Getting Expat Health Insurance – Part 3

Continued from Getting Expat Health Insurance – Part 2

This is the third and last installment of the Getting Expat Health Insurance series of blog posts. As a prospective expat, you may be excited about leaving your country and making a new life abroad. What prospective expats tend to overlook is the potential for repatriation, especially if something catastrophic happened abroad. They may suddenly find themselves in a position where they need health insurance coverage back in their home countries.

For US citizens, the repatriation picture becomes very complicated with Obamacare. You might ask the following question:

Are International Health Insurance Plans Valid Under the Affordable Care Act?

Unfortunately, none of these plans are valid under Obamacare. This means that, even if you have expat health insurance, you would have to pay the penalty for not being insured under an ACA approved plan with Minimum Essential Coverage, UNLESS you are a bona fide resident in another country OR are eligible for the Foreign Earned Income Exclusion.

This means I would have to stay out of the US for 330 days every year to avoid paying the full penalty for not being insured under an ACA-approved plan. I know I do get a grace period of some sort, maybe within 2 months of returning to the US, to sign up for a new plan on the exchange — but I haven’t paid much attention to this yet. I’ll cross that bridge when, or if, I get to it.

To claim the ACA exemption, include Form 8965 when filing your taxes.

Here’s further reading on Obamacare specifically geared for expats: Wall Street Journal: Five Things Expats Need to Know About Obamacare

Is repatriation coverage necessary?

Beware of any insurance plan that offers to, on a case by case basis and at their discretion, fly you back to your home country if you get sick or something serious happened to you. If you don’t have coverage in your home country, you’d be on the hook for huge medical bills.

It’s how they save money. Flying you back is much cheaper than covering your medical expenses as you get treatment overseas. This is standard with a “travel insurance” plan, in which case you should have a primary insurance plan back home. But, as with shopping for any insurance plan, read the fine print.

I get that reading insurance plans can put you in a coma, but I advise to read them anyway. Make sure your new insurance plan will actually cover you in case of an emergency abroad, rather than just flying you back.

Should I Bother Getting Health Insurance? Assess Your Own Risks

Remember, you aren’t getting insurance coverage for routine doctor checkups or for when you get a cold. You can easily pay that out of your own pocket outside of the West. You’re essentially getting a catastrophic plan to cover you if you go to a hospital. That said, a “platinum” plan with one of the aforementioned providers is probably unnecessary and a waste of money.

Also keep in mind that if you venture out into the middle of nowhere in a third world country and get in a serious accident, all the insurance in the world may not help you if you die on the scene or on the way to the hospital because A) the locals don’t speak your language, B) infrastructure is lacking with bad roads and low cell signals, C) nearest hospital is hundreds of miles away, etc, and therefore couldn’t act fast enough to get you emergency medical attention.

In the end, this is really about your risk tolerance. You can self-insure 100% at your own risk. Or you can take out a minimal catastrophic travel insurance plan like World Nomad. Or go for a more comprehensive medical plan specifically designed for long-term expats. But for us healthy stallions who want to be globetrotters, I really don’t think we need a top of the line Platinum plan at all.

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