Health Insurance for Van Life Before 65: An EA's Guide
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Insurance Disclaimer: The information in this post is for educational and informational purposes only and is not insurance advice. I'm a Federally Credentialed Enrolled Agent — a tax professional, not a licensed insurance agent. Every person's situation is unique. Always speak with a licensed insurance professional about your specific coverage needs before making any insurance decisions.
There's a stretch of life that van life content almost never talks about - the years between leaving a career and turning 65. Old enough to have real healthcare needs. Young enough that Medicare isn't available yet. If you're a woman considering van life in your 40s, 50s, or early 60s, how you handle health insurance will shape your budget, your route, and your peace of mind more than almost any gear decision you'll make.
I've navigated this as a full-time solo vanlifer since 2023, and I look at it through the same lens I bring to everything, systems, not guesswork. Here's what you need to understand about health coverage on the road before Medicare.
The Trap Nobody Warns You About: Networks Have Borders. You Don't.
Health insurance is built on provider networks, doctors and facilities that have negotiated rates with your insurer. Those networks are geographic. Your life, once you launch, is not.
Here's how that plays out. When you're traveling away from your domicile state, you're almost always outside your network. Emergencies are generally covered wherever you are, that's federal law doing its job. It's everything after the emergency that catches travelers off guard - the follow-up appointment, the physical therapy, the specialist referral, the urgent care visit for something that isn't an emergency but can't wait three states. Out-of-network care can mean higher deductibles, less coverage, and bills that look nothing like what you're used to.
The plan that looks cheapest on paper is not always the cheapest on the road. That single sentence should sit underneath every insurance decision you make as a future vanlifer.
Your Domicile State Is a Healthcare Decision
If you buy your own insurance, you'll shop the ACA Marketplace (Healthcare.gov) and here's the part that surprises almost everyone: the plans available to you are determined by your domicile state. My permanent address is in Nebraska, so my options are Nebraska plans even though I'm rarely there.
Most marketplace plans have networks concentrated in their home state. Plans with genuinely nationwide networks exist, but they're rare, and labels can be misleading. Always read the network details, not the plan name.
This is why I tell women choosing a domicile state that they're not just making a tax decision, they're choosing their health insurance marketplace at the same time. Some states' marketplaces are significantly friendlier to travelers than others. If you haven't settled on a domicile yet, healthcare belongs on your comparison list right next to taxes and vehicle registration — I walk through the full comparison in my domicile state guide →.
If You're Leaving a Career to Launch
For many women in my audience, van life starts with walking away from employer coverage. At that moment you typically have two paths:
COBRA lets you keep your exact employer plan. Same network, same doctors, for a limited period. The catch is you pay the full premium your employer was subsidizing, which is often a shocking number. The advantage is continuity, especially mid-treatment or mid-year when you've already met a deductible.
A marketplace plan through special enrollment. Losing employer coverage is a qualifying life event, which opens a window to enroll in a marketplace plan outside the normal November–January open enrollment. Depending on your income, subsidies can make this dramatically cheaper than COBRA, but the network you're buying will almost certainly be smaller than the one you're leaving.
Which is right depends on your health situation, your income in the launch year, and your timeline. This is one of the decisions I'd encourage you to make with professional guidance and real numbers rather than a Facebook group's opinion.
The Subsidy Piece: Your Premium Is Tied to Your Income Estimate
Marketplace premiums aren't fixed, they're adjusted by subsidies based on your estimated annual income. There are two things every future vanlifer should understand.
First, estimate carefully. If you underestimate your income, you can owe money back at tax time. The subsidy gets reconciled against what you actually earned.
Second, your income in the launch year is often unusual due to severance, a house sale, or retirement account moves. Those events can affect your subsidy in ways that are very manageable with planning and very expensive without it. How you structure income during the pre-Medicare years is genuinely a strategy, not an accident. It's one of the areas I cover in depth in the Van Life Foundations Manual, because getting it right can be worth thousands of dollars a year. Get My Van Life Foundations Manual →
Telemedicine: Your First Line of Care on the Road
Whatever plan you land on, telemedicine changes the math of minor medical needs. Most plans cover telehealth at little or no cost even when you're outside your network, and a virtual visit can evaluate symptoms, prescribe medication, and tell you whether you actually need hands-on care. My rule for any non-emergency issue is to start with a telehealth visit before spending real money at an out-of-network urgent care.
A Word About Health Share Ministries
You'll encounter these in every van life Facebook group, monthly-cost programs that look like insurance. Understand clearly they are not insurance. There's no legal guarantee of payment, pre-existing conditions are often excluded, and they're not regulated the way insurance is. Some travelers use them with open eyes. Just make sure your eyes are open and talk to a licensed professional before relying on one.
Budget for Healthcare Like It's a Category, Because It Is
Even insured, life on the road means out-of-network moments, prescriptions filled at unfamiliar pharmacies, and the occasional urgent care visit. Healthcare deserves its own line in your monthly van life budget, and its own dedicated emergency fund on top of your regular buffers. The Manual includes the worksheets I use, what numbers to pull from your plan documents before you launch, how much to budget monthly based on your health situation, and how to build the medical fund alongside your 3-6-9 Buffer™.
And Then You Turn 65
Medicare changes everything, mostly for the better, if you choose correctly. But the choice between Original Medicare and Medicare Advantage has enormous consequences for full-time travelers, and the default most people drift into is the wrong one for life on the road. That decision deserves its own deep treatment, and it gets one in the Manual's insurance chapter.
The Bottom Line
Health insurance before 65 is the least glamorous part of planning van life, and one of the most consequential. The questions to answer before you launch: Does my plan cover more than emergencies outside my domicile state? Have I compared COBRA against a subsidized marketplace plan with real numbers? Does my domicile choice help or hurt my healthcare options? Is my income estimate accurate and is my launch-year income structured with my premiums in mind?
If you want to work through your specific situation, that's exactly what a Compass Call is for. And the Van Life Foundations Manual covers the complete healthcare picture - evaluating plans for a traveling lifestyle, the cost worksheets, out-of-network strategies, the income planning that protects your subsidy, and the Medicare transition when you get there. Get My Van Life Foundations Manual →
