As I was chatting with other hikers and reading blogs and forums, I realized that the topic of risk insurance is often misunderstood and that it’s a cost item people tend to forget, either by negligence or by ignorance of the risks. But risks there are, and they are far from negligible as we will see on the Health & Safety page. When you spend 5 months in the outdoors practicing 12 hours a day of physical activities, there is a certain chance to be confronted with more or less serious health issues, and the possibility of having an accident, even though I wouldn’t wish it on anyone, cannot be completely ruled out
On this page I’m sharing my understanding of this topic and how, to the best of my knowledge, one can protect themselves from costs going out of control in case risks would materialize. Disclaimer: I am no specialist of insurance policies. What I’m sharing here is drawn from my own experience preparing for the PCT, and I strongly encourage you to address this serious topic with your insurance company who will advise you with the best solution for your specific case.

Cost of health care

This is the costs you will face when going to health practitioners on your own initiative. For example if you feel sick and go to the GP’s, or if you have a toothache and need to go to the dentist’s.

On the French page that mirrors this one I go to great lengths explaining how it works for French citizens when they incur health costs abroad. I’m not sure it’s worth translating that because health insurance systems vary greatly from country to country, and depending on where you live, reading about French social security might be completely worthless to you. So what I’m giving you here is the general mechanism of what happens if you incur health costs away from your home country and what you need to pay attention to in order to be fully covered:

  1. In general you’ll have to pay upfront for the care you’ve received.
  2. Once you get back to your home country, you’ll need to file a claim to your Social Security system (if there is one), and they will reimburse you whatever share of the bill they normally reimburse, which in general is not the full amount.
  3. Then your file will be transferred to your private health insurance (if you have one), and they will pay whatever was agreed in the policy you have contracted. Maybe it will match the full amount of the bill you had to pay, maybe it won’t.

That’s where it gets complicated…
It is very likely that your private insurance will cover the cost of health care as normally practiced in your home country, but they will not match any cost anywhere in the world for the same type of care.
Let me explain with an example: let’s say going to the GP’s in your home country costs 10, out of which social security pays 2 and because you have a good private health insurance, they pay the remaining 8. So you pay for private health insurance and what you get in return is that as long as you go to the GP’s in your home country you’re fine. Costs are under control. Now let’s imagine you’re traveling to a country where going to the GP’s costs 15. You pay 15 upfront and back to your home country, social security is still gonna reimburse you 2, your private health insurance is still gonna reimburse you 8 because that’s what they would normally pay for the type of care you’ve received… and you’ll be left with the remaining 5.
Now add 2 or 3 zeros and a dollar sign behind those figures and you’ll see where the problem is…

So you need to make sure you are fully covered not only for what health costs would be in your home country, but for whatever they might be in the country you’re visiting. Here’s how:

  1. First, call your insurance company to check the extent of their coverage. Maybe you have a super duper contract and they will reimburse you whatever health bills you’re paying on your travels.
  2. If they don’t, maybe you have a premium credit or debit card (Visa Premier, American Express Gold or Platinum, Master Card Gold etc.)…? Then it normally includes an insurance that covers you when you’re traveling and matches whatever cost your health insurance is not covering. Call them to double-check that, it’s normally the way it works but if they don’t cover you (or if you don’t have that type of card) then you’ll need to get back to your insurance company and buy a specific policy for your trip.

But it’s not over yet!!!
In most cases, the insurance policy that goes with your premium credit card will cover you for up to 3 months after the day of your departure. From the first day of the 4th month, you’re on your own. So again, call them to check that (maybe Platinum cards have an extended period of coverage, I don’t know). That’s very important, because for the PCT you’ll be away from home for longer than 3 months.

  1. So now you need to extend your insurance, not only for the country you’re visiting but also for the period of time you’ll be away from home. Personally I called Visa Premier and bought an insurance extension to be covered for the months 4, 5 and 6 of my stay in the US. Those are the 140€ you can see in my budget under the title “Insurance extension”.

Obviously if you don’t have a premium card and you’ve contracted an insurance policy you don’t need to go through this step, as your policy is already tailored to cover you for the geographic zone and the duration of your travel.

Cost incurred in case of accident

Paradoxically and somewhat sadly, things are way simpler in the event of an accident… as long as you have a Life Accident insurance. In general, this type of contract covers ALL costs incurred as a result of an accident: search & rescue, victim transport, hospital fees, flying a relative from their home country, repatriation, assistance at home in case of temporary or permanent disability, compensation for wage loss, etc. and usually all costs are paid for by the insurance company, the victim doesn’t have to pay any money upfront.

Keep in mind that hospital expenses in the US are disproportionate to those we are accustomed to in Europe. For example, a broken leg, if reducing the fracture requires surgery followed by a few days in the hospital, can cost up to a $100,000

In addition to that, the rules governing who will pay for search & rescue are quite complex (as they are elsewhere in the world). Depending on the exact location of the accident, this charge may fall to the Federal State, the State, other public or private entities or… the victim themselves. Now imagine that to get you to the hospital with your broken leg they had to send a chopper, and that for some reason the chopper in question didn’t find you right away and had to fly over the accident zone for a while before it could rescue you… the bill increases by anything from $1,500 to $3,000… for every hour in the air!

Clearly this is a very serious subject that shouldn’t be taken lightly: the costs involved in an accident are extremely high and without insurance, unless you’re lucky enough to be very rich (in which case you probably do have an insurance anyway), you can find yourself in a truly catastrophic situation. Of course one always hopes they won’t have an accident, and of course one will always try their best to avoid having one, in which case the insurance will have been useless. Like the first aid kit and the emergency beacon, the insurance contract has the paradox that you buy it hoping you’ll never use it. But consequences in the event that the risk materializes are too great to ignore. I therefore strongly encourage you to make sure you are fully covered against health & safety hazards throughout your journey. For everyday life in your country of residence it’s your own business, but on an adventure like the PCT I consider it an absolute must.

As far as I am concerned, I have a contract with the French insurance company MAIF called “Praxis Solutions”. For less than €10 per month, I’m covered against everyday life accidents (sport, leisure, domestic accidents) in France and elsewhere in the world.

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