As I started to contemplate my life beyond work, one of the things I came back to time and time again was medical insurance. The options are endless, and the complications daunting. But before I get into it, I should say up front that I am not an expert in this field. To the contrary, I’m still trying to figure everything out for myself. (Keep reading to the end and I’ll connect you with some people who are experts.)

But I am trained as an attorney, and one of the skills I learned more than 30 years ago in law school is “issue spotting.” The idea is not necessarily to be able to solve all the problems. Rather, the first goal is to be able to identify the problems, and to then find other experts (where necessary) to solve them.

So this post is really more about issue spotting then it is about solving these complicated issues. But from my perspective, spotting the issues is a crucial first step to navigating these complicated waters, so maybe my ability to spot issues will help someone else on their journey.

So here’s issue number one from my perspective: when traveling full time, are you going to maintain traditional medical insurance in the United States? The simple version of this is an Affordable Care Act plan. These can be expensive, and they aren’t necessarily the best choice overseas, meaning that even with an ACA plan, you may still want or need travel insurance to cover you outside the United States.

If you want to maintain a United States health plan, this raises several issues, one of which is whether you can structure your financial situation in order to take advantage of health care subsidies. These issues are also complicated, but in very simple terms, if you can maintain a relatively low Modified Adjusted Gross Income (or MAGI), you will be eligible for subsidies that can make maintaining an ACA plan extremely affordable, even if you plan in buying an international plan. WIthout getting into specific numbers, because every situation is different, here’s an “order of magnitude” example. Without subsidies, an ACA plan can easily cost $2,000 or more per month for a couple. But with a MAGI of around $50,000 per year, subsidies might cover all but only a few hundred dollars per month, changing the economics dramatically.

And this does not mean that you necessarily have to live off $50,000 per year in order to secure these subsidies. MAGI is all about certain type of income; it has nothing to do with net worth, assets, or spending. Thus, for example, actual income earned at a job and any withdrawals from a traditional 401k or IRA will count towards your MAGI, but withdrawals from a Roth IRA or a traditional brokerage account typically do not. So if you have flexibility regarding where you draw your income, you can manipulate your MAGI in order to maximize your ACA subsidies.

But let’s say you cannot control your MAGI or for whatever reason decide that you don’t want to keep an ACA plan. This is going to lead to another key issue: do you have preexisting conditions that will be difficult or impossible to cover through an international plan of some kind? This can be a huge issue for some people. I have several heart stents, and one of my concerns is that I will need future heart-related care and will be told that my insurance does not cover me. This is not a concern if I maintain an ACA plan, because preexisting conditions are covered. But if I abandon my ACA plan for an international plan of some kind, things get a lot murkier. Many of the options I have considered have only limited or no coverage for preexisting conditions, which may end up driving some of my ultimate decisions.

Let’s assume you don’t have preexisting conditions to worry about, and you decide you don’t want to maintain an ACA plan, particularly if you plan to be outside the United States the vast majority of the time. You’ll likely be looking at an international plan of some kind, which leads to another key issue: will your international health insurance plan cover you when you are in the United States? Some plans cover you worldwide; others cover you everywhere except the United States (and often a few other, high-cost countries). And still others will cover you in the United States, but only for short periods of time – say, 15 days out of every 90, or 30 days every six months. And some plans offer you the choice of whether you want at least some U.S. coverage.

These choices have a huge impact on cost. Some of the plans I’ve been looking at literally double in price just to have limited, short-term coverage in the United States. These issues may be fairly easy to address if you know in advance how much time (if any) you plan to spend in the United States. But for many people starting a journey like this (including me), I’m not really sure how much time I’ll spend in the United States, and I’m not sure I want to be in a situation where I have to leave the country after 15 days or risk being here without insurance.

Before this wanders too long and risks confusing people more than it helps them, I think I’ll stop here for now. But what does this all mean for me and my family? To be honest, I’m not sure yet; if you keep reading, I’ll have more on this topic over the coming months. For now, my hope is that for 2026, I can find a way to structure my MAGI to take advantage of ACA subsidies, which will allow me to keep an ACA plan, have full coverage when I’m in the United States, and not have to worry about having coverage for preexisting conditions.

I will likely pair that with an international plan that has a high deductible and that does not cover anything in the United States. I would plan to pay for any routine medical care out of pocket overseas, where things tend to be a lot more affordable than they are here in the United States. But if something catastrophic happens, I will have coverage.

Is this a perfect solution for everyone? Almost certainly not. It may not even be the best solution for me. But I have to make some decisions before the end of the year, and I’m going to make the best choice I can for now, knowing I can reassess next year if necessary.

Hopefully you’ll stick with me as I make these decisions. And if you have gone through this process (or are contemplating it), please let me know what you decided.

In the meantime, I’ll finish where I started: I am not an expert here. And I also don’t have much content to offer you at this point. So I will end by providing you a few links to some of the people that have helped me navigate these issues so far.

I have really enjoyed the content put out by James Conole and Ari Taublieb at Root Financial on all things retirement. But in particular on this subject, check out these posts about Health Insurance for Early Retirement:

A recent post by Eric Amzalag was really helpful in terms of talking about MAGI and how it works.

Finally, in terms of actually choosing an international insurance plan, I found some of the material from Warren and Julie Travel very helpful, and Warren responded promptly to some email questions I had for him unique to my situation. Here’s one of their posts on the subject:

So that’s it for now. If this helps you at all, let me know. And if you have thoughts are suggestions on how to navigate these issues, please let me know.