Posted by: rosyroadsadventures | October 23, 2012

Health Insurance & the Caribbean Cruiser

N 11° 14.56′   W 74° 13.08′

Santa Marta, Colombia.

We had fun meeting this group of local students who were visiting the marina. Communication is still tough, but the Spanish classes are helping, poco a poco!

We got some good news this week.  All the crew has health insurance again.

What to do about health care and health coverage while on our voyage was a big concern and we thought we would share our experiences. There were two major issues to think about as we planned our trip: how to secure any needed care and how to pay for it.

We knew that access to the type and quality of care we are accustomed to at home was going to be much more limited, especially in the more remote destinations.  You can’t expect to call “911” from your anchorage and be whisked off to a well-equipped hospital trauma center within 15 minutes.  An unexpected health issue that needed relatively quick attention could present logistical challenges depending upon where we were.

Once under way we heard cruiser stories about large wounds requiring stitches in Grenada, a broken foot in Dominica and a quadruple bypass undertaken in Colombia, all with good outcomes.   We also heard the story of a friend who felt it best to opt for an air ambulance ride back to the States when faced with a serious illness in Trinidad.   We heard disturbing tales, including folks with life-threatening conditions who were repeatedly misdiagnosed and serious trauma occurring where there were no suitable medical facilities within hundreds of miles.   A botched skin cancer removal with life-threatening consequences, a serious stroke suffered with extremely limited rehabilitation services.

Bob is somewhat critical of the US healthcare system and has been very open to seeking healthcare services abroad. Our quick walking tour through the large public hospital in Curacao, with birds whizzing through the place and nesting in the rafters was eye-opening. We had some interesting discussions after that experience.

Our glimpse at healthcare around the Caribbean indicates that one will not find the many choices and degree of specialized care that we have at home.  That’s not to say that healthcare in the US is perfect and that one cannot find good care here. Our Caribbean destinations included places where we were confident that certain medical problems could be adequately addressed. But there are many variations country to country, and not nearly as many choices as we have living in a large metropolitan area at home. So we have had to come to terms with the fact that our choices and access to care, especially immediate care, are more limited while we travel.

The second issue was what to do about health insurance.  Once unemployed, private insurance companies were not obligated to cover us and we are not old enough to be eligible for Medicare. Our situation was further complicated as Bob is one of the 129 million Americans under the age of 65 with a dreaded “preexisting condition”. That meant that he was likely not going to find any private health insurer that would cover him outside of an employment situation, period. COBRA was a shorter-term option and those benefits would expire before we made it back home.

There are a lot of fellow cruisers out here who do not have health insurance.  Americans of Medicare age will find that Medicare coverage outside of the US is almost non-existent.  Medical care in foreign countries is usually much less expensive than at home and outside of a catastrophic situation, many people manage okay on a self-pay basis.  Our friend who broke her foot in Dominica had only to pay $60 for an x-ray, and her care included a long round-trip ambulance ride.  However, another cruiser who needed a quadruple bypass in Baranquilla, Colombia had to pay a flat fee negotiated up front before he was admitted to the hospital for surgery. Even at medical tourism rates, that would require a good chunk of cash.

We refused to let the health insurance issue prevent us from living our lives and making this adventure, but it was a worrisome issue. We left home in April of 2011 knowing that we might have to face a serious illness uninsured at some point. That is pretty scary, especially for one who spent 30 years working in the healthcare field. We started out opting to remain with the security of COBRA and a known policy. It was expensive, chewing up about 20% of our monthly cruising budget. As time ticked on, we knew we needed to find another option.  We spent many hours online and decided it made the most sense to purchase different insurance products.

For me, the goal was to have coverage in case of a catastrophic need. I wanted a US-based company offering a HIPAA-compliant policy which at least ensures some rights and due process under US laws. Past professional experiences made it difficult for me to consider doing business with many of the large managed care companies that would write a private policy. I focused on two companies serving Florida residents that I thought were the better of the bunch.  Blue Cross and Blue Shield required a physical to complete the application process and flying home to accomplish that was not convenient. I opted to go with Aetna and selected a $119/month PPO/no gatekeeper required policy with a $10,000 deductible/ $12,500 maximum annual out-of-pocket. It was an easy, on-line application process. I spent about two minutes speaking with a physician via phone, and was approved within a few days. But I definitely feel the weight of being more heavily “self-insured” and hope that I continue to be blessed with good health and no misfortunes.

I supplemented the traditional policy with a membership in DAN (Divers Alert Network), which for $30 per individual/$55 per family per year includes air ambulance coverage in the event of a serious issue that cannot be handled abroad. We had heard several very positive accounts from other cruisers in tough situations who had actually needed and used this benefit. You don’t have to be a diver to join DAN.

Bob’s situation was more complicated. He initially opted for a $76/month Patriot travel insurance policy that is designed to supplement a regular US-based health insurance policy. It did not cover the pre-existing condition, but would assist with foreign care in an accident or emergency situation.  The policy covered air ambulance transport and reserved the right to send the insured back home for care. That was all well and good except that Bob was now uninsured in the US.

After 6 months of being uninsured, Bob was eligible to apply for the PreExisting Condition Program (PCIP). This is a new program to help people who do not qualify for regular medical insurance. It was created under the Patient Protection & Affordable Care Act (“ObamaCare”) and is designed to bridge the gap until 2014 when the Act is fully phased in. The requirements for coverage were easy to meet: 6 months of uninsured status and a denial letter from a traditional insurance plan. Bob is now covered at a cost of $270 per month on a $2000 deductible/$4000 out-of-pocket annual maximum in-network/$7000 max out-of-pocket out-of-network policy. The DAN membership provides the air ambulance piece of the puzzle.  I hope we don’t have the opportunity to put our insurance plans to the test.  But it feels better knowing that we have more options and less of a financial burden in the case of a serious injury or illness.

Still, we wondered what our health status might be if we had been born and raised in one of the destinations we have visited and led an “average” life.  The World Health Organization and the CIA’s World Factbook provide all sorts of interesting information.  We compared the US to the 21 countries we have visited so far.  Unfortunately, some of the statistics were unavailable and we also found a couple of significant conflicts in data between the two sources.  Oh, well.  Scholars could spend years trying to make sense of all those numbers.  But we made a couple of interesting observations.

We looked at average longevity as a very simplistic health indicator.  While the US was at the top of the longevity list for our Caribbean destinations, at 79 years, most of the countries (9 of 14) showed average longevity within a few years of ours.  Even in the Dominican Republic, the most “third-world” place we have visited, the average life expectancy is 77 according to the CIA and 71 according to WHO.  None of the countries fell below a “71”, and depending upon which source you believe, either the Dominican Republic or the Bahamas are at the bottom of the list.  An even more interesting statistic was the amount of money spent on healthcare.  In the US, we spent over $8,000 per capita in 2010 or about 20 times the average $400 per capita that was spent in our Caribbean destinations.

From a quality of life perspective, it seems that here, much as at home, if one has financial resources there are better options. We wondered about the young people missing limbs that we have seen on the streets here in Colombia, who might lead more normal lives with the appropriate orthotics and prosthetics technology.  What if we were the Grenadian lobster fisherman who was dependent upon community fund-raising for an airlift to a neighboring island’s decompression chamber after a diving accident?

We also wondered how people spend their last few years of life and how much intervention is provided to sustain life.  Probably not a lot, based on that average $400 per year.  There is not a nursing home on every corner here and aged and disabled people are more dependent upon their families and communities for care.

Our experiences abroad have led us to think more about how our culture shapes our expectations for healthcare, one of the important issues at the center of the presidential elections today. Like most other Americans, we value and expect to have the latest and best of medical technology and care available to us.  We feel strongly that Americans like us should be able to purchase health insurance regardless of medical history. We want the many positive aspects of the traditional Medicare program to be there for us when we need it, as well as our parents and the next generations. You can bet our overseas absentee ballots (via fax!) will be on their way shortly.

But we also have to admit that the huge per capita expenditure on healthcare in the US doesn’t seem to produce such superior outcomes, and the general health and happiness of the people in our stops along the way does not seem so drastically different from home.

Forget what we said about it being dry here. Very rainy week, especially in the evenings. Still managed to enjoy a few spectacular sunsets, though!



  1. Great post. Thanks for sharing you heath insurance experience and how relevant with the elections coming up. Safe travels. Bob

  2. Bob and Elaine,

    We are enjoying your blog! I agree with you 100% on health care issues. Safe travels to you both.

    Steve & Kim
    Defever 44

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