How I Spend $1,500 A Year To Manage A Chronic Disease As A Global Nomad

by A Purple Life, posted in Early Retirement, Finance, Spending
This post may contain affiliate links. For more info read my disclosure.

One of my main concerns about retiring early in the US was about how I would handle healthcare. Our country is fucked up for many reasons, but we also happen to spend more per capita than any other developed nation on healthcare AND have worse outcomes. We pay more for less – how wonderful 🙂 !

Besides the obvious, one of the reasons this was a serious concern for me is because I have asthma – a chronic disease that I’ll be trying to manage for the rest of my life. And because I like to further complicate things 🙂 , I wanted to spend the first few years (at least) of my early retirement traveling around the US and the world.

However, the current US healthcare system is set up on a state-by-state basis. Most healthcare plans are linked to one specific state and regular care does not translate to providers outside of their network or outside of that state. Basically if I leave the state where I have signed up for health insurance, I am at best “out-of-network” and at worst won’t be covered basically at all.

My original plan to combat this sad reality was to get Expat Medical Insurance, which in essence is a healthcare plan that can cover you throughout the entire world – including the US. This is slightly different than Travel Insurance, which usually attempts to move you as soon as possible from an international location to your home country where your local health insurance would kick in and take care of a cut of your bills after you hit your deductible.

In 2019 when I was finalizing my plans for retirement, I was planning to sign up for expat insurance with IMG Global, which would provide me with health insurance that I could use anywhere in the world. It even covers preventative care after you’re with the service for one year. However, COVID hit the US and has been with us since. My original plan wouldn’t work because IMG Global expat insurance has two main rules:

  1. Insurance starts the day you leave the US
  2. You must be outside the US for 6 out of 12 months

And I couldn’t do either since borders were understandably closed when I retired in October 2020 🙂 . So I needed a new plan. Over the first two years of retirement, I’ve been able to treat my chronic condition while traveling the world and without breaking the bank. Let’s see how I did it 🙂 .

Travel Insurance

Cost: $1,141.04/year

My biggest healthcare expense by far has been World Nomads Travel Insurance. It is emergency healthcare coverage for any country I list on my policy, and has included Thailand, México, Argentina and the US.

However, the US coverage only applies 100 miles outside of my address, which is in Seattle, WA. Another thing to note is that travel insurance is meant to be a secondary insurance. World Nomads requires that you also hold primary insurance in your state of residence, so I also have WA State insurance that is free because of my basically nonexistent income. I say luckily because it only works in WA and I’m very rarely there so I basically never get to use it.

So with World Nomads, I’m insured against the worst happening. But for everyday issues and fighting my asthma, I still often need to visit a doctor if I’m sick or my breathing gets worse. I also need medication. So what do I do?

In-Person Urgent Care

Even when I had health insurance through work, I often didn’t use it. Instead I went to urgent care facilities like the awesome west coast local ZoomCare, which didn’t accept my insurance at the time (they have more recently expanded what they accept though, which is awesome).

At that time I had pneumonia and wasn’t able to get an insurance-approved doctor’s appointment for months. But it was kinda urgent 🙂 and urgent care picked up the slack. I went in and had a diagnosis and prescription in minutes. It was awesome. So I’ve continued using these options in retirement and have been happy to see that they’ve gotten more prevalent and transparent.

CVS MinuteClinic*

Cost: $189

The first urgent clinic I visited in retirement was a CVS MinuteClinic, but first a caveat. I later learned that CVS was actively working to take civil rights protections from people with disabilities, so I no longer go to their store. However, I did go in the past and wanted to be clear about that.

So the original reason I went to this MinuteClinic was because they have appointments immediately that you can schedule online and are pretty transparent about pricing information on their website. They have a price list with ranges here, which is more than I can say for any other non-urgent care facility I’ve visited. Luckily, this price transparency is very common in urgent care settings – ZoomCare had prices (not ranges 😉 ) listed on their website almost a decade ago.

I went in to have my breathing checked because I was having trouble with the dust in Arizona, and when I was there they asked me if I wanted a flu shot – it was presented like it was free (there were also signs about it being free around the store). However, when I got my bill, they had charged me $50 for it and $139 for my actual appointment. That’s messed up 🙂 .  Luckily, last I checked, Walgreens is working to bring similar urgent care options to their pharmacies.

Washington State

I didn’t expect to visit my state of residence for many years after retiring, but a wedding called me back unexpectedly so I got an annual check up with a doctor while I was in town. This was my first check up since the pandemic began and unfortunately the doctor rushing me through the exam and giving me incorrect information reminded me of why I prefer to get medical care outside the US.

Medical Tourism

Cost: $5

Medical tourism is the act of leaving your home country for medical care. Outside the US options to see a doctor are prevalent and shockingly inexpensive. For example, I had several lovely interactions with doctors while in México that I go into detail about here:

But in summary 🙂 :

Tele-Health

Tele-health options have greatly increased since the pandemic started, which is awesome especially for my nomadic ways!

CVS Virtual Care*

Cost: $59

Once again, this was before I knew CVS was evil 🙂 . I had a bad cold that was causing trouble with my asthma and I wasn’t anywhere near a doctor, so I used their tele-health option and chatted with a doctor for a few minutes who gave me a prescription to help with my breathing. Other tele-health options are also out there including from PlushCare and GoodRX, a company I’ll talk about below.

Prescriptions

Cost: $344.17

It’s fascinating to learn new things about our healthcare system 🙂 . For example, since I pay for prescriptions out of pocket, I at times get interesting responses from the pharmacists at Walgreens. One time they told me to hold on a second, poked around on their computer, and came back to tell me that paying out of pocket gets a big discount on the prescription I was filling – I’ll take it!

GoodRX

Another pharmacist suggested I check out GoodRX, a company that helps you save on prescriptions. You enter the name of your medication and their website tells you the price at all pharmacies. They then give you a coupon code for a discount on that medicine. My first time using it I saved $100 and my jaw was on the floor:

Medical Tourism: Pharmacy Edition

Many countries don’t require a prescription to get medicine while also selling the exact same medicine that is offered in the US at much lower prices. This was my experience in México:

And in Argentina:

In fact, prescriptions were so much cheaper in other countries that I started stockpiling them a bit when I was there and followed the rule of thumb I’ve read in travel forums that I should only have about a 3 month supply when crossing international borders – fair 😉 .

Conclusion

So that is a recap of all the medical care I’ve used over the first two years of retirement. It’s a bit of a messy patchwork, but until we get our shit together in the US and offer transparent and appropriately priced healthcare, this is what I’m doing 🙂 .

All of this would be a little easier if I wasn’t traveling around the world. If I just lived in one spot there would be fewer puzzle pieces to fit together, but the little bit of inconvenience is worth it to me to live all over the world.

How do you deal with medical costs?

37 thoughts on “How I Spend $1,500 A Year To Manage A Chronic Disease As A Global Nomad”

  1. Costplusdrugs.com I have found to be usually cheaper than even GoodRx. They are adding new drugs every month.
    Not only is CVS evil but now Walgreens is too. I have switched my prescriptions to CostPlusDrugs and Costco. You do not need a Costco membership to use their pharmacy, and they take GoodRx coupons.

    Reply

    1. Thank you! I haven’t heard of that site or the Costco work around. I just looked up Costplusdrugs.com and it’s a Mark Cuban company, which I’m not very interested in using given all his crypto scams. One example: https://www.youtube.com/watch?v=7xkgoRkC3pc

      What did Walgreens do? I know about the Walgreens employee refusing to sell contraception, but thought that was a reflection on that ridiculous person and not the company – but I could always be wrong 🙂 .

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  2. “ All of this would be a little easier if I wasn’t traveling around the world. If I just lived in one spot there would be fewer puzzle pieces to fit together, but the little bit of inconvenience is worth it to me to live all over the world.

    How do you deal with medical costs?”

    Thanks for the deep dive and taking the time, these posts are really valuable for anyone striving to retire early.

    To your question, I end up doing what you listed, just stay in the same spot and work a job I am not thrilled about lol which I imagine is what many do….one of these days, I’ll take the leap but would need time for portfolio to build up more.

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  3. My 10yr old cousin passed away after he suffered an asthma attack. Continue to take care of yourself Purple!

    You are so resourceful. Thanks for the information. I’ve learned so much over the years about saving and investing. My favs are you; Rich and Regular; Our Rich Journey; One Big Happy Life and Fun and Budget Act.

    Reply

    1. Oh my goodness – I’m so sorry to hear that.

      And thank you – I’m honored to be listed among those greats.

      Reply

  4. I retired early too and feel the struggle. I live in Puerto Vallarta 5 months, and travel the remaining. I have insurance in my home state CA and have a travel insurance basically for medical evacuation purposes.
    I’m currently in MX and broke my ankle. The cost for a doctor $50, xrays $48, splint $47, anti inflammatory $20. I’ll need a follow up visit which will be another $50. It took less than an hour!
    I’m just thinking in the US this would be thousands!
    Thanks for the info on other travel insurance options, I’m going to check into it!
    I love reading about your young life and how you’re doing it! Congratulations on your success!
    Laurie

    Reply

    1. I’m sorry about your ankle, but happy to hear they took care of it so efficiently and affordably! And thank you so much for your kind words 🙂 . Enjoy PV! I’m visiting there again this fall and am excited to return.

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    1. Yep – thank you. I saw that when I was following the case. The fact that they would even try such bullshit is a dealbreaker for me.

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  6. The one area that isn’t at all messed up in US health care is Medicare. The downside is you have to be old, but that eventually happens to all survivors. Since going on Medicare I’ve had two surgeries totalling $400K that cost me zero out of pocket and most of my prescriptions are totally free. I could pick any surgeons I wanted so I picked the best in the world, in Denver, a thousand miles from home. I do have to pay for my cortisone inhaler (fellow asthmatic) which retails for $350 a month but I get it for $42. Because we’ve had a high income in retirement our Medicare plus supplemental plans cost about $8K per year for the two of us. But that’s less than half of what we were paying for private insurance prior to reaching Medicare age.

    Reply

    1. Good to know. I looked into Medicare briefly and was surprised to see it had tiers you had to pay extra for to get certain kinds of coverage – it sounds like you’ve got that going on with your supplemental coverage. I had hoped it was a more “universal healthcare” kind of option. Anyway, that’s awesome you’ve been covered in those situations. And hi fellow asthmatic 🙂 !

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  7. Thanks Purple for shedding light on our messed up healthcare system. It’s too bad that most Americans scream 😱 at the thought of changing our healthcare system.
    Any time you are getting an Rx, you always want to ask what is the cash price? They are not allowed to tell you if paying cash is cheaper, unless you ask. Luckily some pharmacists will tell you without asking.
    Mark Cuban had started a drug company with the goal of selling Rx’s cheaper. And I’ve heard Amazon plans to do the same.

    Reply

    1. Amazon Pharmacy is available now. Like costplusdrugs, they’re primarily designed for people on recurring monthly maintainence prescriptions.

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    2. Yeah – it’s ridiculous. I’m happy with the strides we’ve made in my adulthood (like pre-existing conditions finally being covered with the ACA – like seriously?!) Anyway, don’t get me started lol. I’m trying to be optimistic and in the meantime use my travel opportunities to my advantage.

      Good to know about the cash price question! I didn’t know they weren’t allowed – that’s messed up. I’m glad a few decided to tell me anyway. Another commenter mentioned the Mark Cuban company. I’m wary of using anything he made given his many crypto scams, but it’s good to know.

      And I didn’t know about Amazon – I just checked their website and it’s listing prices that are almost double what I’ve seen for my medication without insurance. Weird 🙂 , but always good to know about other options!

      Reply

  8. I’ve always questioned these charts that use arbitrary $$$ to create rankings. Wouldn’t buying power or similar be a more useful gauge? For example: Americans spend 30% of their median income for healthcare while Canadians only spend 10% of their median income. How about a $50 doctor visit in Mexico may be low but it’s one week’s worth of work as another example? Then also how much of that is subsidized vs cash out etc? Am I looking at it the wrong way?

    Anyway no matter what numbers are used I’m sure we in the US won’t lose our number one spot 😞.

    Reply

    1. Good point 🙂 . I don’t think you’re looking at it the wrong way, but yes – it looks like we’re the worst either way unfortunately.

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  9. The medical insurance coverage is the big issue for me, too. That’s why I thank you for this article: a great message for me and see the future can be easy to manage, as I have asthma, too. Now I keep under control from lifestyle and never had an attack more than 2-3 times per year and never cold for more than 10 years, but we age and I know things are not going as easy as being young.

    Reply

    1. I’m happy it was helpful! Looks like we’re starting an asthmatic club in the comments today 🙂 . What do you do to help control asthma with lifestyle? I’m open to any and all suggestions! That’s awesome you haven’t had many attacks or a cold in 10 years?! Wow! That’s amazing.

      Reply

      1. I am in the autoimmune lifestyle, even I didn’t know about this name 15 years ago when I had 3-4 attacks per week. With doctors, blood tests, trial and error I learn to listen my body and identified the triggers and eliminated my cat, perfumes and all cosmetics and almost all cleaning chemicals, dust (no more carpets /fluffy toys, I wash the bedsheets weekly at high temp for no chemicals close to my nose on night), cow diary (butter occasionally on small quantities, my addiction, so I am not 100% puritan), industrial food is out, fried food is out, gluten is almost out but it seems gluten + diary combined were worst for me (even my bloodtests for gluten are ok ! ), too much effort is bad but if I take a slow run/fast walk I am ok, but run on stairs is haaaaaaaaaaaaaah, avoid very polluted towns (my first 2 weeks camping in mountains where so revealing and improving!!), I did exercises for increase the respiratory capacity (did periodically spirometry-s and expiration capacity raised with 10% in 3 months of exercises, now I stopped but one day I will restart with a kine-therapeut specialized on respiratory issues) , too cold is bad, too hot is bad for me, I avoid the smokers etc – but most important I increased the immunity with these steps so never had a cold /flu for more than 10 years including for my husband + child, too.

        Reply

        1. Oh wow – I’m so glad you’ve found what works for you! That’s awesome and you’ve given me some ideas for things to try so thank you for that as well!

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  10. I know you’ve chosen to not have kids, but hypothetically, how would you approach the pregnancy process if you were living overseas? Meaning, what health insurance coverage would you obtain? Thank you.

    Reply

    1. I think you just answered your own question 🙂 . I have no idea – I haven’t looked into that at all since it’s not my situation. However, I know GoCurryCracker.com has gotten IVF treatments in Taiwan to have their two kids so that website might have some helpful for you info on there. Good luck!

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  11. i hadn’t heard about the CVS lawsuit, but having gotten in knock down drag out fight with CVS corporate I’m not surprised.

    My dad kept working as a pharmacist, at CVS’s request, up until he was 80. And I found that they told him he wasn’t allowed to sit for the entirety of his 12 hour shift.

    To say this didn’t go over well with me – I was working with a civil rights group for people with disabilities at the time- is an understatement.

    He got his stool, but the whole thing was just awful. He quit shortly after that incident.

    Reply

    1. Wow – that’s horrible. Great job fighting for your dad, but it’s messed up that was even needed. Ughghgh they’re the worst.

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  12. How do I deal with medical costs? Still working, so living in one place and being part of the national medical system. Also travel insurance for visiting other places. Not sure if you’re aware of this, but world travel insurance sometimes comes in two kinds: world excluding North America, world including North America XD Posts like this remind me of how glad I am that I don’t have to navigate the US healthcare system. I haven’t yet encountered a perfect system, but some are more effective and user-friendly than others, that’s for sure.

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  13. This was such an interesting read. I also have asthma along with a few other chronic ailments that require maintenance medication and trying to figure out how I could manage them in early retirement especially if I wanted to travel had me concerned. But as you clearly show, where there’s a will there’s a way. I really appreciate your transparency. I’m on board with you boycotting CVS, but now need to add Walgreens to that list with their refusal to sell the abortion pill… I’d love it if anyone could weigh in on what other options they use here in the US.

    Reply

    1. Of course! I’m glad it was interesting. And yep Walgreens has been added to the list. I’m also all ears for other options 🙂 .

      Reply

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