Part Two: Let’s Get Real About Expat Health Insurance


“Both terrorism and insurance sell fear — and business is business” ― Liam McCurry, Terminal Policy

IMG_9465The greatest fear of mine is a slow, painful, and expensive death from a catastrophic illness or accident. Living abroad poses many health risks, especially living on a tropical island with limited access to quality health care. After a painful bout with Chikungunya, it became necessary to research our options for international health insurance.

I suppose there are pros to being uninsured in Nicaragua. Health care is cheaper. We don’t have to see a doctor to get antibiotics or other prescription medications. We can usually self-diagnose if the illness is small and uncomplicated. For serious illnesses, Vivian Pellas hospital and the new Militar hospital in Managua offer excellent care. But, without health insurance, a catastrophic illness or accident can be expensive.

I’ve written posts about the need to have emergency medical funds when living abroad. If an expat goes to Vivian Pellas for an emergency medical procedure, before anything happens…anything!  VP swipes your credit card. Do you know what your credit card limit is? How will you afford an emergency $16,000 stent or two?

Therefore, because of my fears and “business is business”…we purchased international health insurance. Part One covered our exploration into the world of international health insurance policies. Now….

             Welcome to the world of two happy, healthy insured expats!


I. Worldwide Expatriate Association (WEA) Signature Plan

1. We chose WEA for our health care needs because

  • International health insurance since 1965
  • WEA (Worldwide Expatriate Association) is part of the PA Group
  • Backed by Lloyds of London
  • Great option for Canadians and U.S. citizens (can pay lower premium of not including U.S. coverage and still have coverage in Canada.)
  • If over the age of 65, can keep beyond age 74

2. WEA Signature Care Plan excluding the U.S. and Canada

We chose the Signature Care Plan excluding the U.S. with a maximum lifetime coverage of $1,000,000 for each person covered in the policy. $1,000,000 will go far in Nicaragua because the health care costs are about 1/4 of the U.S.

We excluded coverage in the U.S. making our premiums affordable. Our premium cost in the 60-64 year age group is $2365.48 annually with a $250 deductible for each policy holder. We chose the option to pay the full amount annually, however we could pay monthly $197.12. That is coverage for BOTH of us. Very affordable!!!

3. Process of applying

The application form can be submitted online. You must give your credit card information as part of the application process. In addition, you must have a foreign mailing address. Thus, our need to open a PO Box on Ometepe Island ( I’ll save that for a Let’s Get Real about Nicaraguan Post Offices blog post.)

Once WEA receives your application, it takes 2-4 days for the underwriter to review the application. In our case, we didn’t have any pre-existing conditions except for an eye operation to repair a hole in the retina 7 years ago. WEA contacted us for more information about the retina surgery, we submitted the information, and one day later we were approved. Because we are both under 65 years of age, we didn’t need to have any thorough exams for insurance purposes.

WEA gave us a policy number and their membership website information. WEA Direct
We logged in with our policy number and voilà! Our detailed policy, personal information, payment options, place to send claims….everything is at our fingertips.

4. There is no waiting period. Our policy takes effect immediately. We can go to any hospital, of which the definition is:

HOSPITAL Means an institution that:
1. Is operated in accordance with the laws pertaining to Hospitals of the area in which the Hospital is located;
2. Which, for compensation from its patients and on an inpatient basis, is primarily engaged in providing surgical and medical diagnosis, treatment, and care of injured and sick persons;
3. Is under the supervision of a staff of duly licensed doctors of medicine;
4. Which continuously provides twenty-four (24) hours a day nursing service by registered nurses (R.N.); and 5. Which is not mainly a place for rest, for the aged, for addicts, for alcoholics or a nursing or convalescent home or institution;
6. Makes charges.

5. We are in the AXA Network, but if a hospital does not have our AXA Network listed as a service provider, we can still go anywhere and the PA group can call the hospital direct and work out payment. WEA does this often.

Hospitals in Nicaragua in the AXA Network.
Screen Shot 2015-11-12 at 12.11.24 PMSo, we are happy campers now that we have affordable health insurance in Nicaragua. It is reassuring to know that we have our catastrophic health care needs met in Nicaragua and when we travel to any other country except the U.S. or Canada.

II. Health Coverage in the U.S.

1. Affordable Care Act

We thoroughly investigated our options for ACA and came to the conclusion that the plans were too expensive with high deductibles. Since we still have a residence in the U.S. we qualified for ACA with a $1,000 credit, but since we don’t plan on living in the U.S. again, it seemed to us like a costly idea.

2. Medicare

In a couple of years, we will qualify for medicare. We explored both plans for medicare and our needs will be met with the Original Medicare Plan.

Part A of our medicare plan is premium-free because we already get Social Security benefits, which we EARNED  and were deducted from our 30 years of employment.
Part B will automatically be deducted from our Social Security checks, unless we request that we don’t want it. Presently $104 is deducted from Medicare eligible SS benefits.

Our plans are to receive the Original Medicare Parts A and B when we are eligible. They will just send us our cards and automatically deduct Part B from our SS benefits when we are 65 years old.

NOTE: In most cases, you cannot use medicare abroad.
Check out this case that I helped to uncover in Nicaragua. I was subpoenaed to testify in this case, but fortunately they pled guilty and I didn’t have to testify.
Rare Medicare Fraud Case linking Miami to Nicaragua ends with 10 convictions

3. Travel Insurance for coverage in the United States

Until we are 65 years old and receive medicare, we will continue to buy travel insurance that will cover us in the United States when we rent a car and visit with family and friends.

In May 2015, we bought the travel insurance policy below for $171.70 to cover us for three weeks in the states.

Safe Travels USA from Trawick International – Policy Coverage Limits

This information is in the full policy certificate.

Trip Cancellation No coverage
Trip Interruption $5,000 per person, Return transportation only
Emergency Medical $50,000 per person, Primary coverage
Pre-Existing Condition $1,000 per person Emergency Medical for Unexpected Recurrence
Co-Insurance Plan pays 80% of first $5,000 after deductible, then 100%
Medical Deductible $250 per person
Home Country Coverage Not selected
Medical Evacuation & Repatriation $2,000,000 per person
Non-Medical Evacuation $25,000 per person
Baggage Delay Not selected
Baggage & Personal Items Loss $1,000 per person, $75 per item, Checked luggage only
24 Hour AD&D $25,000 per adult, $10,000 per child
Hazardous Sports Not selected
Amateur Sports Not selected
Money Back Guarantee Up to the day before effective date
24 Hour Assistance Service 24 hour assistance provided
Renewable Policy Renewable up to 24 months

Here is a great website where you can compare 132 travel insurance policies from 22 providers. Squaremouth

We are finally insured and reassured. Retiring abroad is never easy, but we have our health care needs met and my fears have subsided in the case of a catastrophic accident or illness while living abroad, traveling the world, or returning to the U.S. to visit family and friends.

26 thoughts on “Part Two: Let’s Get Real About Expat Health Insurance

  1. Hello Deb: Well I’m about to experience two issues related to these posts — deciding to go uninsured for a while and then needing surgery here in a alleged “third world” country.
    I have no insurance. I may have procrastinated too long. I may have been influenced by the friendly expats in Guatemala who have decided to just pay for what they need.

    On Monday morning, as I was walking up Calle Principal — narrow, steep, busy with pedestrians, tuktuks and pickups, a drunk (so my friend/housekeeper told me afterwards) slapped me in the stomach. He of course did not know that I’ve had an umbilical hernia for a couple years and it’s been manageable and only painful when I bump into tables or the odd protrusion. I let it go and went food shopping with my “ayudante,” carrying most of the weight. Tuesday, I decided that the lingering pain meant it was time to visit a doctor. Short story — hernia surgery Oct. 22; recovery hopefully advanced enough so I can meet my flight home on Nov. 16 to visit Mom and enjoy Thanksgiving with Family. Thrilled now that, thanks to frequent flyer miles, back in August I had purchased a first class upgrade!

    Hospitalito Atitlan is a shiny clean hospital that is small only in size. They seem to have everything I’d find in a U.S. small hospital. It was built after the previous hospitalito was buried, literally, under the mudslide triggered by Hurricane Stan in 2005, which also buried hundreds of Atitecos in the aldea of Panabaj (see Wikipedia). It mainly serves the local population (we are somewhat isolated, though certainly accessible) and focuses on the needs of women and children. In fact, when I arrived there was a jornada (work day with visiting docs) underway for family planning, including IUDs, birth control injections, vasectomies, and other birth control methods also frowned upon by the ubiquitous evangelical and Catholic churches. A Tzu’tujil woman was giving birth via cesarean.

    I waited. Few were speaking Spanish, which was quite interesting; I was treated the same as anyone else. There was an American doctor on a year’s sabbatical; I was grateful to deal with her and set aside my spanish conversation practice. Eventually after conferring with the hospitalito’s head doctor — founding member of impressive credentials — we scheduled hernia surgery asap.

    All of that visit cost Q235/$31 including lab bloodwork and EKG. Dr. Chuc estimated the surgery total cost will be Q4,000/$533 — in cash by the way. Dr. Glass was quite attentive; as she would have been with anyone else I am certain. Without any complications, that will be the expense. I had left about $930 behind in Connecticut in my health savings account last year, and that’s how I will pay this. I may seek some help from friends back home, but in all likelihood I’ll eventually donate any donation to someone here.

    And who knows, I may just buy some health insurance. One interesting tidbit: a couple months ago I decided to stop taking my meds for high cholesterol and high blood pressure. Tuesday, my blood pressure was 120/80! Can’t wait to share that with by “pill doc” enthusiast in Connecticut.

    • Wow! Jim I am so sorry to hear this, but thrilled to know that it can be taken care of in Guatemala with TLC and cheaply. What a bizarre situation…slapped in the stomach by a drunk. Did he slap you as he passed by you? Or was it intentional? Can you imagine how much the exam would have cost in the states, as well as how long you would have had to wait for the results?
      Please write an update after your surgery. I am anxious to hear how it went. I have a feeling you are in good hands and everything will go smoothly. Sending you hugs and thoughts for a quick recovery.
      That is why I feel so much better with International Health Insurance. Weird stuff happens all the time and in case of a catastrophic event, I am reassured that our savings will remain intact.
      We just renewed our WEA International Health Insurance. I moved up into another age bracket. I hate being penalized for getting older. The cost rose about $1,000 so we had to increase our deducible from $250 each to $1,000 each.
      Best wishes, Jim.

  2. I loved your article and decided to go with WEA here in Costa Rica . Still the idea of picking a name off the internet makes me nervous since my company did all the work for me before I retired. So, I am wondering if you have used them or submitted a clam yet and what your experience was . Hoping I never have to use it but want to get a warm fuzzy feeling if I have to

    • Hi Rob,

      Well, we came close to submitting a claim with WEA when I dislocated my kneecap. But,it was so painful that I couldn’t even imagine going to Managua to get a MRI. So we had a healer come to our house, and he reset and realigned my kneecap for $4. It has been over a month now and I am walking again…with a little stiffness. If I hadn’t improved, then I would have definitely have gotten a MRI. So, to answer you question, we have not had to file a claim. However, I have heard good things from people who have filed claims with WEA. I sure hope if we have to file a claim that we will get that warm fuzzy feeling. We are headed to New Zealand for a month and I feel reassured knowing that we will be covered by WEA.

      • My wife and I have pretty much the identical insurance with WEA in Costa Rica. They seemed to have good coverage and easy claims submittals online. But we have submitted 3 claims and have not gotten that “warm and fuzzy feeling” yet. The first claim was “marginal medical” (nutritionist for dietary issues), so I was not surprised that it was denied. The second claim for a medical procedure in a doctor’s office was denied once with a request for more documentation. Not sure what else they needed, but the doctor prepared a more detailed signed statement of the procedure and that claim was resubmitted and has been pending for 3 months – despite their statement to me that claims are processed within 20 business days. I have submitted a third recent claim, but that was within the past couple of weeks. I am getting concerned that they are playing a common insurer’s game of delay and demands for too much detailed paperwork, so that they can try to avoid approving the claims. (Also, we have a $5000 deductible, so it is unlikely they will ever have to pay out these claims unless we have a major medical problem.) The verdict is still out – they may do better with hospital bills, but so far they have done well with doctor’s bills.

        • Deb: I’ve enjoyed reading these exchanges posted on my mother’s 96th birthday. I guess I’m hoping to have inherited enough of her genes to enjoy good health for a while, since I have not yet joined WEA, as is my plan to do … eventually.
          What I’m very curious about is your hiring of a “healer” to reset a dislocated knee cap. Ouch! Here in Guatemala they have curanderas (women usually, so I hear), so that the many “poor” people can get some health care. And they have bonesetters (men, as far as I’ve seen), who I’ve been advised to visit for my two ailments — chronic, mild-but-annoying neck and shoulder pain on the left side and what I call a tailbone injury from my lengthy trip a year ago in chicken buses.
          Can you expand at all on your visit from the healer?

        • Thanks, Jim. Don Ebierto’s father was a sobador (a healer). He reset bones and did deep massage and had a remarkable understanding of the muscles and tendons of the body through feeling them. Don Ebierto followed in his father’s footsteps. When he was young, his father let him massage the fingers of his patients and as he grew, he took on more responsibilities helping his father.
          Sobadors are predominantly called by the poor population who can’t afford to go to a doctor for expensive tests like ultrasounds and MRIs. I was amazed when Don Ebierto first began his exam on my leg. He started at my ankle and worked his way up to my knee feeling and kneading the tendons. Then once he had diagnosed the problem, he told me I had a weak ankle that had contributed to my knee injury. He said he had to realign my kneecap and stationed Ron on one side of me and my neighbor on the other. They had to hold me down when he pulled and reset my kneecap. OMG! Then, he massaged my leg with a homemade cream and checked that everything was realigned. He knew exactly what to feel for. Then, he expertly wrapped my ankle and knee and told me to stay off my feet for two days.
          That wasn’t really any problem because I couldn’t walk anyway. He told me to use a bucket filled with ice and several times a day dunk my leg into the bucket. He didn’t prescribe any medicines or special teas. He returned several times that week and massaged my leg and checked my range of motion until he was satisfied that I would heal properly.
          He is incredible. He said it was important to exercise my leg and knee and showed me several exercises. Then, he told be I would be able to walk…uncomfortably…in 20 days and he was right on.
          I went to see an orthopedic doc last week, just to check on my progress and he verified everything that Don Ebierto told me.
          I would definitely recommend a healer for deep massage, strains, sprains and other tendon and muscle related injuries.

        • As a follow-up, WEA has now approved one of the two outstanding claims that we have submitted – that will go towards our deductible. I had thought that I had submitted all of the backup data, but a few weeks ago I found that some data was missing from my claims filed online – it appears that it was my error in uploading documents. I have found the claims submittal process a bit confusing – they do not inform you when a claim has been processed (but say that it will not take more than 20 business days), so one must log in periodically to check the claims status, and then you must dig down into the EOB form to see that they want more information to be submitted. My last submittal of receipts for the second claim is still in process (not yet 20 business days). Although they could improve the claims process some, it is still very helpful to be able to take care of these claims online.

          I got the coverage “including the USA” since I have another year to go to get medicare coverage, but my wife bought the “excluding the USA” policy since she got medicare coverage just before we bought the policy. I will change my policy next year. My wife has one pre-existing condition permanently excluded from coverage; and I had two conditions that were excluded for 12 months – those exclusions will expire on renewal in a few days.

        • Bill my broker said to bring all my claims to her and she would file and track them though (fortunately) I have not had to do yet

  3. I loved reading your analysis and thought process for choosing WEA. I retired to Costa Rica and came to the same conclusions and your article made me confident I made the right choice

  4. We are in the process of moving to Oaxaca City, Mexico. As long as we keep our house in the US, we will have an address in the US. We will be selling it in a year or two. After that, we will no longer have an address and will have to inform SSA that we live overseas. While that will not impact our Social Security payments, how that affects Medicare Part B is murkier. Any thoughts? Thank you for a most informative read on something that is of great interest to the older boomer set. Saludos, Heidi

    • Hola Heidi,
      Thanks for your comments. I am not sure how Medicare part B will be impacted, if at all. When you notify SS that you are living abroad, every two years they will send you a Proof of Life form that you must complete and return. If you do not return the form in a timely manner, then they will stop your SS checks until you submit the form to prove that you are still alive.
      Apparently, that is the only way that SS has to determine that you are still alive and receiving your checks because they do not accept foreign death certificates.
      Your Medicare can not be used abroad in most cases. So, if you are planning to return to the states for medical care, it is probably wise to keep your Medicare part B. I hope this helps to answer your question.

  5. Too young!

    Hadda write that first, sounds great since so many people say I’m too young to retire, too old to do something for myself. Like semi-retire.

    Like you, I’m too young for medicare. Thanks again for doing all this research. I went searching for it this morning. I’m telling certain friends/family that I’m moving to Guatemala, and hopefully May 1 or so. So I’m going to post around my Guatemala FB groups and see if there is a reason to favor any particular company. I’m not telling many peeps until after I quit my job of course, then I will be in better shape to handle all the negative Nellies. My tenant just kickedme in the ass by telling me she needed to move out! And I was already planning to rent my cabin, so it’s a great time to get two new tenants. At least I can tell myself that it’s unlikely they won’t move out for a year. And I’ll pray they pay the rent.

    Even my first SS check is two years away, so I am going into this thinking I just have to survive until then.

    I have a place to stay as soon as I get there. I’m wondering though if I need to show the policy salesperson that I’ve lived abroad for any length of time. Were you asked that question?

  6. Have you thought about medicare advantage instead of part B medicare? I didn’t know much about medicare at all until I became eligible a few months ago. With medicare advantage prescriptions are also covered without you having to consider Part D for that, BUT that may not apply overseas IF you can get prescriptions cheaper anyway. You pay premiums separate for medicare advantge and have a co-pay for doctors and it isn’t taken out of you SS check. It might be something to look into.

    • Thanks for the information, Sunni. We didn’t really investigate the Medicare Advantage much because we will only use it when we come back to visit. Any medicines we may need can be purchased for very little in Nicaragua without a prescription. The best thing about medicare is that we can use it for long-term care in the states. But, then again, if we need long term care for dementia or something similar, it is much cheaper to hire someone in Nicaragua to be a full-time caregiver. Decisions, decisions. It is difficult to plan for our health care needs living in Nicaragua, and traveling to the states.

  7. WOW ,,,

    ALWAYS WOW!!

    THANK U SOOOOOOOOOOO SOOOOOOOOOOO OOOO HAHAHAHA….

    MUCH FOR THIS AMAZING INFO..!!!!!!

    IT WILL SAVE ME SO MUCH RESEARCH. I PLAN TO GET IT !!!! THE INSURANCE AND THE OTHER TRAVEL INSURANCE ..

    GOD BLESS,
    HEIDI

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