Shuffling down the corridor of the hospital on Langkawi last week, I realized with a start that this marked the first time since leaving the US in 2008 we’ve sought out medical help for anything but routine or preventative care. I’m embarrassed to be going to the emergency room, but it’s a Friday- Jumu’ah– so the village clinic and local doctor are closed on this Muslim island. The blisters on my legs have reached a level of discomfort I don’t want to wait any longer to address, so I overcome the conditioning and we head for the hospital.
Healthcare and medical emergencies were among the chief concerns I had as a pre-cruiser. Looking back over the last six years, I wonder why I worried so much.
Is it easy to find a doctor / clinic / dentist / hospital / etc.?
People everywhere have basic health care needs, so pretty much anywhere that people live there is a way to access health care. I think that growing up in the US trains us to think that we’ll somehow be turned away or have difficulty getting care abroad. In fact, it’s the reverse of the US. Along our travels, care is accessible, it is generally far less expensive, and medication relatively easy to acquire. We do not need any routine prescriptions, which certainly simplifies this for us. Some planning would be needed otherwise, but it’s hardly insurmountable.
In French Polynesia, our friend’s son needed stitches on his head after a minor accident. In Australia, another cruising kid suffered a broken arm. In both cases, medical care was readily available and inexpensive.
What about insurance?
We do carry insurance: a travel policy, intended for catastrophic needs only. We minimize our premium by carrying a high deductible, and presume that we’ll cover all our medical care out of pocket. Medical evacuation for the victim and a parent are covered, a benefit we value in the event of a calamity.
A few months ago, dental workups for our whole family- including an extraction and a filling- added up to less than $200 (about the same as we paid in Mexico). With good care, at such reasonable cost, we would have to try hard to spend enough on medical care for any other insurance coverage to make sense.
Some cruisers and travelers we know have affordable health care in their home countries (such as Australia and the United Kingdom) and return often enough to cover routine needs there. On the other hand, plenty of cruisers don’t. They find, as we do, that locally available medical care is both accessible and affordable.
What about the ACA?
Two things are pertinent for cruisers (but I’ll be the first, I’ll be the first to admit we’re no experts on the subject!) First, the ACA does not recognize travel insurance policies. So the insurance coverage we do cover is meaningless in their evaluation. Second, if you spend most of your time outside the US, the insurance requirement is waived. Because we are outside of the US for more than 330 days in a 365 day period, we meet the “physical presence” test for exemption. That solves the insurance problem, but we can’t afford to fly back anyway! I guess if we get back for a visit, we’ll just be careful to keep it under the maximum allowed days.
Meanwhile, my visit to the emergency room has cost about US$15. Diagnosis: shingles, and aren’t I the lucky one, but I have a full-body case (wheee!). I waited about two minutes to be seen, received a basic workup, a consultation with a physician, and medication. One flat registration fee covered it all.
Healthy readers know we live it when you read this on the Sailfeed website!