Living abroad with little to no health or property insurance – how to manage this and is it wise?

in travel •  21 days ago

I want to preface this article by saying that I am a very prudent person and I usually ALWAYS have insurance – ie, health insurance (my entire life), home and/or contents insurance, landlord insurance, mortgage protection insurance, car insurance and so on. However, at present I am pretty much uninsured.

In Australia I had comprehensive medical insurance and I was paying over $200 a month for this insurance and I found that it really covered not that much – I got some prescription glasses and it covered some dental work but not enough to make it worthwhile. Why, you query, did I bother. Well in the past when I was earning six figures working for the Government I needed to have the medical insurance to cover the Medicare Levy – otherwise I would have to pay an additional $650 in tax to the Australian Government for the privilege of having no substantial medical insurance – ie, no private hospital – just the possibility of some General Practitioner (GP) visits being bulk-billed – being fully covered by presentation of my Medicare card).

However, the reality was when I went to see a GP in the Blue Mountains, outside of Sydney, where I lived, was that it usually cost me close to $100 and I would get $30 back from Medicare. My health insurance didn’t cover that gap

My husband and I recently relocated to Belize from Australia. We have no operational health insurance here nor travel insurance. We purchased a car here (online) and we have third party property insurance – which covers our personal liability if we hit another person or cause damage to another car. If our car is comprehensively damaged – we have no insurance for it. We also have decided not to purchase contents insurance for our possessions in our rental apartment here – even though we live in a moderately crime-prone area. Because our possessions here are only one TV, my cello and violin and heaps of books and clothes, our lack of insurance has been guided by instead adopting other precautions like personal and property security – leaving windows and doors locked when you go out. Not posting on social media that you are going out – it is a small village here and everyone knows everything about everyong else. I shit you not.

Firstly, even though we are both aged 52, we are both in excellent physical and mental health and so we have not got medical or evacuation insurance. That said, I chipped a tooth last week and needed to see a dentist. Found the local dentist here in the Village – it cost me US$75 to have the tooth repaired – which is quite a bit less than what I would have paid in Australia. Then I got a really bad bladder infection with excruciating pain. I saw the local village doctor, got the appropriate medication – doctor visit and medication cost me US$80.

Now, you might say, we are being foolish. For now, our finances are limited so we have decided to forgo insurance as we build up our online business. When our business is bringing in money I will get appropriate basic medical and evac insurance – at a cost of approx AUD$642 per person. But for now, I ensure that we both look after our health as much as possible. We eat very healthily. We don’t smoke cigarettes, drink alcohol at all or take recreational drugs (yes folks we really are that boring). We exercise daily. We don’t take unnecessary risks. Possibly the dumbest thing we did was driving back from Mexico when it was dark and raining and the roads here aren’t great – single lane and there are often people – dark-skinned and dressed in black walking (often drunk) on the roads and there are also some drunk drivers and/or just plain bad drivers. Generally speaking, for now we mitigate risks by making sensible lifestyle choices.

I know that if either one of us had a serious medical emergency and needed medical evacuation to the United States or Australia it would cost hundreds of thousands. Also, we both have five children between us living in Australia and if any of those children became ill or gravely injured we would need to fly home at a moment’s notice to see them.

The point of my article is neither to endorse or advise against the use of insurance. It is more exploratory of the topic of insurance in general for expats living in a Third World country.

Health risks in Belize

Possible diseases you can catch – Yellow Fever – unlikely. However we are both vaccinated against this. Some parts of Central America put you at risk of contracting this. Belize is not one of these. Yellow Fever will kill you in any event. So best to get that vaccination.

Rabies – possible – but unlikely – we are both vaccinated against this, as are our pets. Also, never pat raccoons here or anywhere – they carry diseases which can kill humans. They look very cute – still, never pat them. Raccoons can carry a range of quite dangerous bacterial diseases including rabies but also leptospirosis, listeriosis, tetanus, and tularemia. This is possibly why the Belizean Government BAHA biosecurity folks insisted that we vaccinate our dog for leptospiros before we shipped him here.

Don't pat the cute raccoons

The Belize Wildlife folks specifically advise against locals keeping the cute raccoons as pets:

One disease raccoon’s carry that makes them especially dangerous, particularly for your children, is raccoon roundworm (also known as Baylisascaris). This disease is very common in raccoons and can lead to severe consequences in humans, including brain damage, coma and even death caused by migrating larvae. The infective microscopic eggs are in the raccoons feces, and can survive several years in the soil and can be transmitted via inhalation (when eggs become airborne with dust particles). No treatment is 100% effective, and raccoons are very smart and agile, so unless safely confined, they will get into anything and everything and contaminate your house – table, beds, and floor with feces,” [Source: https://www.sanpedrosun.com/environment/2015/02/22/wild-animals-not-pets/]

Don’t swim in crocodile infested lagoons. The lagoon here in Placencia does have crocs and some numbnut in Belize (not Placencia) recently fed their dog to a croc by deliberately walking it on the water’s edge in a crocodile infested area and boom – dog – gone. There was, rightfully so, community uproar.

Here is one expat’s experience of medical care in Belize:

"I broke my arm down in Belize in Corozal. I went to the local hospital. They gave me a Voltaren injection and set it. They were not allowed to give me anything for pain. I had to go to a pharmacy and get some codeine. I just walked in and got it. I don't think people seem to grasp the idea that in third world countries, at least in Belize, there is hardly any health care per say.” [http://www.expatexchange.com/ctryguide/4955/20/Belize/Expats-in-Belize-9-Healthcare--Health-Insurance-Tips-for-Expats-in-Belize]

Now I don’t completely agree with this. There are general practitioners who are reasonably priced in most parts of Belize unless you are living in the jungle. However, I would not want to break an arm to test this theory out. In Australia, I broke an elbow (in 2005) shortly after giving birth to my daughter (so I had a newborn and a broken arm – was just awesome) and I was given IV morphine – which was appropriate and necessary. Getting an injection of Voltaren would have been almost useless for the pain from a broken arm. You would also need quite a bit of Codeine to deal with it, depending upon the severity of the break.

Australia’s Department of Foreign Affairs & Trade has the following advice about health and in particular mosquito-borne illnesses:

There is some transmission of Zika virus in Belize. If you're pregnant, discuss any travel plans with your doctor and consider deferring non-essential travel to affected areas. (Zero chance of that for us).

Local transmission of chikungunya occurs and the number of cases is increasing. Malaria is a risk throughout the year in all areas except Belize City. Other insect and mosquito-borne diseases (including Chagas' disease, leishmaniosis and dengue fever) are also a risk to travellers, particularly during the wet season (April to November).

A good bug spray will do the trick here. You need a specific one that deters mosquitos known to carry Zika, West Nile Virus and the Chikungunya one. These will also prevent the awful sand fly bites which are particularly bad this time of year when you are out and about.

Protect yourself against mosquito-borne illnesses

More expat Belizean medical horror stories

From an expat doctor:

"I worked both public and private and the former, though essentially free is really grim- a notch above rattles and leeches. Many of the MDs are Cuban, poorly trained and speak no ingles. The private is excellent for basic or minor problems. The Northern Clinic in Orange Walk where I worked had a little inpatient unit with very good specialty care and very attentive nursing but only one spoke English. I had a patient though who needed emergency eye surgery and went to the Hoy clinic in BZE where after the procedure the anesthetist took off before full recovery and he was wheeled out semi consious in an office chair because there were no wheelchairs. He is still blind in that eye. In Consejo I had a fellow who got cut up by a bush hog and 911 was inoperative and it took 90 min to get an ambulance and the paramedics tried to stick the IV while in motion on that crappy road to Corozal. He lost the leg. I am familiar with the health care in Mexico, Nicaragua and Costa Rica and it is first world and inexpensive. No comparison. I had lunch with the only neurosurgeon in BZ and he was very good but the infrastructure he needed to deal with head injury etc was not there. The moral is not to relocate to Belize unless you are in perfect physical and mental health and are not accident prone. Even so, Corozal is close to the first rate Clinico Carranza in Chetumal which is affordable. As for kids there are some terrific pediatricians as good as any up north, but the infrastructure is not there for anything beyond minor issues," cautioned another expat living in Belize. (Source: http://www.expatexchange.com/ctryguide/4955/20/Belize/Expats-in-Belize-9-Healthcare--Health-Insurance-Tips-for-Expats-in-Belize)

Bring your own health kit

We haven’t done this – but this was what was suggested:

"A first-aid manual, sterile gauze pads of different sizes, adhesive tape, adhesive bandages in several sizes, elastic bandage, steri strips, splint, antiseptic wipes, soap, antibiotic ointment, hydrocortisone cream (1%), acetaminophen, ibuprofen, ciprofloxacin 500 tabs, tweezers, sharp, scissors, safety pins, disposable instant cold packs, calamine lotion, epi pen, alcohol wipes, oximeter, tooth preservation kit, plastic non-latex, gloves, flashlight, a blanket, mouthpiece for administering CPR, list of emergency phone numbers, garlic mash for snake bite, portable defibrillator as the local machines are often not inspected or charged and flares." (source: http://www.expatexchange.com/ctryguide/4955/20/Belize/Expats-in-Belize-9-Healthcare--Health-Insurance-Tips-for-Expats-in-Belize)

I'm not sure all of the above is necessary. You can get a lot of this stuff at the Chinese markets here. I particularly got the anti-itch cream for the sand fly bites which are brutal. Not worrying about a defibrillator - would likely do more harm than good.

Belize is okay but not the cheapest place to live because of the high cost of imported goods but basic medical and dental care for minor ailments is fine. You can get quite cheap and excellent health care in Mexico – much cheaper than the USA and Australia. I think eventually we will relocate to Mexico and it is a first world country, but only after we learn and become fluent in Spanish.

Crime Risks

Yes, expats have been murdered here but it still is probably safer than the southside of Chicago. You can manage the risk by:

  • Not dressing like you have wealth – this is easy for us. However all Westerners are assumed to be wealthy.
  • Not giving lifts to people who look dodgy. I only pick up hitchhikers like old ladies doing their shopping – everyone hitchhikes here.
  • Not walking around late at night alone or affected by alcohol and/or drugs.
  • Not being a single or elderly person living alone – as these folks are definite targets.
  • Have a dog at or near your property who can reasonably defend you. We have a small dachshund as well as two stray fierce looking dogs who I feed daily.
  • Always lock your doors and windows and have burglar bars on your windows.

My husband also keeps a machete under our bed, just in case. And we have the killer dachshund.

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I hope my article has covered some of the issues for expats and/or people travelling to Belize or other parts of the Central American region. Yes we are uninsured but life is an adventure and there will always be risks. As long as we don't make rookie mistakes or have a head-on collision in a motor vehicle accident, we will be okay.

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Great post, again. I never considered a rabies shot. That’s it though hu, if a couple of Americans were headed to Central America for a couple years, you’d recommend a yellow fever and a rabies shot?

Great pose, by the way, Weiner dog!

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Yep we had both. They were quite expensive. We had them before we travelled to Belize in Feb. Now Belize is not exactly a risk for Yellow Fever - but any third world country is definitely a risk for rabies. The shot only protects you if you get bitten to allow you time to get urgent medical treatment - which you will still need - it buys you some hours. Rabies does kill. I didn't realise that. And there I was in Thailand in January randomly patting the stray dogs like a total numbnut - one looked like Benji - turned out to be Cujo. Found out more about rabies - its worth getting the shots. We came here with four animals - all had rabies shots and the killer dachshund had leptospiros as well. Yellow Fever vax is definitely worth it for Central America - if you get it it will kill you. That said, we will all probably get malaria - so travel with your bug spray and your doxycillin. And you are good to go

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It’s a pleasure to have met you by the way. We’ll be hitting Indonesia, Thailand, a couple other spots and eventually to Central America. I’m glad I got a ‘hook up!’

And congratulations on the reward on this article, well deserved. I’m going to try to get you some more.

To listen to the audio version of this article click on the play image.

Brought to you by @tts. If you find it useful please consider upvoting this reply.

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Wacky and my broad Australian accent doesn't sound much like that. Cool though.