Colombia • Uruguay • Argentina

How we handle health and travel insurance for semi-nomadic travel and international trips over 90 days.

We left conventional employment in 2020 and 2021 and have discovered that doesn’t eliminate health insurance options; in our case it expanded our options.

Our view is that insurance exists to protect against rare, catastrophic medical events that could permanently damage our balance sheet, not minor travel inconveniences one can absorb with cash.

For nationwide and international health insurance, we use Farm Bureau Health Plans. Our HDHP plan is administered by UnitedHealthcare. To learn more about HDHPs, scroll down to the bottom. (Note: To get this plan, we went through medical underwriting in 2023 and a 12 month “pre-existing condition waiting period” (or pre-existing condition exclusion period). It means that benefits for any condition that existed before the effective date of our coverage wasn’t paid by the plan until after that waiting period passed.)

These plans have in-network and out-of-network coverages. International coverage is out-of-network. Our calendar year deductible is $4,500 for out-of-network charges. After the deductible is met, our plan pays 60% and we are responsible for 40%. Out-of-network out-of-pocket maximum is unlimited (while in network, our out-of-pocket maximum is $11,250 including premiums). Our plans cost us $304/month per person in 2026.

In addition to coverages provided by our credit cards (Delta Reserve, Chase Sapphire Reserve, and VentureX), we have an Allianz AllTrips Premier Plan which covers us on top of our Farm Bureau plan for the first 90 days of travel 100 miles or more from home. The cost of this plan for one calendar year is $210 per person. Like our premium credit cards, the Allianz plan includes some nominal trip cancellation coverage, trip interruption and delay coverage, and baggage loss. However the main purpose of the plan is to have emergency transportation coverage ($500k) and emergency dental and medical ($50k).

And since we’re overstaying our 90 day limit with the Allianz plan, we purchased a small ExactCare Value plan from Berkshire Hathaway for $115 each to cover us on our Tulip Time cruise in Belgium and Netherlands, and travel in Spain. This plan provides coverage for emergency transportation of $150k and medical emergency of $15k.

We track all this insurance documentation and signed international medical directives in our TripIt App plan in case of medical emergencies. TripIt is an amazing application that tracks all travel information, real time flight monitoring, hotels, events, tours, dining, safety information, etc. It even allows you to share itineraries with an inner circle of friends and family. All for about $49.00 per year.

Last, we do sign up for the Smart Traveler Enrollment Program (STEP), a free service that allows U.S. citizens and nationals to enroll our trip abroad so the Department of State can accurately and quickly contact us in case of emergency. We get updates about diseases, extreme weather, safety, and security for our specific destinations. It also has direct links to the closest embassy or consulate if there's an emergency like a natural disaster, civil unrest, or a family emergency.

About HDHPs
A high-deductible health plan (HDHP) is useful if you’re generally healthy and have some financial cushion, ideally years of invested HSA contributions from a previous employers plan.

You pay lower monthly premiums, but you cover more of the first medical costs yourself. In exchange, you can use a Health Savings Account (HSA). An HSA lets you put money in pre-tax, invest it in low cost index funds, and later withdraw it tax-free for medical expenses - including in retirement.

For a 50-year-old, this matters because healthcare costs usually rise with age. If you can pay routine doctor visits out of pocket, the HSA money can stay invested and grow, creating a dedicated, tax-free fund for future healthcare.

The HDHP works best when insurance is used for big, unpredictable expenses, not small predictable ones. The savings from lower premiums can be invested rather than spent.

It’s a poor fit if medical costs are high every year or cash flow is tight. Otherwise, it’s a practical way to prepare for tax-free healthcare later without overpaying now.

Most people misunderstand HSAs because they treat them like flexible spending accounts (FSAs), when they are closer to a long-term investment account with special tax-advantaged rules.Read more