(Please note this post was originally written in 2019 and revised in 2022 with updated pricing and other details from my experience.)
As a self-employed American, the cost of health care has always been one of my biggest burdens. It’s also part of why I spend half the year abroad. Travel insurance is $40/month (now $68/month in 2022 because I turned 40) with no copays or deductibles while my U.S. insurance was $450/month in 2017 with high copays and deductibles.
Health insurance is one of those topics that gets me all riled up so I’ll do my best to avoid getting on a soapbox. I feel so strongly about the subject that I even wrote a chapter in my book about how to hack the cost of U.S. healthcare because I understand it well, especially the flaws.
In short, the American healthcare system is inefficient and expensive. (Source: The Atlantic) While the quality of care is high in the U.S., the lack of transparency about cost is what frustrates me more than anything because I want to pay upfront and not wait months for some mystery bill to arrive in the mail. Due to this, I’ve started going abroad for my annual physical, routine dental cleaning and other routine doctor appointments. I wanted to explain how I handle medical care in my nomadic lifestyle and dispel myths about the quality of care abroad. I highly recommend it and wish I’d started doing this sooner!
What I Do For Health Insurance
When I quit a part-time job that provided health insurance in May 2017, I paid for a middle-grade healthcare plan through a Texas company called Sendero Health. I purchased it through the health care exchange despite knowing that I’d owe the full premium because my income was too high at the time to have it subsidized. My monthly premium was $350 but jumped to $450 in January 2018. All my co-pays and deductibles doubled, which is why I immediately canceled the plan. While a lot of doctors in Austin were in-network, they often had a limited “quota” for my type of plan that was already filled. Most of the doctors I found that would take my insurance were terrible. I canceled the plan because it was useless and focused on other alternatives. (For the self-employed, the Affordable Care Act (ACA) isn’t perfect, but it was a step in the right direction because it covered preexisting conditions without increasing premiums. This made a huge difference for my mom before she could go on medicare because she was self-employed and has a heart condition. (Only company that would cover her was $1,500/month with $10,000 deductible she had to meet BEFORE they would pay anything!) I had a better experience on the ACA when it first went into effect. It’s been undermined in recent years, which is why I had such a terrible experience in 2017-8.)
To be VERY clear, I ALWAYS have some form of health care coverage. It’s too risky to do without. When I’m traveling, I have travel medical insurance, which is roughly $40/month with no deductible. (2022 Update: It’s now $68/month because I turned 40.) This covers if I get sick while traveling and emergency evacuation. For these policies, I pay upfront and they reimburse me usually in a month or two. (U.S. health insurance rarely covers you abroad.) When I’m in the U.S., I purchase a high-deductible major medical plan that costs roughly $160/month to cover major emergencies only with a $2,500 deductible and 100% co-insurance. This means if I get sick, I pay the first $2,500 and they pay 100% of the rest. (2022 Update: They stopped offering 100% co-insurance so I had to go with 80% and a slightly higher deductible for $183/month.) These plans are strict and often won’t cover you again if you make claims or if you have preexisting conditions. Policy length varies by state, but you can purchase multiple policies back to back.
Important Note: Most of the ACA plans and even private plans have very limited coverage outside of the state that you live in so read the fine print carefully. If you have an emergency out of state, the doctor will most likely be out of network so you’ll be on the hook for that amount. Since I travel nonstop when I’m in the U.S., that’s not a risk I want to take because I don’t want to be on the hook for expensive doctor bills. That’s why I went with these short-term medical policies from Golden Rule from United Healthcare that cover me across the country. United Healthcare has one of the largest networks in the U.S. so most likely I’ll be somewhere with in-network doctors.
(Check out my post on travel insurance here!)
Why I Go To Thailand
Thailand has been my main focus since I lived and worked there multiple times over the past decade. I love the country and spend most of my winters in Chiang Mai. I’ll probably retire in Thailand because it just feels like home and it’s always warm.
I had a great experience in 2012 when I went to Bumrundgrad Hospital in Bangkok when one of my running injuries flared up. They did a hip x-ray, gave me the results immediately, and it all cost a total of $70 compared to the $700 my insurance was billed for the x-ray I had six months prior in the U.S.
Bumrundgrad and Bangkok Hospital have been recommended by all the expats I’ve met living abroad and even my Thai friends. And, these Thai friends have all lived in New York City and other parts of the U.S. so they understand the U.S. healthcare system.
In Hong Kong in 2018, I had lunch with some old friends — a wealthy retired couple from Australia who spends part of their year in Phuket. They both go to Bangkok Hospital in Phuket for their annual physical, which is what led me to start getting health screenings in Thailand as well! I’ve started conversations with other foreigners I’ve met at these hospitals. Most are more affluent than me proving this isn’t something that lower-middle-class folks due to save money. It’s high-end care at an affordable rate!
Healthcare in Thailand is affordable at baseline. Travel insurance doesn’t cover routine care like annual physicals and dental visits. I pay out of pocket for these.
The Cost of an Annual Health Checkup in Thailand
The quality of healthcare in Thailand is extremely high, safe, efficient and affordable. Unlike in the U.S., the prices are clear and posted. Bloodwork and other test results are delivered in roughly 60-90 minutes.
There is a set price list for annual health check options online for both of the major hospital brands in Thailand. Prices increase based on your age due to the extra tests that are included in the package. The prices below are for Bumrungrad Hospital.
2019: I chose the cheapest option since I’m under 40, and the cost was 7,140 Baht/$235 USD. (Note prices are higher for females because a pap smear is included.) This includes normal physical blood work, a pap smear, a chest x-ray, urine and stool samples and detailed consultation with an English-speaking doctor. This takes two to three hours.
2022: Since I’m 40 now, I had to choose a higher-priced package that included a mammogram with ultrasound, pap smear, EKG, ultrasound of the whole abdomen, chest x-ray, extensive bloodwork and urine/stool samples and a detailed consultation with an English-speaking doctor. All results except the pap smear were given to me at the appointment. Cost was 30,500 Baht/$847 USD. Clearly, this is higher than 2019, but it also includes a lot more. Again, prices are cheaper for men because they don’t need a pap smear or mammogram. This takes four to six hours in total.
The doctors all speak fluent English. You can choose a doctor off the website based on their credentials. I did this a few times but honestly, it wasn’t necessary since the doctors I was randomly assigned at other times were great and spoke perfect English.
A Step-by-step guide to a health checkup process at
Bangkok’s Bumrundgrad Hospital
When you arrive at the hospital, you check in and register to be in the hospital system. If it is your first visit, you’ll need your passport, and they’ll take your photo for their charts. You’ll be given a hospital number that’s your reference for future visits and medical records.
Next, you go to the health screening floor. You take a number and are called up to the registration counter in less than 10 minutes. They go over what package you’ve chosen and what’s included. If you have any medical records or previous x-rays/labs, bring those with you as well.
The next counter is the cashier. (You only pay for health screenings in advance since they are packages. Payment is done for normal appointments afterward. Unlike in the U.S., they can easily quote you exact prices before you are given any treatment or tests.)
The floor is set up in a giant circle with the central glass-enclosed area looking down on a manicured courtyard below. Each area you proceed to is labeled by letter from A to D. At Counter A, they take your blood pressure and weight, do bloodwork, measure your waist and check your vision. When doing any records or bloodwork, the nurses are constantly asking you to verify your information on the paperwork and labels. They have you verify your name on the vials for the blood, which is printed on a label. Everything is sealed, packaged and sanitary just like in the U.S. (I used to work in India so I’ve been to some proper third-world hospitals so I know the difference!)
At Counter B, they ask for a urine and stool sample. This is also where you do your chest x-ray, mammogram with ultrasound EKG and whole abdomen ultrasound. They give you a key to a locker in a giant changing room/bathroom that’s separated by gender. Each locker has a set of clean scrubs, slippers and hangers for your clothes. They even give you a cute free scarf to wear if you are cold, which is nicer than the Target scarf I packed for this trip. (I flew to Thailand from Munich where it was cold.)
Your name is printed on the containers for the urine/stool samples. You place those in a little cubby inside the bathroom for the nurses to retrieve. You sit in the lobby for your x-ray and other tests for just a few minutes. They call you, and you are done quickly. (You also wear a hospital bracelet that they use to verify your name with every test.) After you are finished, you toss your scrubs in the bins provided and give back the key. They go through, clean and replenished the lockers after each use. The slippers are disposable so they aren’t reused.
Counter C is my favorite because it’s where they feed you. A free breakfast buffet catered by the J.W. Marriot is provided! All your bloodwork and test results are processed while you wait. For the basic package in 2019, it was roughly a 60- 90 minute process from when they take the bloodwork, which was at Counter A. Keep in mind, they already started processing my bloodwork while I was doing the x-ray and other tests. There’s free, fast wifi so I brought my laptop so I could work while waiting. I barely had a chance to do any work previously because they were so quick to call me! In 2019, I sat at Counter C for about 30 minutes or so before they called me back to see the doctor. The doctor goes over your full bloodwork and chest x-ray, mammogram, EKG and abdomen ultrasound results in detail. They ask about preexisting conditions and if you have any concerns. They also do a normal exam listening to your heart and lungs, etc. For women, this includes a breast exam if you didn’t get a mammogram. (You are randomly assigned a doctor. Mine was amazing and her English was perfect! She grew up in the U.S. and went to medical school in Thailand. I really liked her so I requested her again this year.)
Afterward, men are free to go, but women are ushered over to another hallway to see another doctor to have a pap smear, which was a quick process. This is the only result that’s emailed to you afterward. I got the email about three days later with a detailed PDF with all my test results including the pap smear.
After this, I was done and free to leave. The entire process took about three hours! The cost of the health screening and the roundtrip flight to Thailand is cheaper than paying for three months of my old insurance plan in the U.S.!
Important Note: I have no preexisting conditions or major health concerns. I’ve often thought about what I would do if I did, and I would most likely be forced to live abroad most of the year. This would mean making a base in a country like Thailand where medical care is affordable and only traveling to the U.S. for short visits. I spent too many years working jobs in the U.S. that I hated just for the health insurance and decided life is too short to be that miserable. I would just adjust my lifestyle and move my base elsewhere, which also might mean a shift in the type of work I do.
Specialist Doctors
Dermatologist
Since skin cancer runs in my family, I went to a dermatologist for a full-body skin check. There is an option to choose a doctor off the website based on their photo and their bio, which is what I had done. I chose one who went to school in Boston. (From this experience and my last experience in the U.S., never choose the young, pretty dermatologists because they will make you feel bad about how you are aging and try to sell you all these cosmetic procedures that aren’t necessary. Older women are always nicer.) This was the only doctor I didn’t really like, but I also felt exactly the same about the last dermatologist in the U.S. who tried to sell me cosmetic procedures. I ended up going back to the same lady in 2022 because scheduling was easier with her and she was much nicer.
2019 Total Cost: 1,730 Baht/$57.12 USD
2022 Total Cost: 2,000 Baht/$55.54 USD
Gynecologist
I had a golf-ball-sized ovarian cyst a few years ago so as a preliminary measure I went to see a gynecologist for an ultrasound as a precautionary measure in 2019. This entire process from meeting with the doctor to doing the ultrasound was less than 45 minutes. We sat in her office and discussed everything first. I showed her the results from my previous ultrasound in the U.S., which I keep on my computer. During the process, she even had the ultrasound on the screen and labeled everything during the process. (Thankfully, everything was good!) I feel more comfortable with a woman doctor in most situations especially this one so I chose a women off the website who went to school in Germany. She reminded me of my grandma with her accent, and I totally loved her. I knew this would cost more, but I wanted to be sure things were okay. I knew I was paying for peace of mind! 2019 Total Cost: 7,060 Baht/ $233 USD ($100 for ultrasound, $100 for doctor fee & $33 for supplies)
Which is better: Bangkok Hospital or Bumrundgrad?
In 2019, Bumrundgrad offered more package options for health screenings that are slightly cheaper. Bangkok Hospital has more comprehensive ones that cost more because they include more. In 2022, this seemed to still be the case but Bangkok Hospital had some special pricing this year that made it cheaper. Since Bumrundgrad has my medical records and I like my doctor, I decided to keep using them. Prices increase yearly for all packages.
For appointments, I’d book at least a week ahead. I booked a few weeks ahead so I could get an early morning appointment. In Bangkok, both hospitals are fairly accessible by public transit. The branch of Bangkok Hospital in Chiang Mai is a $3 taxi ride from the center of town. Overall, I thought Bangkok Hospital in Chiang Mai seemed nicer than Bumrundgrad. (I went to Bangkok Hospital in Chiang Mai to redo the urine test that I’d somehow messed up during my physical. It was cheaper than Bumrundgrad for that test and everything checked out fine so I’m healthy!)
Bangkok Hospital is the largest network in Thailand with over 40 hospitals in big cities including Phuket. My Thai friends (even the one who lived in New York) like Bangkok Hospital better but say both have the same quality of healthcare.
Keep in mind that the cost of these hospitals is very expensive to most locals. The average income in Thailand is $10-15 USD/day. (This figure comes from a nonprofit I volunteered with several years ago but has likely increased. I see other sources saying it’s $20/day but can’t verify the accuracy.) The two hospitals I mention are private and the most expensive in the country. There are significantly cheaper options that offer quality care for locals, but those doctors don’t always speak English, which is why I go to the private hospitals, which cater to foreigners.
Medicine
In Thailand, you can just buy common antibiotics at the pharmacy without a prescription like doxycycline (malaria drug) and azithromycin (used to treat strep throat, food poisoning, etc.). This does NOT include controlled substances like pain or anxiety meds, etc. Certain medications are only available at pharmacies inside hospitals with prescriptions. When I am prescribed or suggested to take a medication or dosage that I’m not sure about while traveling, I simply call a 24-hour pharmacy in the U.S. like Walgreens or CVS through Skype and ask to speak to a pharmacist to get their opinion. I do this in the U.S. all the time to check drug interactions, etc.
Travel Vaccines: For travel vaccines, I verify the name of the vaccine to ensure it is one that’s approved by the FDA in the U.S. I recently got my Typhoid Fever vaccine again, which was a shot that lasts for two years. It was a simple process and the vaccine cost 1,533 Baht/$42 USD (2022 prices), which is half the cost in the U.S.
Dentists & Dental Work
I also get my teeth cleaned in Bangkok at Thantakit International Dental Center at their All Season’s branch. This was recommended to me years ago by my expat friends. The best part about this place is that my teeth cleaning included free pick-up and drop-off in a private car! I started getting my teeth cleaned in Thailand in 2013 after a dental hygienist in the U.S. recommended it after she’d scolded me for going too long between cleanings because I’d been living in Asia! She’d lived in Bali previously and said the quality of dentists in Asia was good. In Thailand, an actual dentist cleans your teeth.
2019 Total Price: 1,350 Baht/ $44.56 USD (Thantakit gives you a 10% discount if you pay cash.)
2022 Total Price: $1,200 Baht/ $33 USD + 800 Baht/$22 USD for fluoride application. (I’ll decline the fluoride application in the future because it’s not really needed and I didn’t realize it was extra. It was just kinda shoved in my mouth as part of the procedure. They still give you a 10% discount for paying in cash. My dentist was lovey so I’d go back to her.)
Full disclosure: I have perfect teeth, but I went through literal hell to get them, including five years of braces, a cracked tooth, a root canal and a crown that was another two-year hellish ordeal. I’ve lived in five states in the U.S. and been to many dentists, only three I’ve liked. Now, I only trust my hometown dentist with major dental work and will not do that abroad or in another state in the U.S. (I wish I’d driven 18 hours to him instead of getting that damn root canal/crown in Texas.) While I’m open to doing most things abroad even surgery, I won’t let anyone else touch my teeth for major dental work. No one does teeth as well as America.
Dental tourism is a huge business in Thailand. The island of Koh Samui in Southern Thailand is filled with dental centers, especially ones that do implants. People literally fly in and start the process the first day of their vacation. They vacation then come back at the end to finish the process!
Where else can you go abroad for medical care?
Thailand isn’t the only place with quality medical care at affordable prices in comparison to the U.S. While Thailand is the only place I’ve had extensive medical appointments, other expat friends have recommended Portugal and private hospitals in Mexico. A friend was in a bad motorcycle accident in Bali and went back to the U.S. for part of the recovery. He decided to do all his physical therapy in Portugal, which was a fraction of the cost of the U.S. He raves about the quality of care he’s received. Another American expat friend raves about the private hospitals in Mexico. Health screenings at private hospitals in Cancun start at $400, which is pricer than the base options in Thailand but these do include more tests.
In my book, I briefly mention a former work colleague in the U.S. whose wife has a rare form of cancer. They have traveled across the world multiple times (Netherlands, Singapore, Germany, etc.) for various treatments for several reasons: it’s significantly cheaper and more time efficient. (These were all doctor-recommended treatments approved by the FDA.) If she hadn’t gone abroad for these treatments and waited to get through all the red tape and bureaucracy of her U.S. medical insurance, she said she probably would have been dead six years ago. Going abroad bought her more time with her family.
To dig in a bit deeper into medical care abroad, I also wrote a Travel Insurance Guide here!
