It probably won't come as a surprise to anyone that health and money are sometimes related. Our story isn't very dramatic, I'm happy to say, but it does bring up some points to keep in mind if you are considering working abroad.
When we were offered our jobs in Kazakhstan, one of the benefits we were told we'd receive was no cost global health coverage. I assumed this meant that we could take care of our routine check ups, blood work, prescription refills, etc., in the US and pay some sort of a co-pay. This impression was corroborated by our employer advising us to bring a six-month supply of any prescription drugs we needed to take. If they were specifically telling us to take care of some portion of our health care in our home countries, that must have meant that we were going to have insurance that worked there, right?
Not exactly. After we arrived in Kazakhstan, they told us during orientation that in the US, our health coverage was good only for emergencies during the first 28 days of any visit. I felt like the rug had been pulled out from under us. First of all, we anticipated some of our visits home being longer than 28 days. Secondly, what exactly did the word "emergency" mean? I knew we could pay for routine check ups, etc., out of pocket, but what about non-emergency (but medically advisable) surgeries? What if one of us got sick and needed expensive tests of some sort or another? I had a health scare a few years ago, so I have an idea of how quickly the tests (and costs) can pile up.
Another interesting wrinkle to this policy is that it meant that even if your initial medical emergency in the US was covered, follow-up care might not be. We know of at least one person who learned this lesson the hard way.
Of course, you always hope to not need to use your insurance coverage, but medical care is so expensive in the US that we thought it would be too risky to go without better coverage. One medical emergency without proper coverage could have wiped out all the money we hoped to save over there (and possible more). The first thing we tried to do was to sign up for insurance through the Affordable Care Act ("Obamacare"). Unfortunately, we learned that to sign up in North Carolina, which we were using as our base of operations, we would have to physically reside there for at least six months out of the year.
Fortunately, we were eligible for COBRA coverage from Scott's previous job. Unfortunately, that ended up costing us around $1,100 per month, an amount that largely negated the benefit of free rent, in my opinion.
Obviously, every job will offer somewhat different benefits, every country has a somewhat different healthcare system, and every individual has a different level of comfort with seeking care outside his/her home country. That being said, here are some questions that might be worth mulling over if you are considering working abroad:
1. Do you want to have the option of receiving medical care in your home country while you work abroad?
2. If so, do you have insurance that will support that? Do you have any other options for coverage (COBRA, etc.)?
3. Do you have the funds to travel home in an emergency if you decide you want medical care there, but your insurance does not deem it medically necessary for you to go out of country?
4. Would you be comfortable having a doctor with whom you may not share a common language? A medical interpreter whose credentials you can't verify?
5. Are you comfortable accepting medicine or other treatment that may differ from the standard treatment in your home country?
6. Do you take any prescription drugs? If so, are there any legal or logistical hurdles to bringing a large supply with you? Remember that a medication that may be seen as fairly innocuous in one country may be viewed with suspicion in another. Oh, and as a tip, if you need a several-month supply or your prescription medicine, be sure not to wait until the last minute to get it. I used to work in a pharmacy, so this was something I already knew, but I was glad I started in advance. Even if you are dealing with a conscientious pharmacist, he/she may need some time to work things out with the insurance company or order additional supplies of your medication. If you are not dealing with a conscientious pharmacist, you may make repeated trips to the pharmacy, find out that nothing has been done with your prescription, and ultimately have to stand there and yell at him/her in order to get it done.
7. Do you have any medical dietary restrictions? If so, how easy will it be to follow your diet in the country where you plan to work?
Money is another topic to think consider, especially since the potential to save money is often a draw to jobs overseas. We did manage to save money, but there are some sneaky ways that money can get away from you. Here are some that come to mind:
1. Additional health insurance coverage. Enough said on that topic.
2. Assuming that you are being paid in the local currency and to a foreign bank account, exchanging the local currency for your home country's currency, and then transferring it to your home bank account eats up some money. Also, be very careful about unstable currencies. We always exchanged our tenge for dollars as quickly as we could once we were paid, out of fear of a devaluation. Also, find out what you can about how your employer handles a devaluation. Kazakhstan's central bank decided to let the tenge "float" during our last semester there, which resulted in an immediate and sharp drop in its value.
3. Buying things you don't already have that you plan to use over there. We had to beef up our winter clothing, and Scott in particular needed to purchase research materials that he wouldn't have access to out there.
4. Transporting your stuff. We had an allowance for shipping household goods. I'll write more about this another time, but suffice to say for now that we ended up exceeding it. We didn't exceed it by much with the actual shipping, but then we were charged an arm and a leg in customs fees. Also, if you're doing stuff like shipping research materials back and forth or traveling with additional bags, those fees add up, too.
5. Taxes in your home country. US taxpayers, if you plan to take advantage of the tax break on foreign income, be sure to know how many days you can be in the US each year. We didn't look into this very closely before we went. For a variety of reasons, I don't think we would have done anything differently, but we did just end up paying a largish chunk of change in taxes here. So this is something to be aware of. Also keep in mind that you may be taxed on certain benefits (plane tickets home, shipping allowances, etc.). In our case, at least, these were reported as income on the earnings documents our employer provided.
6. Treating yourself when the going gets tough. This one probably won't apply to everyone. If you end up getting a job someplace where you speak the language, the climate is nice, the cuisine is world famous, and there is plenty to see and do around you, you might not feel very stressed out. And...some of things things weren't the case in our situation. We spent a good amount of money traveling as a reward to ourselves. This was fine--it was something we planned to do, and we'll have lasting wonderful memories of it--but it costs money just the same. Sometimes people also treat themselves by going out to eat or drink a lot, shopping, etc., and all of those things add up.
7. Storing any stuff you neither got rid of nor brought with you.
Wishing everyone job offers in sunny, happy locations for now!