Health Insurance Coverage while Thru-Hiking
Preparing for a thru-hike often revolves around gear choices, resupply strategies, and mileage planning—but what about the life logistics? One of the biggest challenges before starting a long-distance trail is figuring out health insurance. If you’ve relied on employer sponsored healthcare, don’t have a domestic partner or spouse, and are over 26 what are your options?
What coverage do you need?
To break down health insurance simply, think about plans as one of two categories: comprehensive health insurance and catastrophic health insurance. You may not see these exact terms used when selecting the type of health insurance, knowing the general level of insurance you need will help you sift through your options.
Comprehensive Health Insurance
Covers routine doctor visits, preventive care, prescriptions, emergency services, hospital stays, mental health, maternity care, and more. Because they offer more services, they are higher in monthly premiums but lower in out-of-pocket costs (deductibles or copays). Comprehensive coverage is more cost-effective for regular medical care or ongoing health needs.
📌 Best For:
People who need regular medical care, prescriptions, or preventive services.
If you have a pre-existing condition.
“Catastrophic” Health Insurance
Covers major medical emergencies (hospitalizations, severe illness, or accidents). This is a more ‘budget-friendly’ option that provides protection under worst-case scenarios. These plans will have lower premiums but high deductibles. They will cover routine doctor’s visits, but your out-of-pocket cost will still count to your deductible.
📌 Best For:
Individuals who do not visit the doctor on a regular basis.
KNow your Options
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Pros: Simple enrollment, no lapse in coverage, comprehensive coverage
Cons: Expensive
COBRA allows you to stay on an employer-sponsored insurance plan for a duration of time after a qualifying event (in this case that is leaving a job or aging out of a parent’s plan.) Typically, a COBRA plan extends your coverage for 18-36 months after the qualifying event.
These plans tend to be more expensive because you are paying the full premium cost, when before your employer was covering a portion of that cost. You do not have the option of selecting a lower cost plan through COBRA because you must remain on the health insurance plan you had previously. Whichever plan you have the time of the qualifying event is the coverage you will have with a COBRA plan.
How to Enroll: When you leave an employer their HR department will provide details about enrolling with COBRA. You will most likely also receive enrollment options in the mail.
Off-Marketplace Insurance (Short Term Insurance)
Pros: Cheaper premiums, but does not qualify for subsidies or tax credits.
Cons: Allowed to deny for pre-existing conditions; not comprehensive coverage.
Private or “Off-Marketplace” are health insurance plans that can be purchased privately through insurance companies, agents, or individual brokers. They are available at any time, not just during open enrollment. These plans fall outside of the Affordable Care Act (ACA) which means that they (1) are allowed to deny for pre-existing conditions and (2) do not cover primary care.
Catastrophic plans are just that - to protect you from a financial burden in an extreme medical case - and not designed for routine medical care. These plans have a lower premium (cost of the plan to you), but they have high deductibles, strict limitations on what medical care is covered, and caps on total pay-out.
*Make sure to pay attention to the coinsurance rate on these plans. You might see numbers like 80%/20% which means that EVEN once you hit your deductible your insurance will only cover 80% of the costs and you will have to cover the remaining 20%.
How to Enroll: Search for short-term medical plans online. United Healthcare offers short-term plans and Anthem Blue Cross Blue Shield offers “Bronze” levels plans.There are also insurance brokers who can provide you with quotes and help you sign-up for a plan. *This is state specific as the broker must be licensed in your state to sell you a plan. These brokers can also sell ACA compliant plans.
Marketplace Plans
Pros: Comprehensive coverage; select a plan that works you; apply for subsidies
Cons: More expensive premiums
Marketplace or Exchange is your one stop shop to search and compare ACA compliant plans and Medicaid options. Marketplace also allows you to apply for government subsidies toward your premium cost based on income.
What is the difference between Medicaid and ACA Plans? Medicaid is a government-funded program for low-income individuals, with eligibility based on income and other factors (ex: disability, pregnancy, or age). ACA plans are available to anyone, but subsidies are offered based on income to make coverage more affordable. See the chart below to compare Medicaid vs ACA plans.
How to Enroll: Visit Healthcare.gov or some states have their own marketplace exhange.
OTher Options
Travelers Insurance
A more unconventional plan is travelers insurance which offers travel protection for unexpected events including medical emergencies. There are different plans you can buy depending on length of coverage needed. These plans can be bought online through a travelers insurance website, a travel agency, or even through airlines when booking flights. This option may be more beneficial for international travelers. The Trek has a great blog post on travelers insurance for the internal traveler. See here.
Health Savings Account (HSA)
Something that can offset these costs is a Health Saving Accounts (HSA). HSA is NOT health insurance, but does allow you to save money tax-free for qualified medical expenses. How does this help on trail? If you are contributing to one of these plans through an employer or independently with a High Deductible Health Plan (HDHP), you can use this money to pay for medical bills. Money from your HSA account can assist with paying for health insurance or pay out-of-pocket for medical bills as needed. Using a HSA may require greater planning or budgeting prior to a long-distance hike.
OUr Experience
SPeed Goat - Subsized MarketPlace Plan
Research Marketplace plans and coverage through your state. I opted for an ACA plan on my thru hike of the Appalachian Trail and was able to get a subsidy based on income level through the state I lived in. The subsidy was calculated from my projected income for the year (I had to provide this estimate). This did require additional tax forms at the end of the year. If you make less than your forecasted income, you may be eligible for a greater tax return and vice-versa if you make more than forecasted. Do not let this stress you out! The subsidy and tax information is a lot easier than it sounds.
Riveter- SHort Term Coverage
For my PCT hike I opted for short term coverage through United HealthCare. Note that the cost and plan options vary state to state so the plan I selected may not be exactly available in your home state. This plan cost me roughly $600 for 6 months of coverage. I did have to complete a questionnaire regarding medical history and depending on your medical history coverage you may be denied. Though I never needed to use my insurance, I liked the peace of mind of having it. Overall, I found the application and premium costs reasonable through United HealthCare.
