The first time I became sick overseas, I resisted seeing a doctor for fear of it being complicated or expensive. How American.
I did go though, and the experience was incredible. I was seen right away, the care was amazing, the process left me with zero confusion and the cost was so low I could have paid with the cash in my pocket. With the exception of American nurses, who really are the best of us, the whole experience was the opposite of home.
You almost certainly will need medical care abroad, and I encourage you seek it out enthusiastically; not just for health but enlightenment too. No other experience has changed my views more than seeing how other societies care for their sick and wounded.
If all insurance is just an instrument of financial insulation, then it’s essential to first understand the costs it would defray. Spoiler: those costs are low, and this is the essential point that underpins the discussion of health insurance for American travelers.
Ask a foreigner how much it costs to call an ambulance where they live, and they’re likely to respond “What do you mean ‘cost?’” Even in places that charge, the price they pay is a fraction of what you pay in the US.
If you get hit by a Papa John’s delivery driver in Springfield, Illinois the ambulance will cost about $2,400. In Australia, the second most expensive country (where I happen to be writing this), the cost is barely $900. In Canada, the price is under $300. And in Japan, it’s free if the emergency is severe enough.
When the price is so low, how useful is health insurance then? The answer is, sorry to say, it depends.
If you have an accident on a mountain and need extraction, insurance is crucial. If a meth-head tweaker stabs you six times outside the train station in Oslo, again, insurance please. But coverage for even moderate issues, like a couple days in a Sri Lankan hospital for an infection that’s tricky to treat, for example, will probably cost so little that you’ll decide filing the claim won’t be worth the hassle.
Everyone should have some kind of insurance, so what are the options?
Really there are just two: travel insurance that includes health coverage (which is considered secondary) and primary health insurance like what you probably have at home.
Travel insurance is less comprehensive, so it’s far cheaper. And both typically require you to pay for care up front and submit for reimbursement.
I personally consider the former essential and the latter optional, but this is a completely personal decision, and you have to come to your own conclusions.
The premiums for the health insurance you have at home almost certainly cost more than any care you’d need overseas.
A quick calculation: If you spend $700/month for COBRA (that’s super low, but whatever), then you’re spending $8,400/year. Do you know how hard it is to spend $8,400 in a foreign hospital? Very.
And of course American insurers have copays and deductibles, so that number climbs even higher. The argument for health insurance isn’t very strong.
Travel insurance has serious limits.
It covers things that happen to you, meaning injuries, infections, poisoning, envenomation, etc., but it won’t help with health issues like cancer, routine exams, mental health, management of a chronic condition, etc.
Meanwhile, primary health insurance — theoretically — should cover it all within the guidelines of your individual policy.
So does this mean you need both? Again, that’s up to you.
Personally, I just rely on travel insurance to stabilize me in case of something catastrophic. Beyond that, I’m all out of pocket.
If something medical pops up, let’s say skin cancer, I have savings set aside to cover the cost of treatment in Turkiye or Korea or anywhere else the care is good. No fucking way I’m paying the American price tag. I didn’t leave the States just to fly back and get my pocketbook emptied so some hospital administrator can redo their pool house in the Hamptons.
My privacy policy is simple: I don’t share your information.
Yea, it’s just a name, email and nationality, but I’m sure there are people who would pay for it. My thoughts on that: fuck those people and fuck those fuckers who sell personal information to them. You’ll find none of that monkey business here.
If I get hacked and your info get stolen, I’ll shoot you a note to let you know. I don’t deal in passwords, credit cards or anything like that though, so there’s almost nothing for anyone to take.
To see the full privacy policy — it’s pretty boring and cost me a lot of money — you can follow the link at the bottom of the page or in the confirmation email.
Domestic American air travel is a racket run by three major companies and a few smaller ones who effectively collude on prices to screw passengers and support their bloated executives and corporate structures.
Even regional jets, which are technically independent, are fucking death traps that I literally never, ever fly.
It’s not this way in other countries, because most people are sensible and see transportation as akin to a public utility. It’s therefore common to find flights on foreign carriers for under $100. I frequently see fares less $50.
Booking far in advance is therefore unnecessary, except of course in places where tickets sell out. Avoid the temptation to book months or weeks out if you’re just trying to save money. Not only will doing so lock you into dates you might regret, you may end up paying. Why? Booking sites now sniff for your computer’s location and display higher prices for foreigners.
Rude, right? Blame the mirror. We invented that.
First, some bad news for most Americans: automatic transmissions are as rare overseas as manuals are in the US. Unless you want to seriously overpay, make friends with someone who owns an old Miata and learn.
Second, anyone who wants to rent a car should obtain an international driver’s permit. This is easy — just 30 minutes at AAA.
When it’s time to rent, don’t get tempted by lower prices with small, local companies. Go with a big multi-national.
Understand your insurance situation through-and-through. Know the limits of your credit card’s automatic coverage and have a printout of the policy. If you can get a translated copy, even better. If you’re still in doubt after all that, just pay for their coverage.
Research the scams. Before you drive off the lot, walk around the vehicle and video record it. When you return the car, do the same. Also record yourself locking it and depositing the key in the night box if you return after hours.
If you get a notice from the rental company later saying you owe for damage or not returning the car, you can send them those videos with an E-vite to go get fucked. You might also copy tourist law enforcement, so they get fined to oblivion.
It’s tricky, but you need to basically study each country’s road laws and signs like you’re getting your student driver’s permit again. Most places have tricky rules, and they love to fine gringoes like us for violating them.
In Cyprus, for example, you can be fined for eating or drinking anything behind the wheel, even a Snickers. In Denmark, you’re legally required to look under your car before you get inside to ensure no one is underneath. In Spain, drivers with poor vision have to carry a spare set of glasses. Dirty cars are illegal in Russia, as is splashing pedestrians on a rainy day in Japan.
In some places, driving is really difficult. I pity any fool who tries to drive in Cairo. You can also very swiftly kill yourself on a German highway if you’re untrained. Driving at 120 MPH is far more complex than simply pressing the accelerator further.
Fare classes are highly inconsistent.
First class in one country is generally different to first class in any other. The same is true of second, third and so on. They vary wildly by country and system.
If it’s fiscally reasonable, I choose first for early mornings and overnights. They really are better, even just for security of your belongings.
The one time I settled for a second-class overnight, I had to physically fight a mouth-breathing Russian girl who was sweating vodka and wouldn’t stop burying her face into my lap to huff my underpants like Whip-Its. I wish I was making this up, but it’s true. I arrived sleepless, angry and ugly. It ruined my first day in Lisbon and I only had five. First class would have been worth the cost. Second class is my usual go-to. For shorter trips or anything after 9 a.m. I go second.
If I want an adventure, I go even lower. Some agents won’t sell those tickets to tourists though unless you insist.
Nomads and backpackers who don’t do the travel hacking thing usually buy cheap flights. Be careful of taking that too far.
For starters, you need to observe weight limits on baggage. In the US, no one gives a shit, but elsewhere they care. The care deeply. Never buy a ticket that forces you to pay weight overages.
Seats are also important, but not for comfort. I never take bulkhead or exit-row seats unless I pay for early boarding. Both offer less (or zero) under-seat storage, so being in a later boarding group puts you at risk of having nowhere to put your carry on — or as you’ll hear them called “cabin bags.”
I’ve even been on a flight where the attendant nearly made me check my personal item. I shut that down by threatening to create a scene and de-board, but I could have avoided it by paying $8 for priority boarding.
Countless people have asked if I used an around-the-world plane ticket for my first trip.
My simple response: Don’t ask dumb fucking questions. Also, no, I didn’t.
ATW tickets are nearly useless. They typically require you to book your stops in advance, so there’s too little flexibility. The fine print is also brutal and changes constantly.
Last time I researched them, the price was based on allotments of miles. The number of stops also changed the equation. All of them required you to choose a direction (east-to-west, for example) and none permitted travel in the reverse direction even slightly. Some airlines even insisted all departures had to occur from the same point as arrival, meaning if you traveled by land elsewhere, the airline penalized your mileage allotment.
I said airline there, but ATW tickets come come from a single carrier. Instead, you buy into an alliance, of which I believe there are still only three. Quite the lack of competition there.
ATW fares do lend themselves marvelously to itineraries where you go to a different city each month and make it the base from which you explore the region. This is something we’ll talk about later when we discuss hub-and-spoke travel.
If you have status with a particular airline, you may want to consider their ATW option — emphasis on ‘may’ — but be warned that flying everywhere robs you of some great experiences.
Domestic American air travel is a racket run by three major companies and a few smaller ones who effectively collude on prices to screw passengers and support their bloated executives and corporate structures.
Even regional jets, which are technically independent, are fucking death traps that I literally never, ever fly.
It’s not this way in other countries, because most people are sensible and see transportation as akin to a public utility. It’s therefore common to find flights on foreign carriers for under $100. I frequently see fares less $50.
Booking far in advance is therefore unnecessary, except of course in places where tickets sell out. Avoid the temptation to book months or weeks out if you’re just trying to save money. Not only will doing so lock you into dates you might regret, you may end up paying. Why? Booking sites now sniff for your computer’s location and display higher prices for foreigners.
Rude, right? Blame the mirror. We invented that.
The beauty of hub cities is the slow pace. How slow you take it will vary according to the number of side trips as well as your pace. If you commit to a month though, this introduces the possibility of renting an apartment. Even if you don’t plan to stay the full 30 days, apartment rental is generally very cheap. It can also make cooking easier, which also saves cash.
Cooking for yourself doesn’t have to mean eggs for breakfast and chicken dinners. You can dial up the adventure full throttle if you sign up for a greenmarket food tour and a cooking class right after you arrive. Not only will you know what to do with the local ingredients, you’ll eat better. Plus if you know what you’re doing, the vendors may screw you less, which will offset the price of the guide.
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