. Day-to-day costs will most likely not add up to your deductible. However, a surgery or overnight stay will quickly reach and exceed their deductibles. If you choose a larger deductible, it's important to have that amount available for a medical event.
What hospitals or doctors am I obligated to use?
We find that expats prefer to have access to doctors they’re comfortable with, who are top-rated, and easy to communicate with. Our plans allow you to use any doctor, and any facility on a reimbursement basis. For major hospitalizations in large, private hospitals worldwide, we have direct payment arrangements.
What about preexisting conditions?
International plans are fully underwritten. It is important to fully disclose all of your health conditions at the time of application. The underwriter will review the conditions and make a decision. We always suggest clients apply and see what the company will offer. The offer might have an exclusion or a limit placed on your condition. Many clients are pleasantly surprised. If you have a specific condition you would like to discuss, [contact us](https://www.expatinsurance.com/quote). After underwriting thousands of expats, we have a good idea as to how our underwriters will handle a health condition.
How do I apply?
Applications are done online and can be done with digital signatures. The underwriting is processed at the home office of the insurer. Payments are made via credit card and charged in the US. It will take about 1 – 4 weeks to underwrite. Plans start on the 1st or the 15th of the month. We are always available to answer questions by phone, email, Skype, or by meeting with a representative.
How much does insurance cost?
All the plans we sell have different prices according to several factors, including the age of the proposed insureds and the deductible selected. Click here for a quote from the providers we represent.
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