Thru-hiking and Health Insurance
First off, let me state for the record that I am not in any way an expert on health insurance. In fact, I would say that I am a total country yokel when it comes to this stuff (Farm girl, remember?). That in mind though, I thought it’d be worthwhile to write up what I learned in the last few weeks or so, while I was burning the midnight old trying to decipher deductibles, the Affordable Care Act, and more in search of a good health insurance solution for my thru-hike. And, of course, I wanted to do it in the most mature way possible – with animated gifs.
Ahem. So. When I first talked about taking a six month leave of absence from my job, I just sort of automatically assumed I would keep my current health insurance (via COBRA), and that would be that. Fast forward four months to this week, when someone else’s very astute question made me re-check my insurance policy… and discover an ugly can of worms.
Lesson 1: Your health insurance does not necessarily work in full capacity outside of your immediate area.
Turns out my health insurance coverage is localized to New York, New Jersey, and a couple other states in the near vicinity…. which leaves a big gaping hole for disaster for 80% of my hike. Outside of said states, all care would be considered “out of network,” and would act essentially like a high deductible or “catastrophic plan” (whoever came up with these plan names, bravo), and I’d have to pay a costly out of pocket payment before the insurance would kick in and pay the rest.
Discovering this, I decided that instead of paying for an expensive plan I wouldn’t be able to use for a majority of the 6 months, I’d find a cheaper, but still viable alternative.
Lesson 2: There are full health insurance plans that have national coverage. They’re probably always going to be pretty expensive.
Early on, I heard about plans like the Blue Card, from Blue Cross Blue Shield, and the United Health Care Plus Card, from United Health Care. These are plans that allow for extended coverage outside of your immediate area. They are also generally pretty expensive. I knew this wouldn’t work for me, so I moved on.
Lesson 3: Short-term health insurance is a low-cost option, but only in some states.
Short-term plans are essentially high-deductible insurance plans for a period less than a year. They are, however, not considered to be minimal essential coverage by the Affordable Care Act, which means that you will have to pay a tax penalty. In addition, you cannot even get short-term plans in some states.
Lesson 4: Catastrophic Plans are… well… catastrophic.
Catastrophic plans are the least expensive option for someone under age 30 who is paying for insurance out of pocket, and wants to keep minimal essential health insurance, in accordance with the Affordable Healthcare Act. This type of plan will keep you financially afloat if you sever off a limb, get life-threateningly dehydrated from giardia (it happens), or in some other respect require hospitalization or emergency care. Your hike will probably be ruined, but your (literal and financial) life won’t be. A catastrophic plan will generally have a high deductible or payment you have to make, often north of $4000, after which the insurance will pay the rest, often without limit. Some catastrophic plans do also offer preventative care, such as physical exams and vaccinations, but are otherwise bare bones.
Lesson 5: Travel insurance is awesome! But if you live near the trail, you should be careful.
In searching for tips and tricks from past thru-hikers (I basically typed into google: how the hell did you deal with this, past thru-hikers?? Fess up!) I ran into a thread on travel insurance as a good alternative to health insurance for thru-hiking. Travel insurance, again, is not considered minimal coverage, so you’d get charged a tax penalty, but it does offer coverage in all states (and often abroad), and will cover all emergency treatments, most often with a 0% deductible, meaning no ridiculous $5000 doctor bills. Sah-weet! My caveat here is this: most travel insurance policies are not valid if you are 100 miles or less from your permanent residence. If you happen to live outside of the east coast— awesome, you’re all set! If you’re the dumb shmuck who chose to live in New York or any of the other states the AT goes through, well, read on my friend. In the grand scheme of things, the chances of you face planting off a cliff in those 100-200 miles you’re in range is small, but it’s a risk you have to weigh.
The Solution: Double Combo
After tearing my hair out with insurance, I realized that because I’ll be on trail for six months, I won’t be earning almost anything this year, placing me in a very low income tax bracket. So like a good citizen, I went to the healthcare.gov site, and applied for healthcare. After a few weird mistakes and a phone call wherein I had to try to explain why there would be a six month gap in employment, I got the news that I qualified for a very low cost plan. Woo hoo! Thanks Obama. No, seriously. Thank you. I won’t have to spend my savings on paying for an expensive plan while out on my hike. I also decided to get travel insurance as a buffer for the times that I am not in or near NY state (most specifically, World Nomads, because I’ve heard good things). So there you have it— I am now happily insured, and one step closer to Springer Mountain. So what’s the lesson to learn here? The Affordable Care Act might be the best thing that ever happened to thru-hikers.
** Again, please take all of this with a grain of salt, and DO YOUR RESEARCH. Health insurance is serious business, and I am not qualified to tell you what you should do. As Pox and Puss would say, “Do not try this at home.” ALSO, if you have other solutions, share them below! **
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Informative blog and something hikers really need to consider. Several of our bubble were injured or sustained injury. One broke his ankle, one his finger, two had foot issues requiring specialist treatment, two had NORO and three Lymes which resulted in doctors visits. I visited ER/Specialist three times during hike, required two sets of x-rays and meds/injections, I am glad I had insurance. I was on leave of absence so fortunately my employer continued my insurance plan.
My son is from England so we bought him travel insurance. Visitors can use ER/Urgent Care in emergency but BOY they will pay! I was so impressed with his level of coverage and cost of the insurance we used for him that I started advertising it on my blog site. Its is the ONLY commercial advert I carry on my site, I felt it was that important.
Thanks Big Tex! Any chance you could tell us what the insurance your son used was?
Catastrophic and bronze plans are nothing alike. Catastrophic plans (only available to those under 30) don’t meet federal standards for essential health benefits -1. Ambulatory Patient Services 2. Prescription Drugs 3. Emergency Care 4. Mental Health Services 5. Hospitalization 6. Rehabilitative and Habilitative Services 7. Preventive and Wellness Services 8. Laboratory Services 9. Pediatric Care 10. Maternity and Newborn Care -but braze plans cover all of these benefits benefits at an actuarial value of 60% (meaning, on average, a bronze plan will pay 60% of annual medical costs for an enrollee, leaving the patient financially responsible for the remaining 40%). The difference between the different medals on the exchanges are their actuarial value: platinum plans pay 90%, gold plans pay 80%, silver plans pay 70%.
As for exchange plans, you should try to establish a relationship with your primary care provider prior to your departure. since s/he will act as a gatekeeper and referral source for specialty care. The earlier you can do this, the better since exchange plan networks are very narrow resulting in exceedingly long wait times (generally higher than for the Medicaid population). Access is a concern with exchange plans, just do a google search and you’ll find dozens of investigations and reports (as well as lawsuits [especially against Blue Cross plans]) related to false/fraudulent networks and wait times.
Before this gets any bleaker, know that when all else fails with an exchange plan (or any other plan), you can always seek care from a federally qualified health center (FQHC); They can’t turn you away, even if they don’t participate with your plan. Also good to know: FQHCs are required by federal law to charge patients on a sliding fee-scale that takes into account income and assets (some will be more diligent in checking your assets than others).
Hey Dani, thanks for clarifying the difference between the two (catastrophic and bronze)! I’ve updated the article to just talk about catastrophic, since I am more familiar with it.
I’m over 30 (no catastrophic option) but live on the west coast (no worries about World Nomad’s “distance from home” issue). I’ll be employed until the end of March and starting the trail April 1. So for me, the most cost effective option is to get standard World Nomad coverage from April through October, sign up for coverage during open enrollment in November, and take the penalty fee for the few months of “unofficial” coverage. Why? Because even the cheapest plan will be around $70/mo (after the low income credit) with a $5000 required spend before you get any coverage at all. No point in spending $420 to avoid a ~$300 fee.
Wow, good call on taking a look into this! I just called my heath insurance provider and was surprised to hear that I am covered nationwide, score!! Nice GIFs btw
How do you get to keep your insurance while you are not working ?
I am drowning in health insurance decisions… thanks for the informative article! I think I might do the travel insurance and take the $300 hit on taxes/fee. World Nomads seems like a reliable source. Thanks!
Even though this post is a few years old, it helped me answer so many questions! Thank you!! The health insurance decision has been the only obstacle in my thru-hike planning process thus far that I have yet to conquer.