When Paul and I started our slow travel, we were 64 and 65 years old. After living most of our lives in the U.S. midwest, working in sedentary jobs, we had the usual medical conditions: we struggled with Type 2 diabetes, weight problems, stiff joints and under-used muscles. Each of us had specific, but not life-threatening, medical ills of other kinds. We had a good internal medicine doctor we liked, and had regular check-ups. When I worked we had good health insurance mostly paid by my employer. We regularly got dental and vision check-ups.
Our plan to travel full-time, frequently out of the country, presented us with a host of concerns. Some of these included:
Insurance to cover routine medical care. In December, 2021, I was retiring and would no longer get medical insurance covered by my employer. Paul was turning 65 and would be eligible for Medicare. I would not be eligible for Medicare for another year.
Travel insurance. We didn’t know what we might need to be covered while we were out of the country.
Prescription medications. How would we get refills of our medications?
Non-prescription supplements. What might be available in other countries? What did we need to take with us?
Out of pocket costs. We had no idea what out of pocket medical costs might look like.
Between 2022 and 2024, we have traveled in the United States, Europe, Oceania, and Asia. We have seen medical providers in our home base of Lansing, Michigan, as well as Seattle, Melbourne, Australia, Wellington, NZ, Auckland, NZ, Kuala Lumpur, Malaysia, and Osaka, Japan.
The good news
Medical professionals are, for the most part, caring and competent all over the world.
It is relatively easy to get an appointment with doctors outside the United States, usually within a few days.
Most doctors are comfortable refilling prescriptions when we show them our medical records and they examine us and ask some questions.
Medical care outside the U.S. is relatively low cost and inside the U.S. our insurance covers most of our costs.
Most of the non-prescription supplements we take (certain vitamins and minerals) are generally available outside the U.S., with a few exceptions.
Prescription medications are available outside the U.S. if a local doctor prescribes them.
The bad news
We ended up paying for U.S. insurance we can’t use outside the U.S. except during a narrow window, and haven’t been in the U.S. much the past two years. Then, to ensure we don’t have a catastrophic expense, we have to buy additional travel medical insurance.
Scheduling specialty care within the U.S. can be difficult with long-ish wait times and sometimes incessant phone tag.
The costs (all prices converted to U.S. dollars)
We are now both on Medicare. Medicare Part A (80% of hospitalization) is free, but you pay additional for Part B (doctor visits), Part D (prescription drugs) and a supplemental policy to cover non-covered items such as vision and dental care, plus co-pays. Our total bill for all of this (Medicare A, B, D and supplement) comes to about $500 per person per month. Our Part B is higher than for some because it is partially income-based.
We paid out of pocket costs for uncovered services in the following locations:
Doctor visit to discuss refilling prescriptions, 1/2023: $51 each, 4 times (total about $200)
Prescriptions (all medications for both of us, refilling for 6 months): $700 (this averages about $15 per prescription per month)
Full set of lab tests for both of us: $800
COVID tests for Kim: $30
Eyeglass exam and glasses for Paul: $1100
Kim went to physical therapy for back pain. Cost, about $60 per visit, times three visits.
Doctor visit for Kim, facial nerve pain: $82
Prescriptions: $65
Specialist doctor in neurology for Kim: $90 per visit
Prescriptions: refills and new medication - $660 (4 month supply, 5 medications; interestingly, the omeprazole (prescribed by the doctor in Auckland) cost over $200, and it would have been far less expensive in the U.S. but the others medications were less expensive in Malaysia).
Kim two doctor visits; I had sudden high blood pressure and swollen feet and I saw a cardiologist at an out-patient hospital clinic; total cost of two visits, plus lab work and new prescription medication for 2 months: $250
We also bought emergency travel insurance. This insurance is designed to cover any illness or accident while traveling abroad, to pay for the physician, hospitalization,medications, and if needed evacuate to the U.S. when stable (at which point our U.S. insurance would begin coverage). There are several travel medical insurance companies. Only a few are designed for nomads (most envision a round-trip experience with a beginning and end date). We chose World Nomads because for our ages it was cheaper than the others (including Safety Wing and Genki). We weren’t concerned about the coverage being less because our home insurance is very good and we only needed it for a catastrophic emergency. Like most travel insurance, it only covers a pre-existing condition if there is a “new” flare-up, for example a sudden spike in blood pressure even though currently treated for hypertension. We paid about $6/day for both of us combined $3/day each). Figuring out what type of travel medical insurance we needed was extremely complex. You can get evacuation-only insurance, which is a much cheaper alternative, but if you had a stroke or heart attack costs of care would likely be more than $100,000 before stable enough to travel. To see several detailed discussions of travel medical insurance for Americans, I recommend www.brentandmichaelaregoingplaces.com, I didn’t ultimately agree with their bottom line, for us anyway, but it is a great explanation of the issues.
We have both received medical care since our return to the U.S. in late November. Medical care is good in the U.S., but often must be scheduled far in advance for routine care. We had to schedule December dermatology appointments in July, and when I tried to book vision appointments at the same time the earliest I could get was mid-January. But with our insurance, the costs are very low. I visited a doctor in Honolulu to get a refill on a prescription that had to be locally prescribed, and the visit cost me nothing. This was my first experience with using my Medicare and supplemental insurance, and it really does cover almost everything. Since that experience in Honolulu, Paul and I have had dental exams, vision exams, colonoscopies, dermatology exams and two visits with our primary care physician. I have also had an echocardiogram (to explore the blood pressure issues - thankfully it showed that my heart is normal); an EMG (to explore the nerve pain in my hands - it showed I have carpal tunnel in both hands); a follow-up specialist visit to a hand surgeon (who prescribed hand splints and took me off the nerve medication);a bone density scan (showing osteopenia in my right hip); a pap smear (normal) and mammogram (normal). We’ve had two 90-day supplies of our prescriptions filled. I went to physical therapy 3x/week for two months (shout-out to ATI, whose PTs are shown in the photo at the top of this post)! Most of those expenses were completely covered by our insurance. We did have to pay $600 for dental care (1 visit for me, 2 for Paul), and $100 for colonoscopy prep but virtually nothing else.
What we have learned
Even though medical care in the U.S. is very expensive, if you have good insurance, you pay almost nothing but the insurance policy premiums. By contrast, medical care in other countries - when paying out of pocket - is a lot less expensive. But, it is all out of pocket because insurance doesn’t cover it.
Other than the first 30 days outside the U.S., our Medicare and supplements do not cover anything international. (But, they would cover services in American territories such as American Samoa, Puerto Rico, etc.)
Most front-line medical providers are terrific people. The doctors in Melbourne, Auckland, and KL were super friendly and kind. The cardiologist in Osaka went out of his way to make sure I understood what was going on, how we were treating it, what choices I had - and he spoke little English. We used Google translate. He drew pictures and showed me websites. The PTs at ATI in Lansing were incredibly helpful. They worked with me to design exercises to strengthen my hips and lower back, and to help me walk the long distances I’m getting used to walking in our nomadic lifestyle. Kevin, especially, was a great communicator, helping me do the exercises the correct way, and selecting ones that I can do at home. I can’t thank them enough. Our own doctor and dentist are fabulous.
Some places are more organized than others. The system in Osaka was really amazing. It was streamlined and coherent. Once you checked in, you were given a map of where to go. When you got there, there was a number system. Likewise, in Kuala Lumpur, the administration of services was extremely clear and organized. In the United States, most medical service offices are fine. But some of the back-office medical staff can be less helpful. One office in particular - our dermatologist - can’t seem to get Paul’s insurance correct. They call and call but are impossible to reach.
You can get good medical care around the world.
It is important to have a primary care physician you trust, who knows you and who can help you interpret all the information. Our doctor - Amit Ghose of Capital Internal Medicine in Lansing, Michigan, is such a trusted doctor. Sometimes different doctors see the same condition through different lenses. The PT in Wellington was sure my hand pain was from a spinal misalignment; the neurologist in KL was sure it was small fiber neuropathy. The EMG doctor was sure it was carpal tunnel. The hand surgeon explained the differences and why the EMG ruled out the spinal explanation but did not test for neuropathy. However, she believed the hand splints would address the definite carpal tunnel and probably also any neuropathy. It was important to me to discuss all of these different ideas with my own primary care physician. He was available to me by email the entire time we were traveling, and weighed in on my blood pressure data, my AIC data, and treatment courses proposed by other doctors.
If you are planning to travel to Japan for more than 30 days, you will need to complete a medical visa form. Japan only allows a tourist to bring in a 30-day supply of medications, including prescription medications, without obtaining a medical visa in advance. To complete the medical visa, you'll need your medical records, photos of your prescriptions and diagnosis to back up each medication you bring in that is over a 30 day supply. This includes non-prescription medications. You will need an exact count of each medication you are bringing in. You also need to indicate where you are entering the country and the flight or ship number, and when you are exiting Japan. This took me a few days to complete and it took about a week to get it approved for me and for Paul. You can find the form here: https://impconf.mhlw.go.jp/about_en.htm
Travel with a prescription controlled substance can be extremely difficult. The neurologist in Malaysia prescribed Lyrica (pregabalin) for my nerve pain, and allowed me a 4-month supply. Japan approved my taking it into the country. I didn't think anything about it. When I got to Honolulu, need an immediate refill, my Michigan doctor's call to the pharmacy didn't work because in the U.S. Lyrica is a controlled substance. I had to see a local Honolulu doctor, who prescribed a 45-day supply. When I saw my Michigan doctor a few weeks later, their office called in all my refills after a routine check-up with my doctor, but because it was a controlled substance the doctor himself had to call it in and he had gone on holiday break. This resulted in a delay. Once that was worked out, I learned in Michigan you can only get a 30-day supply at a time. This would mean that my ability to get a sufficient supply for long-term travel would be really difficult. The medication is a controlled substance in some countries and not others, and in some U.S. states and not others. This led me to consult with doctors about alternatives, and happily the non-medication hand splints seem to be working.
Bottom line:
Yes, you can get good medical care around the world.
Yes, you can get prescription refills if you see local doctors.
Yes, you can buy vitamins and minerals in other countries, although I couldn’t get Niacin anywhere outside the U.S.
Medical insurance is not cheap. Each person has to weigh the risks of not having catastrophic insurance when traveling a long time.
Our total out of pocket medical expenses, not counting insurance, was a little over $4,000 for both of us for a year in 2023. We could have skimped and not gotten lab tests in Melbourne if we had been overly concerned about the costs. Paul could have avoided getting new glasses. That would have reduced our more pressing medical needs by about $1,900, to a little over $2,000. I’m still hoping to recoup the $250 we paid in Osaka through a claim with World Nomads but they require that you get denials from your other insurers and a form from your PCP which I don’t have yet.
In the U.S., it is wise in the long run to pay for the Medicare supplements because the price rises dramatically if you don’t get Parts D and B when eligible, and you can’t be guaranteed the supplement if you don’t get it when first eligible.
For a lighter take on medical care, I’ve recorded a song by Richard Starkey (Ringo Starr) and Vini Poncia called “Oh My My”. It was a hit on the radio when I was in high school and is very fun.
Lyrics:
Oh My My by Richard Starkey & Vini Poncia
I phoned up my doctor to see what's the matter.. he said, "Come on over,"I said, "Do I have to?" My knees started shaking, my wrists started aching,when my doctor said to me. CHORUS: Oh, my, my, oh, my, my, can you Boogie, can you Slide? Oh, my, my, oh, my, my, you can boogie if you try. Oh, my, my, oh, my, my, it's guaranteed to keep you alive.The head nurse, she blew in, just like a tornado..when they started dancing I jumped off the table. I felt myself healing and as I was leaving,
this is what they said to me
CHORUS:
Oh, my, my, oh, my, my, can you Boogie, can you Slide?
Oh, my, my, oh, my, my, you can boogie, you can Slide.
Oh, my, my, if you try, it's guaranteed to keep you alive.
Now, if you should slow down and you're feeling low down.
Don't call up your doctor, just grab you a partner.
It's what you've been missing, I've got your prescription,
That Boogie Woogie remedy.
CHORUS:
Oh, my, my, oh, my, my, you can Boogie, you can Slide.
Oh, my, my, oh, my, my, we can boogie till we die.
Oh, my, my, oh, my, my, it's guaranteed to keep you alive.
CHORUS:
Oh, my, my, oh, my, my, watch me Boogie, watch me Slide.
Oh, my, my, oh, my, my, ooo-wee, boogie, ooo-wee, yi.