While we are United States citizens, we expect to have a slow travel lifestyle for many years to come. We don’t yet know how long. A lot will depend on how well we maintain our health, if we still enjoy the travel, where our son chooses to live/work, and if grandchildren enter the picture. At this point, we are planning as if we may never return to the US. We may even choose to ultimately go into an assisted care or nursing home overseas. We don’t know for sure, but we aren’t ruling anything out.
We already have long term care (LTC) insurance which we have had since our 30’s. For the time being, we are keeping it, though it doesn’t pay if we don’t use LTC in the United States. Otherwise, the biggies for health, medical and insurance for slow travel are global health insurance, advance directives and medical power of attorney, and any other kind of insurance we can think of (reminder we have no real-estate or vehicles).
What Is Truly Important to Us In a Healthcare Plan?
As we’ve planned for slow travel we’ve seen two things… First, we’ve seen many influencers claiming to go without health insurance entirely – highlighting the low cost of healthcare in many countries overseas. Second, we’ve seen lots of people talking about health insurance but highlighting companies that seem to focus on travel insurance, not long term overseas health insurance.
The lower cost of healthcare overseas resonates with us. We like the idea of just paying out of pocket as necessary. However, we also want to be able to travel as widely as possible. Not all countries have such inexpensive healthcare. Almost all countries are cheaper than the USA, but still, some can have quite high costs as well. An increasing number of countries also, technically, require you to have health insurance to visit. Schengen Zone (Europe) for example requires you to carry health insurance. Some countries may not technically require health insurance for tourist visas but may demand it for visa on arrival (UAE for example).
We consider ourselves to be quite active and healthy. At age 50 we have no chronic conditions and take no medication. We have a Health Savings Account (HSA) and are willing to spend a good deal out of pocket should the need arise. However, we do want some coverage should something catastrophic occur.
When evaluating our needs we realized several things. We aren’t early/mid-career digital nomads, so we don’t need maternity care or loss of income coverage. We are happy to have a high deductible, as high as $25,000 USD. We want to pay for most healthcare out of pocket and will arrange preventative care in low cost countries. We do want telehealth, mainly to easily get prescriptions written for the few things we do need. Finally, we do want catastrophic care coverage to protect our upside exposure, especially when we have to return to the US to visit relatives.
Our Approach to Choosing Global Health Insurance
To address our needs we looked at the following providers and purchased a plan from one of them (intentionally vague on our selection): BCBS Global Solutions (formerly GeoBlue), Cigna Global, Allianz, and IMG Global.
Making the ultimate decision took more than six months. Partly because we weren’t rushed and partly because we wanted to sit with our thoughts before choosing. We gathered as much material as we could, including sample contracts. We fed all the data into Google Notebooklm to interpret and find answers. Finally, we contacted our shortlist of companies and spoke to reps (interestingly all based in the Middle East). We ultimately focused the decision criteria on:
- Temporary Coverage for Emergencies in the US (short term travel back)
- Breadth of Global Coverage
- Telehealth to Write Prescriptions
- High Deductible, High Co-Insurance, With Ability to Change Year to Year
- Renewability as We Age, With No Arbitrary Cutoff
- No Weight Loss Drug/Surgery or Maternity Coverage
- Emergency Health Evacuation
- Overall Cost Given The Above
The plan we chose allows for lengthy stays in the US if needed, and features a very high deductible and cost-share amount. We skipped emergency evacuation, deciding we will buy short term travel insurance for this feature when traveling in remote places. Essentially, we settled on catastrophic coverage, meaning we are self insuring for most healthcare needs.
A Tangent on Evacuation for Political Disturbance or Natural Disaster
Medical evacuation, repatriation, and return of mortal remains are significant considerations in health care plans. That got us thinking about evacuation for other reasons as well. Could we get a plan that included these items? Should we get separate insurance to cover these?
We researched options and discussed these together at length. In the end, we decided what we really needed was intelligence, not insurance. While you can buy such plans, our opinion is that they are very expensive. Plus, in a true emergency where the State Department is advising citizens to get out, the chance that these companies could do anything beyond providing advice would be quite low.
Instead, we are opting to take full advantage of the U.S. State Department Smart Traveler Enrollment Program (STEP). In addition, we will layer in intelligence from the non-profit CrisisWatch and the independent global monitor Armed Conflict Location and Event Database (ACLED) to research any places we want to travel both in advance and during longer stays.
Advance Directives (Living Will & Medical Power of Attorney)
If we were going to be living in the United States, an advance directive and medical power of attorney would be relatively easy. The State of Florida, where we are residents, has specific requirements. We can outline who should make healthcare decisions for each of us if incapacitated. Additionally, we can outline what life saving measures we would want if in a terminal or long term vegetative state. Thankfully, the options aren’t terribly exhaustive and a quick Google search will provide the major choices.
However…. we do not expect to return to the United States for many years. In fact, if possible, we actually do NOT want to be returned to the United States should we need more complex healthcare. Therein lies two problems; recognition of advance directives overseas and the practicality of them as nomads.
Are Advanced Directives Recognized Overseas?
The first problem that becomes apparent is recognition of an advance directive in another country. This appears to be mixed. Some countries may recognize an advance directive but likely will require a specific authentication process. Some countries may not recognize it at all.
Authentication can be simple or quite complex. If a country is a signatory to the Apostille Convention of 1961 then you can have your advance directive authenticated by the Secretary of State in your home state and it will be accepted. Unfortunately, large chunks of the world are not signatories (like most of Asia). If a country is not a signatory then you will need to have your document authenticated by the Secretary of State in your home state, the local consulate in the country you are in, and the country itself. Additionally, you really need an authenticated official local language translation too.
Are Advanced Directives Practical With Regular Nomadic Travel?
As far as we can see, the authentication problem for countries that are not part of the Apostille Convention of 1961 presents the biggest challenge for nomadic travel. In 2026, for example we expect to visit at least five countries including France, Spain, China, Turkey, and Malaysia. In 2027 we are likely to visit Thailand, Laos, Cambodia and Vietnam at a minimum.
We see it as cost prohibitive, as well as logistically unfeasible, to authenticate our advance directives and get authenticated local language translations for a long list of countries we may visit for durations of 1 to 3 months at a time.
Our Planned Approach for Advance Directives Overseas
We do think having an advance directive is important. It forces us to think about and document what we really want if we were incapacitated and either vegetative or terminal. It may not be fully accepted world-wide. And, while we believe it to be impractical to authenticate in all the non-signatory countries, we are hopeful that having it authenticated by the Florida Secretary of State will improve the odds should the situation arise.
Summing Up Our Health and Insurance Plan
Setting aside end of life insurance, like Long Term Care insurance plans, we view the important considerations for health, medical and insurance in a slow travel context to be global health insurance and doing the best we can about documenting advance directives in a reasonably authoritative manner.
We see global health insurance as a must, both for easy entry into most countries of the world and to limit upside financial exposure if something major comes up. For us, this means a very high deductible plan without preventative care or extra bells and whistles. In much of the world healthcare costs are far lower than the United States and we can self fund as needed.
If something were to happen, where one of us were suddenly incapacitated AND terminal or vegetative, we will be able to produce advance directives authenticated by the Secretary of State for our home state – knowing they may or may not fully produce the outcome we want.
This post is part of a larger series covering our approach to getting our affairs together and estate planning ahead of a long adventure in slow travel around the world. Read more background on this series or jump to other topics in the series.