Travel and Health Insurance, an Ultimate Guide

Be honest. How many times have you packed up for an international flight and completely ignored this thought: what happens if I get sick or injured? If you're like us, you've probably ignored that thought every time... and you've probably gotten away with it too. 

Most of us ignore this important question because it is very hard to understand what coverage you do/do not need overseas. We've created this comprehensive guide to help answer all your questions. So now, let's stop ignoring travel health insurance and get informed.  

First, what best describes your scenario?

1. I have a health plan in the United States and want to see what overseas coverage it has.
2. I'm not comfortable with what my U.S. plan offers, what about travel insurance? 
3. I'm not comfortable with what my U.S. plan offers, what about travel medical insurance?
4. I'm going abroad for more than 6 months... I need something substantial.

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United States Health Insurance Overseas Coverage

The Short Story: Whether you get health insurance from an employer, buy it yourself, or are on Medicare/Medicaid, you are very minimally covered (at best) overseas. And if something happens, expect any foreign healthcare reimbursement to be a hassle with your U.S.-based health insurance company. We don't like to incite fear, but you're truly chancing it by traveling abroad with only your U.S.-based insurance. 

The Longer Story: 

• U.S.-based health plans usually limit overseas coverage to just emergency care, and the burden will be on you to prove it's an emergency.
• Emergency medical evacuation is almost never covered.  
• Government sponsored health programs, like Medicare, almost never cover foreign care received.

What qualifies as an Emergency?

Insurance companies have a phrase they use called the "prudent layperson standard." If a reasonable person would believe your condition could lead to death or permanent damage, it is considered an emergency and may be covered (depending on your policy).

If a member experiences chest pains and thinks he's having a heart attack, an emergency-room visit would be covered, even if it turns out to be gas. - Jackie Aube, VP Cigna

Other examples that would most likely be covered under this standard include: dog bites, broken bones, heat stroke, and cuts requiring stitches. Poison oak, mild cases of the flu, and other ailments that don't seriously threaten your life are rarely covered abroad. 

And remember: even if an initial symptom qualifies as an emergency, you'll probably have to pay for follow-up care overseas. Bummer!

According to the CDC, consider this list (i.e. read you plan documentation or call your provider) to understand what health coverage you will have access to abroad:

• Exclusions for treating exacerbations of pre-existing medical conditions
• Your insurance company’s policy for “out-of-network” services
• Coverage for complications of pregnancy or newborn
• Exclusions for high-risk activities such as skydiving, scuba diving, and mountain climbing
• Whether preauthorization is needed for treatment, hospital admission, or other services
• Whether a second opinion is required before obtaining emergency treatment
• Whether there is a 24-hour physician-backed support center

Paying for health services abroad

Normally, you'll owe the foreign hospital or clinic cash/credit card upon service. Then you get to take their bills back to the U.S. and haggle with your insurance company (or let us do it for you!) Obviously, this could result in a large out-of-pocket expenditures, so prepare yourself for this.

Tips if you decide to chance it with only US-based coverage abroad:

1. Always obtain copies of all bills and receipts. Poor documentation was one of the main reasons for emergency reimbursement refusal.
2. The existence of nationalized health care services in a given destination does not ensure that nonresidents will be given full coverage. 
3. Travelers with complicated medical conditions should find a medical assistance company that allows medical history to be accessed anywhere.
4. Carry a letter listing your medical conditions and current medications (including generic names), written in the local language if possible.
5. Those with cardiac disease should carry a copy of their most recent ECG. 
6. Pack all medications in original bottles, checking beforehand with the destination’s embassy to ensure that none are considered illegal in the destination country.

FAQs about using U.S.-based healthcare abroad

What international coverage is offered under Medicare/Medicaid?

Neither Medicare or Medicaid provides coverage for medical costs outside the United States, except in limited circumstances. Some Medigap plans may provide limited coverage for emergency care abroad. Medicare beneficiaries should examine their coverage and supplement with insurances above. Per this Medicare document, these services abroad would be covered while abroad. 

1. You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat your illness or injury.
2. You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury.
3. You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it’s an emergency.

Do US-based health plans include evacuation for emergency surgery?

Assume they do not. Emergency evacuations can cost more than $100,000. If you're visiting a place that's isolated or where the quality of health care is subpar (refer to early map), we highly suggest investing in a supplemental plan that includes evacuation insurance.

Does the in-network/out-of-network concept apply overseas?

Assume your care will be considered out-of-network, and any reimbursement your U.S.-based insurer provides will paid according to your out-of-network benefits. 

If you've purchased a Blue Cross Blue Shield PPO plan in the U.S., some international providers may be considered in-network via the BlueCard program. Get the latest information and find those providers here. 

Does my credit card reimburse any health care costs overseas?

Some credit cards may offer benefits that overlap with travel insurance. No credit cards that we've found cover healthcare emergencies and evacuation like supplemental insurance does. Back to top