Of all the various issues both present and presumed future that the emigrant must consider, health care may by the single most important. As tricky as arranging health coverage may be in the US, moving to an entirely different country can present an absolute maze of highly varying regulations and possible disqualifying conditions. Some countries have waiting periods even for approved immigrants, while others will guarantee coverage for emergency purposes upon arrival at the point of entry.
To take one country as a case study, Nicaragua will serve as an example. The Government of the United Kingdom advises that, 'There are good international quality hospitals in Managua – Hospital Central and Hospital Metropolitano amongst others. Facilities are less comprehensive outside Managua. Travellers will be required to pay for treatment, and although costs are lower than in Europe or the United States, health insurance is essential. While many providers will accept credit cards and arrangements with insurers, there are reports of some providers requiring cash.'
The above sounds rather ominous so it is vital that arrangements should be made with a local clinic before arrival so that its billing procedures are known. Much more heartening is the knowledge that even if one has to pay directly, the out-of-pocket expenses are significantly lower than in the US. An office visit to a General Practitioner costs generally around $30 and Nicaraguan GP's actually do house calls. Similarly, testing procedures usually cost in the hundreds rather than in thousands of dollars.
Nevertheless, the wise immigrant will make sure that he or she has adequate private insurance before moving, especially as the World Health Organization reports on Nicaragua report a wide range from poor to excellent among the nation's publicly funded clinics. Besides which, it is reasonable to assume that one will not spend all the rest of one's days just in Nicaragua. Therefore, carrying a good private insurance policy is a wise caution.
With that, when evaluating private health insurers, it makes sense to compile a checklist. A suggestion would then to take that checklist to an independent insurance broker who can do a comparison among the many private insurance companies. Here is some information that the potential emigrant should provide his or her broker:
- A comprehensive personal medical history. Is there anything in one's past or present physical state that would act as a disqualifier? Even a simple heart check conducted in the course of a routine physical may be a disqualification.
- Is there an age limit on the policy?
- What surgeries are covered? Besides emergency, how does the insurer define electives?
- Is post-operative or other physiotherapy covered and if so to what extent?
- What of dental work, vision and hearing?
- Is there coverage for prescription drugs? And even if so, are there any specific drugs that are not covered?
- Are there deductible payments? If so, how much are they and is the insured party liable to pay those directly to the practitioner first, or to the insurer after the practitioner has been paid?
- Is the policy portable, e.g. if one travels or moves either elsewhere within the country or to a third nation either temporarily or permanently?
- What hospitals and/or clinics within Nicaragua does the insurance provider deal with or not deal with as the case may be?
Yes, there is research to be done but it will prove to be time well-spent in avoiding a financial crisis layered on top of a medical calamity.