International Medical Care and Insurance Coverage for Full-Time Traveling Senior Nomads
As full-time traveling nomads who are retired and need medical insurance, we’ve had a variety of medical insurance solutions over the four years that we’ve traveled. But now as Steve turns 65 and qualifies for Medicare in the USA, we’ve really had to think about medical care and where we’ll want our care in the future.

In addition, after our annual checkups, we both found we had new chronic conditions where we need to pay attention. Our decisions about where we want medical care and how much insurance we need have changed.
Outpatient, Inpatient, Prescriptions and Dental Care
We travel the world, moving locations monthly. As we’ve needed care for outpatient needs, we’ve found doctors or clinics and paid for that care out-of-pocket in Croatia, England, Spain, Malaysia, and Mexico.
For inpatient care, we’ve scheduled surgeries and paid out-of-pocket. We submitted receipts and received reimbursements from our international medical insurance providers.
As for prescriptions, we’ve filled them over the counter, or paid for doctor’s visits to get scripts renewed and filled.
We’ve done the same with our dental needs, paying out-of-pocket. We don’t not carry any dental insurance, nor will we.
Each Year Our Medical Insurance Has Changed
Yet for the first four years of travel, our medical insurance has changed every year because our circumstances changed annually. Let’s walk through each year.

In the first year, after we left the US, we didn’t spend any time in the US and couldn’t afford ACA (also known as Affordable Care Act, the Marketplace, or Obamacare) due to our high pre-retirement incomes. We carried IMG Global and our combined monthly premium was about $200. All our medical care in the first year occurred outside of the USA, which we paid for out of pocket. After we hit our medical insurance deductible (per person) of $5000, we were reimbursed proportionally.
In our second year, we qualified for “free” ACA and also kept our IMG Global policy. We kept IMG because we wanted to be able to have medical care abroad in case of an emergency. We didn’t want to have to return to the US for medical care. We enrolled in ACA, not because we were in the US, but since it was no cost to us, we figured why not have it as a back up in case we did end up back in the US. Our combined premium for IMG was about $250 monthly.
In our third year, we continued with our “free” ACA. We were in the US for six months, so we dropped IMG. When we continued our travels, we picked up Genki due to its lower deductibles. It has less coverage, but it’s enough that if something happens abroad, we’d be covered, or we could return to the US if necessary and use our ACA. Our combined premium on Genki was about $250 monthly.
As a side note, in the first year, I filed a claim with IMG on my knee surgery, and they reimbursed $2500 on a $10,000 bill with a $5000 deductible. In our third year, Genki has paid one claim of $85 on a $135 bill for an outpatient visit and treatment to an ophthalmologist for me. For Steve, Genki has paid twice on two outpatient visits of about the same amounts for a cardiologist.
Medicare for World Travelers
As our four year of world travel approaches, I’m 58 and Steve ages into Medicare at 65. We’ve had to really have some deep thoughts about our insurance coverage. How long will we travel, and where we’ll end up eventually as traveling nomads? Will insurance coverage stop our travel?
In the past, we haven’t worried about continuity of care, thought about where we’d get treatment if something happened, or where we’d land if we couldn’t travel anymore. We’ve never thought about developing relationships with doctors because we’ve never had conditions that required higher levels of care.

But now, these are the concerns we’re investigating. We have several general questions we’re asking about our health and its care.
- Where do we want to establish relationships with doctors to create continutiy of care?
- Where do we want to live for a few months if we need procedures or treatment?
- Do we see ourselves back in the US relying on US medicare and/or ACA soley?
- Do we see ourselves establishing some type of residency and using other country’s healthcare system?
Understanding our answers to these questions has guided our next year(s) decisions about health insurance. Let’s go through them a bit.
Continuity of Care
We have learned in our travels that medical care is excellent in many cases around the world and more often than not, it’s affordable. It’s so affordable, we can pay for both inpatient and outpatient with out-of-pocket budgets. For example, a heart valve replacement in Portugal costs $25,000 and in Malaysia it costs $18,000.
Thus, we’ve thought about a solution where we have doctors established in three or four places around the world, and we check in with them as we move about. Those locations include Portugal, Turkey, Malaysia, and still pending Central America. We are currently doing a version of this with our annual wellness checks, but we could see this solution becoming our answer for our chronic needs too.
Live for a Few Months
It’s likely that either Steve or I will need surgery or procedures in the near future for our chronic needs. Not only are we thinking about the cost of these treatments, but we’re thinking about where we want to live while we recover. And when we mean live, we also think about the cost of living, the livability of an area, and access to the followup care.
If we were to live in the US, we would need to find affordable housing with transit or walkable/uber-able to the medical facility. It’s difficult to find both in one place in the US that is also where we’d like to live for the other quality aspects of our live. Yes, for example, Oklahoma City might have super hospitals, affordable rent, and easy transit, but we don’t want to like in Oklahoma City.
On the other hand, we could live in an affordable Southeast Asia city like Bangkok where the healthcare is fantastic and the rent is cheap, but the air pollution is horrendous.
Relying on US Medicare
As Steve ages into Medicare, he’s learning the ins and outs of signing up for Medicare and the types of coverage he can receive. The bottom line to Medicare is this: the basic level of Medicare is free, and then Steve can pay more to have better coverage and more options. The challenge is that if he doesn’t buy those extra options now during his initial sign-up period, he receives financial penalties for delaying his sign-up.
Thus, Steve is in the scenario that he could pay for something now (for example, Medicare and Plan B) and possibly never use it, or wait until he actually needs it and must pay penalties for not having signed up earlier. This is a very hard situation for us to foreshadow; we have no idea how long we’re going to travel or where we will end up eventually.
The good news is that Steve will at least have basic Medicare in the US. His Medicare will replace his “free” ACA for our fourth year.
Establishing Residency Elsewhere
The other option we’re evaluating is establishing residency someplace and signing up for another country’s medical plans. This is complicated by a wealth of options worldwide. But basically, all countries require you to live in their country for a period of time before you can use their healthcare as their residents do. We like this option, but this option requires us to pick a place to live and begin the paperwork. We’re not ready for this decision yet.
Will Insurance Coverage Force Us to Slow Down?
We are not ready to slow down. Frankly, we don’t think we’ll ever slow down. But logic does tell us we will at some point. We’re in our go-go years, and up until just a few months ago, we thought we were quite healthy. Now, we’re not as healthy as we thought, and we need to consider longer-term health care options as we age. We have many nomad friends older than us that we see as role models. If they can keep going, so can we! We’re pushing off the slow-go and no-go years as long as we can.

Back to Where We Started, Essentially
So here we are, trying to decide how to handle our medical insurance for our fourth year of travel. Steve is required to sign up for basic Medicare, but it doesn’t cover him for outpatient care in the USA or any care outside of the USA. If we wants outpatient care in the USA, he has to buy at least Medicare Part B.
Then to get his international coverage, he has to buy a plan like IMG or Genki, or he could decide to self-insure, paying out-of-pocket outside of the USA. Thus, his full medical coverage, including international coverage, would be the price of Medicare Part B (or more) plus the price of IMG, or about $500 a month.
For me, I’ll continue with the ACA plus Genki option for about $125 a month.
Moving Abroad for Medical Care
The underlying question we grapple with is whether or not we will live in the USA in the future. We have no home there. We have family. We’re not big fans of the US medical care system, and we’ve found better and more affordable care elsewhere. We’ve also found several locations around the world where we could see ourselves living long-term.
If we were to move abroad as expats and establish residency, we could qualify for health care abroad and/or we could buy insurance policies in the country where we lived more permanently. In this case, would Steve drop his Medicare altogether? We don’t see a scenario where he’d need coverage in the USA if we were to establish residency abroad.
The Final Decision about Medical Insurance for Now
Deciding on our insurance coverage for our fourth year has been quite complicated. I’ll continue with my ACA+Genki combo. Steve has decided he’ll buy into Medicare Parts. If he will need medical care abroad, he’ll have two choices. He can either return to the US for care, or he can pay out of pocket abroad. In the future, if we decide to establish ourselves as full-timers, we’ll fulfill the residency requirements and drop his Medicare.
My costs will continue to be about $135 a month, and Steve under his new Medicare coverage with various parts, etc, will be about $250 a month. (Note: He hasn’t made his final decision on which Parts and/or HMO he might sign up for. When he does, we’ll update here with his coverage and costs and final decision about any international coverage he’ll have to buy separately.)
I still have six years before I have to make this decision for me. In that time ACA will surely change, Medicare will probably change, and international insurance will adjust accordingly. Thus, I imagine I’ll have to keep reviewing and weaving with the changes as we go into our sixth, seventh, and eighth year abroad. Stay tuned.
Chris Englert, the Walking Traveler, believes walking is the platform for life. Wanderlusting since the age of 5, she’s since traveled all 50 US states and 62 countries. Chris shares her love of walking while traveling via blogs, books, and presentations. A natural storyteller, she invites you along as she explores the world, one walk at a time.
Currently, Chris and her husband, Steve, travel the world, full-time as nomads, with just their two carry-ons. They’ve been traveling since May, 2021.