nikki wynn surgery overseas

International Healthcare As A Nomad

When we dream about exploring the world we envision dramatic landscapes, crystal clear blue waters, dolphin swims, and exotic foods.  Not broken ankles, food poisoning, or dengue fever.

So, what happens if you get deathly ill at sea? Or have a serious injury on a remote island?  What do you do about regular doctor’s visits while in a foreign country?

All good questions.  Because most domestic health programs and traditional health insurance are tied to one specific country.  Which won’t do you any good once you leave that country.

We sailors, perpetual travelers, and digital nomads don’t live in a world built with us in mind. Because while some countries may have universal health coverage for their citizens, that doesn’t mean they will fit the bill for us travelers, in most cases, they won’t.

Thankfully, as our community grows, so do our options.  There are now plans tailored for all types of traveling lifestyles.  And we are not talking about old-school travelers’ insurance aimed at the typical vacationer.  We’re talking legit global health plans.

I recently had my first surgery in a foreign country after more than a decade of being a perpetual traveler and digital nomad.  I also filed my first claim with my international health insurance.  So, it feels like a good time to cover the subject of healthcare abroad.  The costs, quality of care, and in general share what we’ve learned over the years from our smattering of global medical experiences.

Watch the video first!  We show a lot of medical offices from around the world.

Quality of Care Abroad

Overall, we’ve been able to find caring, knowledgeable, and experienced doctors throughout our travels.  In some places, like Panama, South Africa, and here in New Zealand, we have experienced an incredible quality of care at a fraction of what it would cost in the USA.

Research the country you are headed to next.  It’s the key to setting realistic expectations and planning out routine appointments.  There will be a few countries, or remote areas, you’ll want to be self-sufficient and avoid medical services.  But there will be some countries you will want to get everything taken care of and then some!

Medical For Extreme Remote Travel

For some of the extremely remote islands we’ve been to, the services and facilities have been bare bones.  On some islands, there is nothing…because there are no people.  In these cases, we have our satellite communications and make sure to come fully prepared to take care of ourselves.

We have insurance that includes emergency evacuation and repatriation.  We have taken first-aid classes and have had some additional training on severe wounds.

We have an extensive medical kit specially designed for sailors who might not have access to a hospital or trained medical personnel. These kits can be purchased online or at boat shows.  They are great for most situations and you can always add extras to suit your needs.

If you want to really kick it up a notch, some companies specialize in offshore medical training, telemedicine & custom kits used by cruisers and professional Yachts.  Like these:

FREE Ships Captains Medical Guide

If nothing else (or in addition), download the Ships Captains Medical Guide. It is put together by the UK government for practical medical guidance (non-doctors) working onboard a ship.  It covers just about everything including basic first aid, poisoning, sexually transmitted diseases, and how to deal with a burial at sea.

You May NEED Proof of Insurance to Travel

More and more, it’s becoming a requirement to have international health insurance to enter certain countries.  Especially as sailors or anyone applying for visas.  For example, Panama and New Zealand both requested we have proof of health insurance before they approved our visa.

Murky Waters of Global Health Insurance

There are a lot of different options out there and they are NOT created equal.  It’s all in the details and what your specific needs are.  But it’s also about the reputation of the insurer.  No point in paying for insurance if they don’t pay the claims.

There are websites like TrustPilot that have reviews but navigating the murky waters of health insurance isn’t my forte.  This is why we use an agent.  Having an agent doesn’t cost us anything extra, but it means we can get quotes from multiple companies all at once.  And, we have someone who can help guide us to the right plan based on our style of travel, locations, and needs.

Arno has been our agent for years now.  He is a fellow traveler and sailor who makes it his business to know all the plans, which company has a good reputation, and which doesn’t.  He helps travelers from all over the world.  A quick glance at his website will give you an idea of some of the companies and services out there.  We don’t get anything if you click…but if you reach out, tell him we sent you.

Some things to consider

  • What countries are covered? Some companies are specific to a handful of neighboring countries while others cover practically every country except a handful of ones where health care is more expensive, such as the USA. (For example, our insurance works anywhere in the world except the USA). To include these, you can expect an additional cost or you may be required to purchase another plan entirely to cover that one “special” place.
  • Types of Coverage:  Most policies will have a huge list of treatments that are both covered and not covered.  If service is not covered automatically, you may be able to add it such as dental, vision, maternity, physical therapy, and mental health services.
  • Sports/Diving? Sports can be something as benign as hiking – you don’t want to find out you’re not covered after you break your leg on a tree root.
  • Emergency health coverage, evacuation, and repatriation.
  • Pre-Existing and chronic conditions:  I don’t have a lot of experience with this, but I have heard both good and bad stories.  Read the fine print and understand exactly what you are covered for and if there are limits or special requirements.
  • Telemedicine:  Access to doctors through phone, email, or video.  Very handy in remote areas or when there are limited healthcare facilities.

Our Health Insurance

We are currently under a grandfathered plan that is no longer offered, so I am not going to mention the name or the price.  Because you can’t buy the same plan, it doesn’t help to share the details.  Should we decide to switch, we will most likely move to a similar plan from Cigna.

Our insurance plan is catastrophic, meaning it covers emergencies or major medical proceduresCatastrophic plans are the most affordable because we pay out of pocket for general care.  Which outside of the USA isn’t a big deal because, in comparison, it can be very affordable!

Our insurance works worldwide (excluding the USA).  If we spend time in our home country, we may get a USA-specific plan.

Some of the big highlights for us are:

  • Comprehensive medical evacuation and repatriation
  • We have free choice of which doctors and hospitals we go to
  • Comprehensive hospitalization coverage
  • Telemedicine
  • Preventive, rehabilitative, and therapeutic services
  • Emergency dental coverage


The premiums for international health insurance vary dramatically.  Because there are so many factors like age, location, medical history, and coverage needs. There is no such thing as a straightforward comparison of plans because no two plans are the same.  Different levels of coverage, limitations, and exclusions, each of which affects the overall cost of a plan.

So, take these numbers with a grain of salt. Here are our (2 healthy adults) quotes for switching to Cigna:

  • A similar plan to the one we have now with a $5000 deductible came in at $6500 a year.
  • A plan with $5000 deductible that only covers hospitalization, ER, and Cancer is $3500 a year.

Similar to our Sailboat Insurance there is one guarantee:  Prices will continue to rise every year.  And bonus…as you reach milestone birthdays (like turning 40) your reward is a BIG increase 🍾


hospital costs around the world


We’ve found Meds and prescriptions are easy to get, and easy to stock up on as we travel.  It’s common to have a doctor write an extra prescription, or even recommend ones as a precaution for our travels.  Especially as offshore sailors.  If you are headed into an area with malaria or want some broad-spectrum antibiotics or steroids to keep on the boat, just ask.

Anytime we schedule a consultation with a doctor, we check our medical kit and make notes on what we need to update.  We tell the doctor about our situation, where we’re sailing and what the scrips are for.  So far we’ve never been told “no”.  For safety at sea, we keep a wide variety of prescriptions in our kit with notes on what they treat such as “bacterial infection” or “severe sinus infection”.

medicine costs around the world



Final Thoughts

We’re not experts and can only speak from our own experiences.  But from our 10+ years of travel, we’ve found healthcare abroad can be great…as long as you’re prepared and do a little research on the area you are visiting in advance.

If you have questions or want us to elaborate on something, drop us a note down below.  I can’t promise I will have the answer, but we’ll do our best.  If you have any tips you want to share with us or the community, please do!  We’ll update this post as we gain new information or if anything big changes with our approach.



This article and video are made possible because of you!  If you like what you see, there are lots of ways you can show your support.




Hello there! I honestly don’t know what to say, so I am going to tell you a bunch of random facts instead. I'm a fish eating vegetarian who hates spiders and loves snakes. I almost never took vacations growing up. I wanted to be Pippi Longstocking (still do). I misspell about every other word I write and still struggle with grammar. I love splurging on a good high tea (which is really hard to find these days). And whatever you do, don’t tell me I can’t do something, because then I'll HAVE to do it!

Comments (41)

  • Dieter R.

    Are the two annual cost examples $6500 and $3500 per person or for two people please ?
    Thanks for all your hard work!

  • Michael

    Thank you both for the wonderful and eye-opening information. It is always a pleasure to watch and learn from you folks. I like how it is simple and easy to understand, and up-to-date. Keep up the great work!

  • Alan Solomon

    Thanks for another Awesome Sunday Video. Thank you for videoing your doctor appointments and the like. You both do a great job bringing us along for most things.
    Always went to the doctor in the U.S. After reading all the comments I guess I am used to paying through the nose. Ha Ha. My cousin had the same thing done and it positively changed her life forever.
    Feel better. Heal quickly. Enjoy newfound breathing.
    Safe Boating and Travels,
    Happy and Joyous.

  • Sharon Krallman-Barker

    We were traveling in Naples Italy with a friend that fell and broke his finger and a big gash above his eye. An ambulance came and took him to the hospital where they set the finger, stitched the gash and did X-rays. No charge at all. He was expecting a big bill. Pleasant surprise.

    • AlainCh2

      Italy has Emergency AND Basic Health Services completely free for everybody… ambulance, stitches, drugs whatever >but Dentalsthey got an ER surgery + a harm plaster. Got so surprised: They walked away without paying a cent, they got it all for free.
      I’m a french Out-Pat living in Italy.
      When in France once upon a time, I needed 4 stitches done at night in Er, that cost me 290€ 😀

  • Debi Simmons

    🤦‍♀️Oops! With reference to salaries for UK’s GPs/Consultants it should read £80,000 ($99,880) and £90,000 to £100,000 (£112,365 to £124,850), based on today’s approximate exchange rate.

    • Debi Simmons

      Duh! I did it again, the salary equivalents in round brackets should reflect the USD ($). Sorry. Nikki, for messing up your lovely Comments page. Thanks again for your help.

  • Debi Simmons

    Please accept my apologies if many of you already know the following information. I live in the UK and am bemused as to where John Morris and the Ennis couple get some of their information. I truly appreciate Nikki’s good and thoughtful report. Well done, Nikki, that’s a lot of research to sort through, very helpful.

    I will add that when I first moved here NHS services were completely free to foreign visitors. That has since changed. (I believe our A&E/ambulance services are still exempt from recent government changes.) Our NHS healthcare is ‘free at the point of use’ (one of its main foundational principles). We do indeed pay taxes for the privilege of the NHS however our annual individual taxes (income taxes) are nothing near the high costs reported by the Ennis’. (The National Insurance is the UK equivalent of the IRS/Social Security.) Their misinformation has been propagated by America’s healthcare industry since the 1950’s, which I quickly learned when I moved here and had to schedule my first appointment with our GP. I am an American expat (British hubby) and we both have extensive experience with both systems.

    As well our medication/repeat prescriptions become free at the age of 60.🍾 However there are some medical items that are not freebies (NHS resource links below), but you will note the costings for most of these items are very reasonable and in some cases lower than prices on Amazon. If someone cannot afford these items or qualifies with a low income the NHS has schemes that will assist and take care of the costs, without miles of attached red tape (no debts incurred). In today’s economy (with the Tory/Conservative government sitting in Parliament) all of our prescription items (inclusive of monthly repeat prescriptions) we pay only £9.35 per item. My family uses PPC’s (prescription prepayment certificate) which are great! That costing will be gone when we turn 60. Remember we use pound sterling as our currency in the UK (England, Wales, Scotland, Northern Ireland). Ireland – the Republic of Ireland – has always used the Euro (€) as their currency (as with European nation members of the EU) and are part of the EU system whereas the UK is no longer a part of the EU system due to Brexit. Many Americans (inclusive of their media) mistakenly believe the UK is part of Europe but it is its own separate sovereign nation as is the Republic of Ireland – they just chose to use the Euro as their currency rather than keeping with the pound sterling.

    Do bear in mind all NHS GPs’/Consultants’ salaries are significantly lower than their American counterparts. GPs make around $80,000/annum whilst Consultants might make $90,000-$100,000/annum. Many of them supplement these incomes by having a private practice in addition (usually with colleagues).

    NHS prescription charges:

    Who can get free prescriptions;

    NHS Charges for Overseas Visitors::

    • Cruiser Doc

      All interesting pieces of information, but any comparison between health care in the US and other countries has to take into account these facts as well:

      – It costs a physician in the United States hundreds of thousands of dollars to complete college and medical school.
      – Annual malpractice insurance premiums depending on your specialty and region can be as high as $100,000 a year.
      – Over the past three decades, the number of physicians in the United States has increased by 150%, while the number of workers in medical administration has increased by 3200%. This second group adds nothing to direct patient care, and doesn’t work for free.

  • Paul Smith

    The link below is the Ships Captains Medical Guide PDF without the annoying “withdrawn publication” sprawled across the pages, copy and paste into a browser:

      • Michael

        You do have to give your personal info to get the download.

  • LM

    P.S. I forgot to mention…
    1. Nikki, Congratulations on the success of your surgery. I, too, have severe allergies all my life. It was not until last Summer, I had the same surgery you had. I can not begin to tell you the positive impact the good outcome of my surgery has had on every aspect of my life. I sleep MUCH better (which has such a positive impact on the quality of my life, it is truly unbelievable) now that I can breathe and my airborne allergy symptoms have GREATLY diminished. I wish I had done this surgery decades ago!
    I hope your results are as good, if not better than my own.

    2. We watch your videos every Sunday morning. You and Jason have had such a positive influence on our lives, that we are looking into the RV life full time.
    Thank you, two for sharing your lives with others; but most importantly, inspiring us to ‘live our lives’ with adventure and curiosity and not to ‘live to work’. 👍

  • LM

    All very good comments, thus far, with many mentioning ‘Government provided / subsidized’ healthcare.
    I too have had family in Canada and the USA need very similar procedures, to find that the wait time for example, the start of cancer treatment was much faster in the USA. By faster I mean, the family member in the USA was starting chemo months before the family member in Canada was first seen by the Oncologist, in Canada. (Both family members being both Canadians, and one being a US citizen too, and both diagnosed, within 3 days of each other, with the same type of cancer in the same location.

    Aside from the anidodical examples, one major difference in many countries vs. the USA, is that other countries set cost and price limits on drugs and procedures.
    Thus, when referring to drug prices, with the cost of R&D benefiting all, the citizens of the USA are, indirectly, subsidizing the drug costs overseas.

    This isn’t to say that there are not many other factors that contribute to health care costs; but just remember, the great Economist Milton Freedman said that when it comes to Government spending, Government cares nothing about Costs nor Quality.

  • Michael J. Bahr

    Great article!
    As to other issues commented on, when it comes to government and the word “free” you have to look at what you are giving up for that “free”. When you start paying up to, and in some cases over 70% of your income to get “free” then you are basically an employee or even a slave to the government. If you are a hard worker and innovator who uses your intellect to its full ability your abnormally higher income is being confiscated for those with less drive and ambition in many cases. If that is fine with you great, but if you want to decide who your earned wealth benefits there are still a few countries like the United States that still allow that.

      • Michael

        Right you are, Nikki.

  • Joan Varga

    Unfortunately the UK gov’t no longer makes it available. All pages have “document withdrawn” and if you keep following the updates, you’ll get a message that they no longer make it available for free because there is now copyrighted updating in it.

    “Where There Is No Doctor” can be found on Amazon, Kindle, or can be downloaded in its 2020 edition for free here:
    It’s been invaluable for our family here in Mexico.

  • Casey B

    Been watching your adventures for years now. Appreciate you sharing about your surgery and healthcare info. My nose hurts just thinking about that surgery! 😮Bless you. I can’t imagine you having anymore energy then you already have, but wow, can’t wait to see what you’re up to next. 😉Wishing you and Jason safe travels.

  • Fred Kaluza

  • Jacquie Mason

    I live in Canada and have never paid for all the many surgery’s I have had from cancer etc. our medical is free and before that very cheap if you where not working.
    I moved my 90+ elderly parents back to Canada. For example my elderly mother broke her pelvis in three places and they would not let her stay in the hospital past two days because Medicare would then have to pay for all the rehab. she needed.
    She was turned away from the hospital at 89 twice, they refused to see her to rule out if she was having a stroke. The second time my brother said I will leave my mother here alone if you don’t look at her now. It was the only way the hospital staff would look at her. And when they did they saw she was having a stroke. If they took her in hours earlier they could have prevented the stroke. Again, they released her immediately so Medicare would not have to pay for the proper rehab. She needed. Then they sent her home from rehab. far to soon and the next morning she had another massive stroke which paralyzed her. Their health insurance cost over 1,300.00 a month over a third of their pensions.
    My parents thought they had good medical in the US and talked like the Ennis’ . Wait till your old, see how your treated in the US. Your now a burden to the Government costing money.
    That’s how I witnessed it with my parents. They are alive today at 94 and 93, in Canada with great free medical care.
    I have family in the states in California, Washington, Idaho, and Hawaii and this is where I get my info. The us taxes for everything, even inheritance tax or lotto winnings.
    I think your article is great and you are bang on correct with your info. So is John Morris.

    • Craig Olsen

      I have Family in Canada as well and personally are a born and bred Aussie, I can say that for both situations (family overseas and her in Oz) we have never had the costs you list, BUT I think its important to point out to anyone else thinking this that This article is not accurate based on their experiences living in those countries, or for countries where your government has arrangements for universal health care (for example Australians can go to New Zealand or the UK and get the same costs as a local and vice versa) that their experiences are not correct.

      What this article is explaining and comparing i believe is comparisons for if you visit a country where you have no existing coverage and are not a citizen then these figures seem accurate for all the countries listed, and this is why the international coverage is such a great idea.

  • Stacey C

    Congrats Nikki! It is so important to breathe! Thanks for updating us on this, as I remembered it being one of the reasons that allowed you to get into NZ. Thank you for sharing your experiences cause I think you have the best attitude and outlook!

  • Roy E Hardcastle

    glad you are doing good after surgery. Roy H

  • John S.

    That video (and this website) is crammed full of good information for travellers. Thanks for posting.

    I would like to be the first to say “Thanks You” on behalf of Canadians who live in border towns that already appreciate the many many Americans who visit Canada to drink at age 18, to see a moose, or to visit a pharmacy. There are bus tours for the last two and after this video there will be even more interest in the last one.

    Very glad to see you taking deep breaths (and not having the sound edited out).

    • John S.

      That middle paragraph refers to the chart at 7:06 in the video.


    Medial guide:

    This publication was withdrawn on 17 October 2019
    This version of the document is no longer valid. Please contact HMSO for the current document.


  • Kara Krantz

    The UK medical guide was removed in 2019.

  • Lenny

    One quick note: I don’t think the medical guide is free any more. “Due to intellectual property included in the 23rd edition. the SCMG will no longer be freely
    available from “.

    I followed the links and it looks like the 23d Edition of the Ship Captains Medical Guide now sells for about $50.

  • Leslie and Audi Ennis

    We love your show and watch it often. Something you failed to mention on your US vs World Heathcare system is that most foreign countries have much higher taxes that help pay for their healthcare. Some as much as 70 to 80%, so regardless of the exact amount the relative tax rate is higher.
    Also, the US will take care of people without insurance or cash unlike many foreign countries. I’m sure that is not a blanket statement but the relative difference needs to be noted. Someone has to pay for people that get free healthcare one way or another, whether it’s through higher insurance costs or higher taxes.

    • John S.

      When I researched healthcare one of the main factors is that is unique in the US is how much healthcare management/executives get paid. No other country has such a plethora of multi-million dollar compensations.

      Perhaps one reason is that when the national government pays the executive salaries (via taxes as you point out) the voters would not stand for it.

      • Michael

        Damn straight, Nikki!

  • John Morris

    Great article , the European countries you mention all have free universal healthcare , for example the UK medical care is free for Uk residents including all medication , in Ireland it’s free if you are below a certain income and for higher incomes all medication is capped at €200 a month for a family , so you could have a child with diabetes and someone else in the family on cancer drugs it’s still capped at €200 , if you are a high earner.
    France and the UK are the gold standard, it’s free for everyone.
    For Americans 🙂 Free = paid for out of general taxation .


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