The true cost of healthcare as nomads

A year ago we wrote a post about why long-term travel is the best health insurance plan you can get explaining that we only purchase insurance for catastrophic medical needs and we will be paying out-of-pocket for the rest since we expect the cost of medical coverage outside of the USA to be a fraction of the cost.

At that time, we did not have much “experience” with having medical expenditures as we have today. After traveling for more than 800 days, visiting 30 locations in 14 countries, we have some data that starts to confirm the assumption we had before starting our nomadic journey.

In this article, I will go over all the health-related care we have had since we became nomadic and the experience associated with each of them. We will then look at how much money we spent on medical care over the past 2+ years and draw some conclusions from it. Ready to discover the true cost of medical care as full-time nomads and slow travelers? 

Two important notes/reminders before we diving into these expenses related to our personal situation:

1. We pay all of our medical expenses out of pocket as part of our strategy to only get healthcare coverage for catastrophic emergencies. For more on this, please read our article about our health insurance.
2. Mrs. NN kept working from July 2018 until March 4th, 2019. During this time we both had medical + dental coverage with high deductibles.

What health-related care have we had since we became nomadic?

Since we started our nomadic journey on July 1st, 2018, here is a list of our healthcare visits, experiences associated with them (with pictures when possible) as well as the cost for each of these expenses.

Dermatology Physical exam | Taiwan

Date: September 2020 | Cost: 32 USD

I went to the (west wing of the) National Taiwan University Hospital (in Taipei) to get my annual routine skin check done. This hospital was built during the Japanese colonial era and was previously named the Taipei Hospital and is such a beautiful building!

I made the appointment online and then went to the hospital. I checked-in at the lobby to complete my registration and I then waited in the designated waiting room for my physician to check on me. Pretty straightforward as the signage was in both Chinese & English.

Once I met with the physician, she was able to perform the exam within minutes by examining every inch of my body. Our exchange was easy as she spoke really good English. The physician was also able to answer the few questions I had about my skin condition.

Since we did not have access to Taiwan National Healthcare Insurance (or NHI) yet (we need to wait 6 months from the time we received our Taiwan Employment Gold Card to qualify for NHI as we aren’t employed in Taiwan), I planned on paying out of pocket for this exam. I knew that it would not be too expensive because of our experience with healthcare in Asia. At the same time, my only data point was how much I used to pay for a similar exam back in California which was between 150-200 USD

During our exchange, she noticed that I had two soft fibromas on my eyelid and asked me if they were bothering me, and if I wanted to get them removed. I asked for the cost of such surgery as I would rather wait for our NHI to kick in before engaging in some minor cosmetic surgery. She told me that such surgery wasn’t covered by the NHI but followed up by saying that I should not worry about the cost as it was about 100 NTD (~3 USD) per operation. Since she needed to place an order for this, I decided to go ahead and schedule an appointment for that surgery on the day of my visit.  

⇒ In total I left the exam with a bill that included: the physical fee of 439 NTD (~15 USD), the one-time registration fee of 130 NTD (~4 USD) and the cost of the two surgeries + some prescription related to the surgery 379 NTD (~13 USD) for a total of 948 NTD (or ~32 USD)

(Note: For a first timer in Taiwan with no local insurance and no need for surgery, the cost of such a visit would be only 439+130=569 NTD (or 19USD) – a far cry from the 150-200 USD I used to pay back in the US). 

Dental Cleaning | Taipei (Taiwan)

Date: September 2020 | Cost: 43 USD per person

Every 6 months or so we like to get our teeth cleaned. We made an appointment at Talent Dental. A really nice office located in Taipei. Not the cheapest option you can find here but we prioritized ease of communication by having people that speak good English. 

Mrs. NN booked appointments for the two of us via email and we then had to fill out an application form upon check-in. Our dentist spoke good english and did the checkup and cleaning in about 30 minutes. 

⇒ In total, each of us left their office with a bill of 100 NTD (~3 USD) for the registration fee and 1200 NTD (~40 USD) for the checkup and cleaning itself for a total of 1300 NTD (~43 USD) per person. 

Exhaustive Blood test panel | Da Nang (Vietnam)

Date: February 2020 | Cost 65 USD

Besides getting my teeth and skin checked, I also like having extensive blood panels done to get some insights into how my body is doing. As we were in Vietnam in February 2020, I decided to look for a lab that could get my blood and run a panel of tests on them as I’ve heard the cost was quite affordable.  

I ordered 33 different tests that go well beyond what you might get if you ask your physician during your annual exam. I believe that you can only improve what you can measure and there are a lot of insights you can learn from looking at your blood.

If you are curious here are the type of tests I ordered:

• Cholesterol (like Total, HDL, LDL, Triglyceride, ApoB, …)
• Liver & Kidney Health (like BUN/Creatinine, AST, ALT, Albumin, Total Protein, …)
• Performance Hormones (like Testosterone) 
• Metabolic Hormones (like IGF-1, Insulin, …)
• Thyroid & Blood Sugar (like TSH, Glucose, HbA1c, …)
• Nutrients (like Calcium, Magnesium, Vitamin B12, Vitamin D, Iron, …)

Making the appointment was easy and the staff spoke English (which was a lifesaver as I don’t speak Vietnamse and very few people in Vietnam nowadays speak French :-/). Getting my blood drawn was pretty quick and the place was definitely clean.

The results were emailed to me about a week later and were translated in English.

⇒ In total, the bill came down to 1.5M VDN (or 65 USD), which is about 10% of the cost of a similar test in the US (ordered via companies like WellnessFX.com that offers a similar panel for ~700 USD). 

Dental Cleaning | Da Nang (Vietnam)

Date: February 2020 | Cost 25 USD per person

We got our first dental cleaning of 2020 while we were in Vietnam. Again we looked for a place that was expat friendly and the overall experience was pretty smooth. We really enjoyed the view we had from the dental office.

⇒ In total, the bill came out to about 587,000 VDN (or 25 USD) per person. 

Ear Infection + Prescriptions | Penang (Malaysia)

Date: January 2020 | Cost 23 USD

I got an ear infection while in Malaysia so I had to see a physician to get it diagnosed. After looking for recommendations, I went to the Loke-Kun Clinic in Penang (a child clinic) that managed to provide me with a great diagnostic and even made my prescription for me while at their office, which saved me a trip to the pharmacy! No problem speaking english with the physician.

⇒ In total, I paid 45 RM (~11 USD) for the consultation and I paid 50 RM (12 USD) for two types of ear drops.  

Dental Cleaning | Chiang Mai (Thailand)

Date: October 2019 | Cost 23 USD per person

When we first arrived in South East Asia, we wanted to get our teeth cleaned while in Thailand and went to Dental 4U dental office (after booking our appointment online). The office staff speaks great English, their dentist studied in California and he specialized in implant surgery and the nurses that did our cleaning were really gentle and very capable. It was an outstanding first experience in Dental tourism, and we plan on continuing to get our cleaning done overseas.

As you can see they have a sparkling clean office!

⇒ In total, each of us paid 700 THB (~23 USD). 

Dental Checkup + Cleaning | San Francisco, California (USA)

Date: March 2019 | Cost 186 USD per person

When we returned to California to visit family and friends (after an amazing month on the island of Aruba), we decided to pay a visit to our dentist in San Francisco (Integrative Dentistry) for a checkup and cleaning. We choose this dental clinic because it “recognizes the link between oral health and general health and [understands] that any oral issues or materials placed in the mouth can have lasting effects on other systems”. (For more about Biological dentistry read this).

⇒ In total, the cost for a comprehensive check-up + cleaning was 186 USD, which at the time seemed to be an acceptable price to pay, especially as we did not have dental insurance coverage in California. If we had planned better, we would have looked for a dentist in Mexico and got our cleaning done outside of the US but we were just newbies at the time! 

Routine Physical Exam | San Francisco, California (USA)

Date: March 2019 | Cost 295 USD 

I had my routine yearly physical exam. This cost me nothing as it was covered as part of Mrs. NN medicare insurance.

Targeted Physical Exam | San Francisco, California (USA)

Date: February 2019 | Cost 295 USD 

I had to have a medical exam done by a specialist that was not covered at all by our medical insurance so I ended up paying everything out of pocket. Even with health insurance coverage, this US healthcare expense was substantial.

⇒ In total, it ended up being 268 USD for this exam + 27 USD of prescriptions.  

What was our cost of medical care since July 2018?

Alright, so that’s quite a lot of healthcare-related expenses since we became nomadic. Luckily they were mostly routine exams, but that being said, how much do you think we ended up spending?

Here is a recap of our out-of-pocket health-related expenses since we started our long term travels (July 2018)

Medical Expense	Location	Cost per person (USD)
2020 (256 USD)
Routine skin check (+ 2x minor surgery) – Mr. NN	Taipei, Taiwan	32 USD
Dental Cleaning 2020 H2	Taipei, Taiwan	43 USD x2
Exhaustice Blood Test Panel – Mr. NN	Da Nang, Vietnam	65 USD
Dental Cleaning 2020 H1	Da Nang, Vietnam	25 USD x2
Ear Infection (w/ prescriptions) – Mr. NN	Penang, Malaysia	23 USD
2019 (713 USD)
Dental Cleaning 2019 H2	Chiang Mai, Thailand	23 USD x2
Dental Cleaning 2019 H1	San Francisco, California	186 USD x2
Annual Physical exam – Mr. NN	San Francisco, California	0 USD
Targeted Physical exam – Mr. NN	San Francisco, California	295 USD
2018 (0 USD)
	No expenses
	TOTAL	969 USD

So here you have it, between the two of us, we ended up spending less than 1000 USD over the last 2.5 years, that’s less than $250/year per person (or 50 cents/day and per person).

And since 70%+ of these expenses incurred in the US early on in our journey, we expect our medical cost to get much lower as we plan to perform such exams moving forward outside of the USA.

Note about Taiwan/COVID19: As we made plans to stay in Taiwan until we can resume international travel safely, we will be able to get access to the National Healthcare Insurance (NHI) here. For a modest monthly contribution (~30 USD/month/person), we should get access to nearly-free healthcare. Something we will definitely discuss more on this blog if we get first-hand experience.

Our bottom line

As we demonstrated in this article and through our blog, we visited many countries in the world that have a great low cost of living and affordable healthcare that would lower your overall spending and can increase your quality of life.

What about you? How much are you spending on healthcare in your own country? How does our cost compare to yours? Would you consider moving to a different country so you don’t have to worry to go bankrupt if you need to be treated for a long-term illness?