Mailbag with Jennifer Pharr Davis: Health Insurance for Long-Distance Hikers

Welcome to Mailbag with Jennifer Pharr Davis, where we take hikers’ questions and pass them off to the trail legend for her wisdom and analysis. JPD’s newest book, The Pursuit of Endurance is available now.

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 My question is about health insurance for long-distance hikers. Many hikers are young and still covered under their parent’s insurance, others are covered by a spouse or Medicare. I’m a 38-year-old single gal, self insured under the ACA as my employer doesn’t offer coverage. Like many, I struggle with cost and high deductibles, and don’t qualify for a catastrophic plan due to age. I don’t see how I can afford a monthly premium on a hiker salary, but going without insurance seems risky. Advice?
~ Stargazer

This is a great question and a challenging topic. Health insurance is a complicated, ever-changing, hot-button issue. It can be personal and often polarizing. It is also one of the biggest hurdles for individuals hoping to thru-hike, explore extended travel, or figure out self employment.

With this Mailbag, I wanted to include various voices of thru-hikers and their experiences with health insurance on the trail, but many of them were hesitant to share their choice of coverage (if any) and hardly anyone was willing to put their name next to their chosen plan. It became clear through this process just how much judgment is associated with health coverage in our culture.

The options that hikers shared with me included lack of coverage, Medicaid, shopping for low-cost coverage in the Marketplace, buying individual coverage through a provider, staying on a parent’s plan or qualifying for a catastrophic plan, COBRA, and joining a Health Care Ministry.

Here are some different options based on the feedback I received from hikers, plus research and consulting with an expert in the field. This is by no means a comprehensive or conclusive list, but because this is an important and under addressed issue I am hoping the conversations continues through comments and corrections to this post.

Reach out to different health insurance companies and see what they have to offer.

I had individual and family policies through Blue Cross Blue Shield for most of my thru-hikes. This is one of the more expensive options and it doesn’t necessarily provide the best coverage, lowest deductibles, or highest quality customer service. It was hard to get answers on what was covered, how much I owed for services, and once I spent 20 hours on the phone trying to remove a broken elbow and ambulance ride from my statement, because they had never happened. The insurance company kept referring me to a provider who referred me to a billing office who referred me to the insurance company, and for all I know I still have a broken elbow on my patient history.

Buying ACA Coverage through the Health Insurance Marketplace

Trying to find a reasonably priced health insurance plan through the Affordable Care Act is probably going to be the best option for most long distance hikers. The catch is that for most individuals, their policy will be based on income from the previous year and not the six months they spend hiking the Appalachian Trail. It can be hard to afford the same level of health insurance when you no longer have a salary. That said, if you stay on the exchange the year after your thru hike you will likely qualify for a much lower rate. That trade might make it worthwhile for some folks. You can always update your income, but be aware that a major concern with any commercial plan is the insurance network of covered providers. Hikers will need coverage for out-of-network providers.

Stay on your Parent’s Plan

If you are under 26, you can stay on your parent’s health insurance plan if they have one, and if the situation applies. This is good news since a large demographic of long-distance hikers are just out of college. Your parents may be willing to continue paying for your insurance while you are trekking as a gift, or you can also pay your portion of the policy directly to your parents.

Qualify for a Catastrophic Plan

If you are under the age of 30 or have qualifying circumstances then you may be eligible for a catastrophic plan. This is a popular option with hikers when they can get it. The monthly premium is affordable, but the deductibles are extremely high. Assuming you are in good health and don’t have any medical emergencies on the trail this is probably the most cos- effective plan for thru-hiking. Catastrophic plans are handled differently in each state, so be sure you know your state’s policies.

When I was researching this option in North Carolina, I found a job change or loss could make you eligible for a catastrophic plan. If approved, you can also start coverage at a time of the year other than the open enrollment period. That seems like good news, but it’s unclear how difficult it is to get approved, or if quitting your job to thru-hike would allow you to qualify.

Medicare

Another large demographic on long-distance trails are recent retirees. I used to think that the large number of thru-hikers in their early 20s or mid-60s was due to time and life circumstances, but maybe it has just as much to do with health insurance! If you are 65 or older then you should be eligible for Medicare benefits.

Medicaid

I know several hikers who have qualified for Medicaid and have used it as health insurance during their time on the trail. The two main catches for Medicaid are A.) You have to qualify, which typically means that you can’t have much of a pre-existing income before you start hiking, and B.) You have to meet standards to stay on Medicaid such as applying for jobs. One hiker who used Medicaid on a long-distance trail said that while the coverage was basic, it was also straightforward and user friendly. When I asked about applying for jobs, he said that he was able to meet his quota of job applications before and after the hike, and didn’t worry about it on the trail. Through his experience with health insurance, including corporate coverage and buying plans through ACA, Medicaid offered the best basic coverage.

COBRA

If you are laid off or quit your job and set off for a long-distance hike within the subsequent 18 months, you can usually extend the existing coverage you had through your employer by purchasing COBRA. Typically employers pay part of your premiums, but when you go on COBRA on your own, you foot the whole bill. It can be a very expensive option. If you like what you had for health insurance through your work and want to continue on the same plan, you can use COBRA and benefit from the reduced group coverage rate your employer received.

Association-Based Plans

After accessing all our health insurance options, my husband and I opted for a Healthcare Ministry, an association-based plan. A Healthcare Ministry is not standard health insurance, but it does count as coverage and you do not have to pay a penalty.
More or less, it is a health care co-op where your premium goes into a pool that pays out coverage to other members. Our monthly premiums are 1/3 of what we would pay through Blue Cross Blue Shield, and the deductibles are the same. But their in-network providers are limited and there are a lot more out-of-pocket costs, and little to no help with prescription costs.

If we have a healthy year, this coverage saves us a good deal of money. If we have an ER trip or two—or a baby—it’s basically a wash. And it is no more or less of a headache than traditional insurance. It’s still confusing and the customer service representatives provide unclear—if not contradictory—answers… and they pray with you at the end of the call. Maybe it’s just me, but I’d much rather have an honest answer than a prayer.

On that note, because this instance is a religious exemption from traditional health care, participants must adhere to a specific religion and/or sign a profession of faith. My husband and I are Christians, so we qualify for several different groups based off our faith. I do know of hikers, however, who have made false claims about their religion when joining these groups… so they may have coverage in this life but we all know we’re they’re going in the next one. Kidding, I’m kidding! Not about the hikers lying on their forms, but IMO Jesus would want everyone to have access to health care.

There are other “pool” options not based off faith that are worth looking into as well.

Travel or Adventure Insurance Supplements

When my husband and I hiked abroad we joined the American Alpine Club. With our membership came an Accident Insurance Benefit that would have help cover the cost of rescue from the trail and injury-related treatment. There are several organizations that offer travel and adventure-based insurance. One of my hiking friends has taken out coverage several times from World Nomads and was pleased with their response and coverage after sustaining an injury in South America. However, all of these plans are considered a supplement to traditional health insurance and they are not going to cover any health condition that is not a direct result of your adventure-based travel. It might help cover the cost of an evacuation and treatment of a broken arm on a climbing expedition, but won’t help if you discover that you have an autoimmune disorder during the trip.

Foregoing Health Insurance

Another option is to not carry health insurance. This used to be more popular among hikers before there was a financial penalty for not having coverage. Note: this penalty will disappear in 2019. These days, I know very few people who don’t carry some type of health insurance during long-distance hikes, but it is still an option.

Ultimately, this list provides options but not much help to people like Stargazer, who asked the initial question. It is very hard to live simply, yet responsibly, and have adequate healthcare coverage. It is challenging to accept government assistance or supplements without shame. And it is difficult to pursue emotional health and creativity through entrepreneurship, artistry, and adventure when you are not able to meet your  healthcare needs.

As a writer, I don’t usually ask for input, but I am hopeful that readers of this blog will be able to add additional information or points of clarification that can help everyone, myself included, better navigate health care for long-distance hiking.

Special thanks to Meghan Nechrebecki of Health Care Transformation for her help with this piece! 

Looking for more? Find our entire collection of Jennifer’s sage wisdom here.

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Comments 6

  • Perry : Oct 23rd

    Veterans should see if they qualify for VA healthcare. I did and have full coverage of everything (medications, treatment, etc). No cost to me but some may be required a co-pay. The VA meets all ACA minimums and then some.

    Reply
  • Heidi : Oct 23rd

    Well, my husband and I are some of those folks caught in the “we can’t afford health insurance” crowd (in our middle income group). If you don’t qualify for the ACA (Obamacare) discounts, and you don’t work for a company with a health insurance plan, or you are an entrepeneur on your own, well, there you are, with no health insurance. Many countries have a national health care system for the masses, but still allow for private insurance in addition to it, if you want it (called a two-tier system). This seems like a decent solution. Why can’t we do this in the US? There is a difference between universal health insurance and universal health care/national health coverage, which I hope we can get in the US soon. These countries have managed to do this: https://www.verywellhealth.com/difference-between-universal-coverage-and-single-payer-system-1738546

    Reply
  • Aidan : Oct 24th

    ACA subsidies are based not on the previous years income, but the current year’s income estimation. If you earn more, then you just have to pay back the subsidy on your tax return.

    https://www.healthcare.gov/income-and-household-information/how-to-report/

    Reply
  • Quentin : Oct 26th

    Setting out, from Nevis, West Indies, to hike the AT in 2012 I scarcely gave a thought to medical insurance, which some might argue was totally irresponsible. Over 3 summers I completed the hike, without injury or illness and consider myself as very lucky.

    We have on Nevis an American run medical school, and a doctor there told me that if I was seriously injured then no doctor or hospital could deny me medical help, BUT they WOULD bill me forevermore….if I agreed to make agreed minimum payments ‘forever’ this would (hopefully) suffice. I’ve never been sure how sound this advice was or indeed how much a minimum payment would have to be !

    Reply
  • john : Oct 27th

    Thanks for tackling this difficult subject. A friend who owned a mid-sized business told me that every time he talked to his insurance agent, he felt like he had sat in a barber’s chair and the chair would be spinning as he was informed of his financial responsibility. Thanks again for climbing the slippery slope.

    Reply

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