By the time Cari Pattison reached New Jersey on her Appalachian Trail hike, she was attuned to the rhythms of the trail.

“The usual sore feet at night and tired legs the next day, but overall great,” she says of her 2019 NOBO hike.

And then, everything changed. She slipped on a wet, rocky incline and broke her fibula. Hike over.

“Trail injury was totally a fluke,” she says. “I never thought it would be me. I wasn’t a big risk-taker.”

An ambulance took her to a hospital emergency room, a boot cast was put on her right leg, and she began physical therapy.

The good news for Cari was that she had health insurance, COBRA coverage she took out after leaving her job. Most of her medical bills were paid after meeting her deductibles.

Is Health Insurance in Your Kit?

Cari is one of thousands of hikers who set out annually on a long-distance trail with hopes of adding thru-hiker to their name. They probably scoured the internet for advice on gear, food, and resupply stops.

But what about health insurance?

What happens if you fall and break a leg or an arm? If you require hospitalization for an unexpected medical emergency?

The following health insurance options depend on age, work situation, and your bank account. These are the big options for insurance, and with some research you may find other health insurance that you like better.

One important thing to remember when choosing a health insurance plan: Make sure it covers the area where you’re hiking. Some hikers extend the geographic range of their coverage by piggybacking travel insurance on top of their regular insurance.

Cassidy Camp found out how expensive it can be to get medical care outside a health plan’s network.

During her AT SOBO hike in 2019, she went to an urgent care in Damascus, Virginia, with Giardia symptoms. From there she was sent to a hospital emergency room for tests. The tests came back normal and she was given antibiotics.

Although she had insurance through the Affordable Care Act, the emergency room she went to was not in her plan’s network. The bill came to $1,800, and she has applied to the hospital for financial assistance.

“It’s frustrating too because I did attempt to go to urgent care first and was turned away, and the hospital I went to was the only one within a reasonable driving distance from Damascus. I didn’t have any in-network options,” Cassidy says.



A Look at the Options

Your Parents’ Work Health Insurance

For people younger than 26, the easiest answer may be to get health insurance through your parents’ work plan if they have one, and if it covers dependents. Many companies have health insurance enrollment at the end of the year so this requires some planning.

Pro: You may still be on your parents’ plan so you don’t need to do anything.

Con: Your parents may not be happy about continuing to pay your health insurance while you go off on an adventure.

COBRA

If you’re leaving a job to hike for six months you should be able to continue your work health insurance through COBRA (Consolidated Omnibus Budget Reconciliation Act) for at least 18 months. It covers health plans offered by private-sector employers with more than 20 employees, as well as state and local government health plans. In essence, you pick up the entire cost of the health insurance you were getting through work.

This is the option Cari chose after leaving her job.

“It was crazy expensive,” she says. “I was glad to have a major carrier on the trail, though, as I had several urgent care stops along the way for poison ivy. And when I slipped on the mountain in the thunderstorm and broke my ankle, I didn’t have to worry about insurance.”

Pro: Good if you like the insurance you have through work, and if it provides coverage where you’ll be hiking. Coverage rules vary by state so it’s best to contact your state’s insurance department.

Con: This is likely the most expensive insurance option.

Affordable Care Act

If you leave a job and decide against or are not eligible for a COBRA health insurance plan, you are eligible for insurance through the Affordable Care Act (also known as Obamacare). Some states handle ACA signups. If you don’t live in a state that does, visit healthcare.gov. Dental coverage is also available, although it may be limited to certain procedures. ACA costs vary depending on the breadth of coverage, and subsidies are available. Premium costs are based on your income in the year you want coverage.

Pro: You have 60 days after leaving your job to sign up in a special enrollment period.

Con: The most basic, lowest-cost plans may not cover health care outside a geographic provider network, so hiking through multiple states would negate the ACA plan’s effectiveness.

Catastrophic Coverage

Catastrophic health plans are basic, lower-cost health insurance through private carriers available to people under 30 and those of any age who qualify based on financial hardships. These plans typically have low premiums and high deductibles.

Pro: Good for accidents, unexpected injuries, and sudden emergency illnesses.

Con: Does not cover preexisting conditions. Out-of-pocket costs could be almost $7,000, and care must be within a network.

Short-Term Health Insurance

Coverage when you’re between health plans and may need emergency care. Offered through private insurance companies, and coverage does not need to meet the standards of the Affordable Care Act. So no coverage for preexisting conditions. This my be an attractive option for some thru-hikers as monthly premiums and the deductibles are lower than a catastrophic plan. It can be added and dropped at any time.

Pro: Enrollees free to chose any health insurance provider.

Con: Out-of-pocket costs could be nearly $4,000 before coverage kicks in. Less-than-healthy people can be rejected.

Medicaid

Available for people with limited incomes—based on current income—or disabilities. Apply for Medicaid in the state where you live; rules and costs vary by state.

Pro: Low cost if you qualify.

Con: Government rules and bureaucracy can make this a frustrating option. Some states have work requirements, which could make this option a nonstarter.

Medicare

If you’re 65 and not working, there’s a good chance you’re already on Medicare, and have a Medicare Advantage or Medicare supplement plan. Just be sure that whatever plan you have covers medical treatment throughout the US.

Pro: You continue the coverage you have.

Con: Not all plans provide coverage throughout the US.

Buddy

Buddy offers accident insurance to supplement your health insurance. Policy payments by the day or month.

Pro: Pays you cash to cover medical expenses related to an accident.

Con: For accidents only, and is not meant to replace health insurance. Currently offered in Alabama, Arkansas, Arizona, Colorado, District of Columbia, Delaware, Georgia, Hawaii, Illinois, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, North Dakota, Nebraska, Nevada, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, West Virginia, and Wyoming.

Hikers From Other Countries

Esther Burghouwt, who hiked the AT in 2018, had medical insurance in the Netherlands, where she lives. Her insurance covered medical care in the US, but would not cover expenses higher than treatment costs in the Netherlands. So she picked up travel insurance to pay for the difference. She also had a SPOT satellite communicator with added insurance for a backcountry rescue.

“So yeah, I was definitely pretty prepared for anything to happen,” she says.

Likewise, for her Pacific Crest trail hike in 2018, Canadian Taylor Weixl had travel insurance that piggybacked on top of her British Columbia medical coverage.

World Nomads

World Nomads provides coverage for people traveling more than 100 miles from their homes. Covers emergency medical and dental expenses, emergency evacuation, trip delay or cancellation, and lost, damaged, or stolen gear.

Pro: Covers emergency dental and medical expenses while far from home.

Con: You need to contact an emergency medical team, which will decide how you will be treated. Does not cover preexisting medical conditions.

Travel Insurance

Many options exist (including World Nomads), and they are easy to find with a Google search.

Pros: Some cover lost gear and trip cancellation in addition to medical bills.

Cos: May not cover preexisting conditions, and typically only covers medical care if you are more than 100 miles from your residence.

No Health Insurance

You’re young, healthy, and in good physical condition. So you decide to forgo health insurance during your thru-hike. And there is no longer a federal penalty for not having health insurance.

Pro: Zero upfront costs. The key here is weighing the cost of paying your medical bills vs. the cost of a health insurance policy and the plan’s deductibles.

Con: Big medical bills if you are hospitalized, lower costs but still expensive if you see a doctor during your hike.

Dental Insurance

Many employer plans only cover dental services near where you live. Private plans may cover routine dental services such as cleaning and X-rays, and a percentage of major dental work.

Pro: If you have dental insurance through work, it’s a good idea to get your dental needs taken care of before leaving your job to hit the trail. The same goes for a private dental plan.

Con: You could be forced to return home if you need major work and you’re outside the plan’s dental network.

Back to the Trail

As Cari continues her rehab, with an expected June return to the AT, she has this advice for fellow hikers:

“Plan for what you will do in the event of injury. Know it can happen, it’s not your fault (most likely), and that if you’re bound and determined, you *can* save up to do it the following year, or shortly thereafter.”

Featured image via Maggie Slepian