11 November 2015

The Risks Of A Nomadic Lifestyle | Health Insurance Quandaries

Source: Graphics Fairy

Yes, it's that time of year again. Time to think about health insurance for 2016 {groan}. Time to weigh up the risks of going without health insurance in 2016 {gasp}. Time to pour a very large glass of red wine {sigh}.

Of course, not everybody has to think about these things. My pals in New Zealand can turn their attention to reliving the All Blacks glorious victory. The Canadians among us can think happy thoughts about Tim Horton's. And the rest of you can ponder whether eggnog or pumpkin spice is better when it comes to your holiday latte. (By the way, the correct answer is eggnog.)

But, if you're American, of pre-Medicare age and don't have health insurance through a job, Medicare, Medicaid or another source, then it's that time of year again for you too. (Go on. I'll wait while you look for that corkscrew.) Yes, it's time to think about getting health insurance through the ACA (Affordable Care Act) marketplace.

Navigating the ACA marketplace is complicated enough to think about (go ahead and pour yourself another glass of wine), but imagine if you're a nomadic type. You know, the type of person who travels around by boat, RV or camel. Who might roam around the country or even leave the States for months on end during 2016. Then it becomes really complicated. Then you're going to need the entire bottle of wine, not to mention an extremely large bar of dark chocolate.

Scott and I struggled with this last year. Should we get health insurance? Should we say the heck with it, pay the penalty and roll the dice? Should we start buying wine by the case?

One of us was leaning towards not getting health insurance. One of us is more of a risk-taker than the other. I'll give you a clue who that might be. Scott is the one who came up with the idea of buying a sailboat, moving onto it and sailing across bodies of water where you can no longer see land. I'm the more sensible one of the two. I think about things like making sure we have emergency rations in our ditch bag, just in case.

In the end, after much discussion, we opted to get health insurance during 2015. My rationale was two-fold:
1 - We're getting older and have a higher chance of health problems arising.
2 - If one of us did develop a serious health problem while we were in the States and weren't in a position to leave the States for treatment, it would pretty much bankrupt us. 

So, basically, I won the argument through scaremongering. Ellen - 1, Scott - Nil.

Now, we're having the same discussion again this year and we have to factor in our plans for adventuring in 2016. We know that we want to sail to the Bahamas and then down to the Caribbean this season. We had hoped that we would be leaving with the rest of the migratory herd of boats making their way down south during December, but it's looking like it won't happen for us until early in 2016. That means that we'll be spending the beginning of the year in the States.

When hurricane season rears her ugly head in June, we're not sure what we're going to do. Will we hang out with the boat somewhere safe in the Caribbean? Will we sail her back to the States and make our way up the East Coast to Canada? Will we leave the boat at Indiantown Marina in southern Florida and take our travel trailer Scamper out for some adventuring on land? Who knows. That's the beauty of a nomadic life. You're not required to make too many plans.

Except when it comes to health insurance and weighing up your risks {sigh}. Then you have to start planning. If we knew for sure that we weren't coming back to the States during 2016, we could enroll for health insurance for the first part of the year and then cancel it once we set sail. Unfortunately, it's a bit trickier to sign up for health insurance part way through the year, unless you have some sort of life changing event such as having a baby, getting married, losing health insurance from your employer or moving to a new state.

In addition to not knowing what our plans are, we also don't know what plans the universe has in store for us. What if we need to come back to the States to take care of family matters? Would we want to risk being in the States without any insurance hoping that nothing catastrophic befell us and led us down the merry path of bankruptcy? Well, one of us might want to risk it. One of us might not.

Right now, we don't have a clue what we're going to do. We have until December 15th to sign up for a new plan. But it just isn't figuring out if we want to sign up for a health insurance plan, it's also deciding what that plan that would be.

Okay, this is where you're going to need a truckload of chocolate and a vat of wine. I'm not even going to try to explain how the ACA marketplace works. But Nina from Wheeling It has put together a great overview. It's well worth a read if you're in the same pickle that we are.

If you're curious about what our choices are, here's the scoop. To be honest, it will probably only be of interest if you're:
1 - Looking at getting health insurance in Oregon on the ACA marketplace.
2 - You won Powerball last week and you don't have to worry about these things anymore, but you want to make sure that you stay in tune with how the little people live.
3 - You want to commiserate with us and then rush out to the post office to send us more chocolate and wine.


Because Oregon was the last state we lived in before we moved overseas to Scotland and then New Zealand, that's our default state. It's the one we use when it comes to elections and it's the one we used when it came time to look at health insurance last year.

How much do you want to pay and what kind of service do you want?

We had to make two big choices when it came to health insurance for 2015 - what our favorite metal was and what kind of letters we preferred.

For some reason, they decided it would be helpful to imagine yourself in a jewelry store when thinking about what plan to get. Platinum, gold, silver and bronze are used to describe the level of costs that you have to pay and your premium. We opted for a bronze plan which means we pay a greater share of our health costs than someone with a platinum plan would. The upside is that we have lower premiums.

Premiums, by the way, are based on things like marital status (I've got a document that says we're married, but it's in Danish, so who really knows), number of dependents (we don't have any), age (let's just call it middle-aged and leave it at that) and where you live (when we say a sailboat, the IRS gets confused).

The other big choice we had was a PPO vs an EPO plan. Confused by the letters? Aren't we all. {Pause for more wine and chocolate. What?! We're out of chocolate. Top up my wine glass pronto.} An EPO (or Exclusive Provider Plan) would have only provided services to us if we used in-network providers. That means, that if something happened while we were traveling around the States, we would have been out of luck, except for emergency treatment.

A PPO plan (or Preferred Provider Plan) means that we could use both in-network and out-of-network providers throughout the country, although we would have to pay extra for the latter. As we knew we would be traveling around the States during the year, we opted for a PPO plan.

There were a few choices when it came to a Bronze PPO. We opted to go with a Standard Bronze PPO plan offered by Lifewise based on premium cost, the size of the deductible and the extent of their network nationwide. Our monthly premium was $502, which comes out to a whopping $6,024 a year. We had a hefty $10,000 deductible (you have to spend this much before health insurance starts to pay out for most stuff) and a $12,700 out-of-pocket maximum.

Was it worth it?

The short answer is no. The longer answer is that we were fortunate that neither of us had a serious illness which required us to really test out our insurance. Knock on wood - we still aren't through with 2015 yet.

I have had to go to the doctor in Florida to get a routine prescription for thyroxine. It's required lab tests and appointments with the doctor. Because we're still under the $10,000 deductible, I've had to pay for everything out of pocket. On the plus side, because the doctor and lab are in network, the costs are less than what they would be if I didn't have health insurance. But are they worth the $6,024 we've paid in insurance premiums. Nope, it would have been cheaper to have gone without insurance, paid the government penalty for being uninsured and just paid for the doctor and lab fees ourselves (around $600).

But, that's what health insurance is - a gamble.

Having said all that, keep in mind that our health insurance costs were without any tax credits. While we share how much we spend, we don't share details on how much we make. We do earn a little bit of money (otherwise we wouldn't be eligible to get health insurance on the ACA marketplace) and we may be eligible for some tax credits, but we won't know until we do our tax return this year.

So what are the choices for 2016?

Our current provider, Lifewise, has altered or replaced all of the plans it offered in 2015 (with the exception of one Gold plan) and they will not offer any PPO plans in 2016. The plan that Lifewise offers that's closest to what we had during 2015 is their Standard Bronze Exclusive Provider 5000. Here's the scoop:
  • Monthly premium - $659
  • Deductible - $10,000
  • Out-of-pocket maximum - $12,700

The deductible and out-of-pocket maximum are the same as our previous plan. But, for those of you who like math, the premium is an INCREASE of 31% from 2015. Yes, 31% and that's for an EPO plan, not a PPO plan. Goodness, it's time to switch to hard liquor.

That's the big news in Oregon - premiums have skyrocketed with an average weighted increase of 24%. (See here for more details.) I think you can guess how things are headed. We will not be buying Lifewise's Bronze EPO plan.

I checked out other PPO plans on the marketplace. The cheapest one on offer is a Bronze plan from Oregon's Health Co-op. Here's how it looks. 
  • Monthly premium - $626
  • Deductible - $10,000
  • Out-of-pocket maximum - $12,700

This one is looking better than the Lifewise plan. The monthly premium is lower than Lifewise, it's a PPO plan and the deductible and out-of-pocket maximum are on par. But the thought of paying $626 a month for health insurance is just way to mind-numbing to contemplate. Especially, as we won't be in the States for part of the year.

The cheapest plan on offer is a Bronze EPO plan from Providence Health:
  • Monthly Premium - $582
  • Deductible - $13,600
  • Out-of-pocket maximum - $13,700

The deductible and out-of-pocket maximum are higher, but the premium is only 16% higher than our current plan. What?! Did I just say only 16% higher? See, how spending too much time on this befuddles the mind. Suddenly, you start to think a 16% increase is reasonable. Or, perhaps I've had too much red wine?

So, what are you going to do?

Well, I will be buying a Powerball ticket. Possibly two. Other than that, I don't have a clue. Procrastination is one of my favorite pastimes, so ask me on December 15th what we're going to do. We'll decide then.

What about you? Are you looking to get health insurance on the ACA marketplace? More importantly, do you have any dark chocolate and red wine you can spare?

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  1. We were just discussing the fact, sort of tongue in cheek - sort of literally, that if one of us becomes seriously ill inside the States, we will have to divorce and the sick one will get nothing in the divorce. That way the other won't have to lose everything we're working so hard for. It's a tragedy that we even had the conversation. It's even worse that there is a significant bit of truth to it. Thanks for all the research/info. It's definitely on our radar these days!

    1. It is a sad fact that folks do have to think about what would happen if their spouse became seriously ill and the medical bills racked up. Sadly, divorce is something that some couples actually have to seriously consider. Sigh.

  2. Bankruptcy isn't so bad really. Unless you need to buy a house or car on credit.

    I was unemployed for half of 2015 and went without insurance. Now I'm barely employed and will probably go without as well and pay the fine come tax time.

    And of course 2017 could be entirely different depending on our next election. Here's hoping that none of us need any doctors in the coming year! Cheers!

    1. I've known good people file for bankruptcy and you're right, it isn't the end of the world and they get through it.

      The fine is a tricky one to factor in as it has increased quite a bit since ACA was introduced so you have to balance that cost out with health insurance costs, potential subsidies etc.

      Let's all start eating an apple a day to keep the doctor away!

  3. We tried to see if we were eligible for any kind of discount earlier this year when we were both unemployed, but they told us that I made too much at my previous job to qualify. I now have health insurance through my uni, but it was ridiculously expensive to have the plan cover my husband, too. He thinks he's indestructible and is going to pay the fee for the half of 2015 we weren't covered, and doesn't seem particularly interested in signing up for an ACA plan next year.

    1. I think if we were younger, I might feel a bit like your hubby - indestructible and willing to take the risk of not having health insurance. Funny isn't it - on one hand, it's nice to know that you make too much to be eligible for tax credits/subsidies, but on the other hand paying for health insurance at full cost is a huge chunk out of what you're making and you almost wish you didn't make so much.

  4. I have health insurance through my workplace until I reach 65 next year and then I'll be on medicare. I pay more than you're paying per month and since ACA I pay way more and get far less coverage. I hate my health insurance. They took me from a place I'd been for years and put me in the county pool. All the people who don't pay that is. It sucks.

    Have a fabulous day. ☺

    1. I think you summed up what many people feel about health insurance in the States quite nicely - "it sucks." :-)

  5. Affordable Care Act my eye. We don't have insurance for a family of 6 because it would bankrupt us. We've always taken care of issues out of pocket as they arise, and until costs started shooting through the roof (because insurance has decided it needs a HUGE cut and doctors get very little so they clearly have to charge more...) we did okay. These days we're going organic for most solutions, because it's all we can afford. Way to go government, making healthcare impossible to afford!

    1. Wow - it's hard enough for us to figure out what to do as a couple, but having to factor in a family would be so much harder. Not to mention so much more expensive. I would suggest large does of organic dark chocolate :-)

  6. Replies
    1. I think you should pass the wine considering how wonderful New Zealand wine is :-) Maybe a lovely little Pinot Noir?

  7. I don't know how anyone can go without health insurance. I had my appendix out a few years again. I was in the hospital for four days. Insurance is one bill I pay first house,car, boat, health. Just saying. You can died from stress. I bet if something happens and your not insured, your stress goes way high. And life is not fun like that...and if this is about fun, do everything you can to maintain it.

    1. Great point about stress levels - it can have a real influence on your overall level of health. Good food for thought Margaret - thanks!

  8. My husband and I get our insurance through his job. We have had a Blue Cross/Blue Shield PPO for the last several years, and are considering switching to a less expensive Kaiser plan. One of us takes one prescription medication, and other than that, we are in good health. It seems like a good move.

    We'd probably purchase insurance through the ACA if we were self-employed. It sounds like quite an ordeal to go through the process, sign up, and select your plan.

    1. If you're in good health, then Kaiser seems like a good option. Some people complain about them, but if you don't really need to use them that much and you can save money, they it might be a great choice.

  9. Feeling very lucky to not have to use the US insurance system.

    1. I think you're lucky because you live in France - all of that delicious food and wine!

  10. We've had the same dilemma every year as well... and we haven't had insurance in over a decade. For many of those years, we simply couldn't afford it, we were barely scraping by and it just wasn't a choice.

    Now... we're planning to be gone (we will be pretty close to you/your timing as well!) It is still a choice that needs to be discussed, of course, but I just don't know. If we're not going to be in the US anyway, then does it matter? Plus, since we ALREADY aren't insured, I can't imagine its going to matter when we come back to land having not been insured.

    Thanks for sharing all of your thoughts and information. It really is helpful to hear someone else put it all down on paper.

    1. Glad you found it helpful Byn. If you guys aren't coming back to the States in 2016, then I wouldn't think you would need to have American insurance and you shouldn't have to pay the penalty.

  11. Since you're in Florida "right now" maybe its worth checking Florida plans. You can always say you moved, and move again? For the record, we are currently paying about $900/month for really really good comprehensive care. We both have medical issues with pre-existing conditions and both take expensive drugs, so we don't have a lot of options until we're both over 65. Next May will be 10 years cancer-free for Dan!!

    1. That is definitely something to consider. They're one of the few states that has decent nationwide plans. But we would have to balance all the costs of establishing residency in Florida. Lots to think through.

      You need to have a huge party next May - that will be such an incredible milestone!

  12. I think you can only get a catastrophic plan on the ACA marketplace if you're younger - I think below 30. Otherwise, that would have been a definite option to consider for coverage while we're in the States.


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