Most people who switch to van life budget for fuel, insurance on the rig, maybe a propane heater. Health insurance gets pushed to “I’ll figure it out later.” That’s the mistake that ends up costing the most, and it’s the one we hear about most often from readers of Budget Van Journeys who’ve had a bad fall, a kidney stone, or a torn rotator cuff three states from where they’re technically “from.”
The honest answer is that there’s no single best plan for full-time travelers. What works depends on your income, your home state on paper, and how much risk you’re willing to carry yourself. Here’s what actually exists, what it costs, and where people get tripped up.
1. Marketplace (ACA) Plans Still Work, Even Without a Fixed Home
You don’t need to live in a house to buy an ACA marketplace plan. You need a state of legal domicile, meaning the address on file with your insurer and the IRS, even if you never sleep there. Plenty of full-timers use a mail-forwarding service in Texas, Florida, or South Dakota for exactly this reason (we go into the logistics of that setup in How Vanlifers Deal With Mail and ID, since the mailing address question and the insurance question are tied together more than people expect).
Once you have that domicile state sorted, you enroll through healthcare.gov or your state’s exchange like anyone else. Premiums are based on projected annual income, age, and household size, not on where you physically are on a given Tuesday. And because a lot of vanlifers run lean on income, especially in the first year or two, subsidies can bring a silver-tier plan down to under $50 a month. We’ve talked to readers paying close to nothing after subsidies, and others paying $400+, because the system is genuinely income-sensitive rather than lifestyle-sensitive.
The catch is coverage area. ACA plans, especially HMOs, often have narrow in-network regions tied to your domicile state. If you have a non-emergency need in Oregon but your plan network is built around Texas, you’re paying full price or waiting until you’re back in-network. PPOs with broader networks cost more but solve this. It’s a real tradeoff, not a minor detail.
2. Short-Term Medical Plans Are Cheap for a Reason
Short-term plans look tempting on price. $80 to $150 a month, fast approval, available almost anywhere. They are not ACA-compliant, which means they can deny coverage for pre-existing conditions, cap payouts, and exclude entire categories of care like maternity or mental health. They’re built as a bridge between jobs, not a long-term solution for someone living on the road permanently.
Here’s where people usually go wrong with these: they buy a short-term plan, feel “covered,” and don’t read the exclusions list until they’re filing a claim. A torn ACL from a hiking trip might be covered. The same injury, if it’s later linked to a knee issue you mentioned on an old medical form, might not be. These plans are underwritten tightly, and the underwriting works against you more often than people expect going in.
There’s also a state-level wrinkle. A handful of states, California, New Jersey, Massachusetts, Rhode Island, and DC among them, still enforce their own individual mandate with a tax penalty for being uninsured, regardless of what the federal government does. If your domicile state is one of these, a short-term plan alone may not satisfy that requirement.
3. Health Share Ministries: Not Insurance, and That Distinction Matters
Medi-Share, Liberty HealthShare, Samaritan Ministries, and similar organizations are popular in van life circles because they’re often half the cost of a comparable ACA plan. They work by pooling member contributions and “sharing” medical costs rather than guaranteeing payment through a contract. Legally, that distinction matters a lot.
There is no enforceable obligation for a health share to pay your bill. Most have a solid track record of doing so, and members generally report being satisfied, but if a ministry decides your claim falls outside their guidelines, you have very little recourse. Many also require a statement of faith or lifestyle agreement to join, which excludes some people outright and feels invasive to others. And again, in those mandate-enforcing states mentioned above, a health share does not count as qualifying coverage.
If you go this route, read the published guidelines document cover to cover before you need it, not after.
4. Telehealth Subscriptions Fill the Gap, They Don’t Replace the Floor
Services that give you on-demand virtual doctor visits for a flat monthly fee, somewhere in the $20 to $50 range, are genuinely useful for van life. Strep throat, a UTI, a medication refill, a rash that’s probably nothing but you want to be sure. None of that requires a brick-and-mortar visit, and having a doctor on a video call at 9pm from a trailhead parking lot is one of the more underrated conveniences of modern remote living.
What telehealth doesn’t do is cover an ER visit, a broken bone, surgery, or anything requiring imaging beyond what a phone camera can show. Pair it with a real insurance plan. Don’t substitute one for the other, which is a mistake we see more in people who came from corporate jobs with great benefits and underestimate how fast a hospital bill scales once you’re uninsured.
5. Medicaid Is Possible, But Domicile Complicates It
If your income qualifies, Medicaid is the cheapest option by far, often free. The complication is that Medicaid eligibility and coverage are state-administered, tied to where you’re a resident, and most state Medicaid programs expect you to actually be using in-state providers regularly. A full-timer who’s domiciled in a Medicaid-expansion state but spends eight months a year three time zones away is going to run into friction fast, both with eligibility reviews and with finding anywhere nearby that takes their plan.
Some vanlifers structure around this intentionally, choosing a domicile state with Medicaid expansion and looping back through it periodically to maintain residency requirements and use up routine care. It works, but it takes planning, and it’s not a fit for someone who wants total freedom of movement.
Quick Comparison
| Option | Typical Monthly Cost | Pre-existing Conditions Covered | Works Across State Lines |
|---|---|---|---|
| ACA Marketplace Plan | $0–$500+ (income-based) | Yes, by law | Depends on plan network (PPO better than HMO) |
| Short-Term Medical | $80–$150 | No, often excluded | Mostly, but check state licensing |
| Health Share Ministry | $150–$350 | Limited or excluded | Generally yes |
| Telehealth Subscription | $20–$50 | N/A (supplemental only) | Yes, virtual by design |
| Medicaid | $0 (income-based) | Yes | Limited, tied to home state providers |
What People Actually Get Wrong
The single biggest mistake isn’t picking the wrong plan, it’s assuming youth and fitness make insurance optional. Most people don’t end up in the ER because of a chronic illness. They end up there because of a dirt bike spill, a dog bite, a bad reaction to a bee sting they didn’t know they were allergic to. None of that asks how healthy you normally are first.
The second mistake is choosing a domicile state purely for tax reasons (no state income tax sounds great) without checking what that state’s ACA marketplace and Medicaid expansion actually look like. Some no-income-tax states have thin exchange options or didn’t expand Medicaid, which can quietly cost you more than the tax savings were worth. It’s worth running the numbers the same way you’d run the numbers on whether van life is actually cheaper than renting before locking in.
And a smaller one, but it comes up: people forget that vehicle insurance and health insurance are entirely separate systems with separate paperwork, separate renewal dates, separate everything. We’ve covered the vehicle side in detail in Van Insurance Costs: What Budget Vanlifers Pay, and it’s worth treating these as two distinct line items in your monthly van life budget, not one combined “insurance” guess.
Frequently Asked Questions
Can I actually buy ACA insurance without a permanent home address? Yes. You need a domicile address, which is typically a mail-forwarding service address in a state you’ve established legal residency in, not a physical home you live in full-time. This is standard practice among full-time travelers, RVers, and digital nomads.
Is a health share ministry actually insurance? No. It’s a cost-sharing arrangement between members of a religious or values-based community, with no contractual guarantee of payment. Many members are happy with how claims get handled, but it operates on a different legal basis than an insurance policy, and that matters if a dispute ever comes up.
What happens if I need emergency care in a state outside my plan’s network? Emergency care is generally covered at in-network rates under federal law, regardless of where the ER is located, since insurers can’t penalize you for an emergency. Non-emergency, out-of-network care is a different story and can get expensive fast, which is the main reason PPO plans with wider networks tend to suit full-time travelers better than HMOs.
Does Medicaid work if I keep crossing state lines? It can, but it’s not designed for it. Medicaid eligibility and provider access are tied to your state of residency, so a full-timer who rarely returns to their domicile state will likely struggle to use routine Medicaid benefits, even while remaining technically eligible.
Is travel insurance the same as health insurance for van life? No, and this trips people up constantly. Travel insurance is built for short trips abroad and typically covers emergencies and trip interruptions, not ongoing or routine care. It’s not a substitute for a primary health plan if you’re living on the road year-round domestically.
Whatever you land on, the real test isn’t the monthly premium. It’s whether the plan still makes sense the day you’re standing in an ER in a state you weren’t planning to be in. For more on what that looks like financially once you add it all up, our breakdown of van life’s real monthly costs is a useful next stop.
