Insurance during a long hike

Assuming you currently have medical insurance, it will cover emergency care anywhere in the US, but not transport back home. Just make sure to carry your cards, to make the admin/admit goes smoothly.

You won't need insurance for Search and Rescue, at least in California, since taxpayer dollars cover that. What you need to do is call the medical insurance provider and be certain that it covers a med-evac from the wilderness, as when people say they were charged for search and rescue, this is what they are talking about – if you require medical intervention in the wilderness, you will be billed for it. If SAR finds you and brings you out in one piece without medical stabilization, nothing gets billed.

Private insurances may have a rider you can add to your policy. For long trips that's what I recommend.

This is where Obamacare really helps you. They have short term policies on the federal healthcare.gov site as well as regular policies to insure yourself quite inexpensively regardless of why you don't have employer-sponsored health insurance.

I was able to quit my 40-hour/week 2-weeks-vacation/year job to be an independent contractor all because I could finally get my own individual insurance on the exchange. And it's cheaper than what I had through my employer…without any subsidy (I make too much money).

Good luck!

Thanks everyone.

Yeah I'm quitting my 45/hr a week job so the coverage I do have rolls over into this incredibly expensive plan (I have stellar coverage at the moment) which I'm not looking to continue :-)

For domestic travel (AZ, CA, NM constantly), .. I carry my medical and dental insurance cards from my home ("domicile" in legal speak … a judge I've hiked with says to have one) and review the "out of network" co-pays should injury or illness strike. My insurance is "traditional" through a trade group, but pretty sure work policies (incl COBRA)/ACA policies are the same (but those insured need check the company sponsoring said plan and have their co-pays ready). It seems all "network" vs. "out of network" nowadays. Not so sure about those requiring Medicaid – imagine most states are loathe to cover out-of-state medical expenses.

There are actually several viable options here. I am assuming that you want more than just "emergency" care, which, as Greg already indicated, is provided by law anywhere in the USA (of course, they can still bill you for it — it's not actually "free").

1. ACA plans. No need to use (expensive) COBRA any more — quitting your job is considered a "life event" that entitles you to get a brand new ACA plan. No pre-existing conditions, no underwriting, BUT you will be best served by plans that have a large, multi-state network, esp. in the states you'll be passing through. [This will probably mean that you'll need to avoid HMOs, which generally restrict you to coverage in one geographical area, with zero coverage outside that region. You'll do best with a large PPO network, whether through an HSA, or alone.]

2. Travel health insurance. Depending on how long you'll be away, you may be able to keep your regular HMO, but buy a travel policy to supplement it for the time you'll be away. Again, be sure to check the size of the network of Dr.s/hosp./etc. before you purchase. Often, these policies also provide transportation back to your home region. Pre-existing conditions are excluded from coverage.

3. Temporary insurance. Similar benefits to travel insurance, but no transportation option. Again, look at the network carefully. The network is everything! Pre-existing conditions are excluded from coverage.

Do consider it. I have an annual policy that covers Montana and Wyoming, but spot coverage [for the period of time of your trip] is readily available and reasonably affordable. This insurance is especially important if you are outside the US, where helicopter and air rescue can literally run into six figures.

"…which I'm not looking to continue …"

Little bit of a soapbox here –

If you own anything, or have any funds, a "rebuilt" knee will take $25,000 chunk out of them. If you smack your head, or crack a vertebrae, and end up in the ER and ICU, you will take a major financial hit – potentially hundreds of thousands.

The new laws may have changed things, but in the past any funds, property, etc. that you controlled within the last 3 years becomes accessible for payment.

— stepping down now…

Insurance, and especially evacuation insurance is a tough nut to crack. The SPOT device (and others) offers some options, even if you don't like/want SPOT service.

Read the coverage and exclusions very carefully. Past threads have never turned up anything worthwhile, except for coverage for a short specific date range.