A difficult question and one that generates lots of questions and conversations amongst cruisers. Many cruisers decide to go “bare” and either hope for the best or work with local medical professionals. Many islands have very good medical care at drastically reduced prices (compared to the U.S.). We’ve been told by many cruisers that you can get a dental check up for under $40 cash and a broken arm can set and fixed (including an x-ray, several visits, cast, and all) for only a few hundred dollars. So there is certainly reason to believe that this is a good decision for many people.  Plus, if you are an American citizen and live outside the U.S. for 330 days you do not have to pay the ACA (Affordable Care Act or for those of you who think it is called “Obamacare”) penalty.

But those who know me, know that I would worry every minute of every day if I did not have medical coverage. First because I am a world class klutz! I bruise if you look at me funny and cannot seem to make it one day without some injury (big or small). Second, I used to work in the insurance business and truly believe in being prepared for the unforeseen events life brings you. And most importantly, I am a cancer survivor and although I believe I am cancer free and took all necessary precautions to prevent it from returning – you just never know. So, the search begins for healthcare (h/c) alternatives.

My previous company spoiled me rotten with amazing H/C coverage, low deductibles, choice of the best doctors, and supplementary options. Of course, when I made the decision to “retire” that all went away, along with Matt’s coverage as he was covered under my insurance policy.

I must admit that I am envious of our European cruising friends and their universal h/c coverage (yes, I am sure they have their own unique drawbacks, but at this time of my life it seems appealing).

We had three options to consider (since I had already ruled out going “bare” or without coverage (not naked you pervs :)).  1) We could go on my COBRA plan which was $1,350/mo for both Matt and I to continue our current coverage, as is or $642 for me alone.  2) Healthcare.Gov which had several plans ranging around $350-$650 for me alone with incredibly HIGH deductibles, restricted coverage, and restricted doctor selection. 3) Christian Health Ministries (CHM) which is a cost sharing non-profit program, not an insurance plan.  Please note that Matt had opted to go “bare” if I went with either Option 1 or 2 due to cost and the mere fact that he doesn’t go to the doctor.

The one thing I knew we were going to do for sure was to sign up for Divers Alert Network program which is for divers/sailors and provides insurance that provides transportation to bring you back to the U.S. (not necessarily to your home state, but back to the U.S.) for medical treatment.  Basic membership is $35 solo or $55 for Matt and I each year.  In addition, they have an additional coverage plan, “Dive Accident Insurance Plan” that provides additional transportation, housing, and $10k supplemental medical coverage – both the membership and additional coverage plan, for both Matt and I is at the low price of $205 annually!  No brainer, done!

After much research on the different ACA programs and discussing my options with an extremely knowledgeable and helpful friend (thanx Pete), I decided that the ACA programs were not for us – too expensive, ridiculously high deductibles, and too many restrictions.  My care team, medical doctors and prescriptions would NOT be covered under the plans we were considering — plus there is the Trump factor.

So COBRA or CHM???   COBRA was awesome and to be honest, not horribly priced for a COBRA plan (thank you TDC).  But we don’t need that much coverage – in fact over 90% of that coverage would go unused so it was really hard to justify spending almost $8k on this h/c plan.  I did a lot of research on CHM and talked to a few CHM members who are part of the cruising network. The CHM program is a cost sharing program and not an insurance policy.  Meaning you pay for your h/c services up front and submit the expenses for reimbursement based on their qualifying guideline.  They have been around for 30 years and have over 300k members.  General checkups, dentistry, and vision are not included (fine with us as we don’t need those services while cruising).  The kicker is my pre-existing condition.  They do have caveats with pre-existing conditions meaning if you are cancer free for 5 years it no longer is considered pre-existing (of course I am 2 years cancer free so that doesn’t apply to me) and if you have other h/c conditions and are symptom free for a year you are not considered to have a pre-existing condition.  So, what does it mean that I am considered a pre-existing member?  If, I have a recurrence specific to my breast cancer, they will still cover the treatment based on a tiered reimbursement plan.  Well, I am considered a LOW risk since I had everything lopped off and am on medication to prevent a metastasis and I had really good genetic results so I am ok with this plan.  Matt and I signed up for their top tier Gold Program at $150 pp/per month and I signed up for their Brother’s Keeper (a catastrophic additional increased reimbursement plan) at $240/year for both Matt and I.  So, our total annual h/c coverage, for both of us, will be $3,840.00.  I can live with that.  And the bonus part is that they will help you negotiate your medical bills since you are considered a cash paying patient (usually you get 40-50% discount).

Have to be honest, it is a relief having made this decision and knowing that we have the coverage we need for our current lifestyle.