Author(s): Rhett Stoney

Severe illness or injury abroad could cause a financial burden to travelers. Regardless of whether they have a domestic health insurance plan, travelers can substantially reduce their out-of-pocket costs for medical care received abroad by purchasing specialized insurance policies in advance of their trip. Three types of policies—travel insurance, travel health insurance, and medical evacuation insurance—each provide different types of coverage in the event of an illness or injury. Such policies might be particularly beneficial to travelers with preexisting medical conditions. Besides protection against costs, the insurance might also help travelers obtain medical care abroad.

Basic accident or travel health insurance might be necessary for travelers with certain itineraries. For example, although cruise lines employ health care staff, the cost for medical treatment delivered onboard a ship might not be included in the price of a passenger's ticket; thus, travelers on cruise ships might want to consider investing in specialized insurance policies.

Domestic Health Insurance & Overseas Travel

Some US health insurance carriers cover medical emergencies that occur when policyholders travel internationally. Encourage travelers to contact their insurer before traveling to learn what medical services, if any, their policies cover. Box 6-01 includes suggested questions travelers should ask their insurance company.

Paying for Health Services Received Abroad

During the pretravel consultation, discuss insurance options and suggest that all travelers consider purchasing supplemental medical insurance coverage (see Box 6-02 for a discussion checklist), particularly if they are going to remote destinations or places lacking high-quality medical facilities. Strongly encourage supplemental medical insurance coverage for travelers planning extended international travel, those with underlying health conditions, and those participating in high-risk activities (e.g., scuba diving, mountain climbing) abroad. In addition to covering costs of treatment or medical evacuation, travel health insurers can assist the international traveler by organizing and coordinating care and by keeping relatives informed in the event of a medical emergency, which is especially important when the traveler is severely ill or injured and requires medical evacuation.

Nationalized health care services at a given destination do not necessarily cover health care costs of nonresidents. Even with a supplemental travel health insurance policy in force, receiving medical care abroad usually requires a cash or credit card payment at the point of service, which can result in expenditures of thousands of dollars. US citizens paying for health care abroad should obtain copies of all charges and receipts and, if necessary, contact a US consular officer, who can assist the traveler with transferring funds from the United States.

The US Department of State might be able to offer limited emergency medical assistance loans to US citizens who experience a medical emergency abroad but have no means to pay at point of service and cannot arrange for a transfer of funds from the United States. Travelers must repay these loans, but the funds might be available for temporarily destitute US citizens and their qualified dependents. Once a loan is issued, the Department of State will limit the traveler's US passport and, in most cases, will not issue a new passport until the loan is paid in full. US citizens should contact the nearest US embassy or consulate, or the US Department of State, Office of Overseas Citizens Services, at 888-407-4747 (or from abroad, +1-202-501-4444), for information about assistance options and eligibility requirements.

Travel Insurance

Travel insurance protects the traveler's financial investment in a trip, including lost baggage and trip cancellation. Travelers who become ill before departing are more likely to avoid or postpone travel if they know their financial investment in the trip is protected. Depending on the policy, travel insurance might not cover medical expenses abroad, so travelers need to carefully research the coverage offered to determine their need for additional travel health and medical evacuation insurance.

Supplemental Travel Health & Medical Evacuation Insurance

Travel health insurance and medical evacuation insurance are 2 types of short-term supplemental policies that cover health care costs incurred while abroad. Each is relatively inexpensive. Many commercial companies offer travel health insurance; travelers can purchase such policies separately or together with medical evacuation insurance. Some recommended features to consider when purchasing supplemental travel health and medical evacuation insurance include whether the insurer arranges with hospitals to guarantee direct payment; provides assistance via a 24-hour physician-backed support center, which is critical for medical evacuation insurance; offers emergency medical transport to facilities in the home country (repatriation) or to facilities equivalent to those in the home country; and covers high-risk activities (e.g., scuba diving).

Although travel health insurance covers some international health care costs, the quality of care might be inadequate and medical evacuation (sometimes referred to as "medevac") from a resource-poor area to a hospital delivering definitive care might be necessary. The total cost of medevac varies by location, ranging from $25,000 for transport within North America to ≥$250,000 for more distant and remote locations. Costs increase when the patient being evacuated is critically ill or needs complex infection control measures. In such cases, medevac insurance covers the cost of transportation, including transportation to another country if necessary.

Some medical evacuation companies have more extensive experience working in some parts of the world than others; travelers should ask about a company's resources in each region of travel, especially if planning trips to hard-to-reach locations in a region. Even if travelers select their insurance provider carefully, unexpected delays in care can still arise, especially in remote destinations. Thus, if the health risks are too high, a traveler might want to postpone or cancel their international trip.

Finding An Insurance Provider

Several organizations provide information about purchasing travel health and medical evacuation insurance, including the US Department of State; International Association for Medical Assistance to Travelers; US Travel Insurance Association; and the American Association of Retired Persons, among others. The Centers for Disease Control and Prevention does not endorse any provider or medical insurance company.

Travelers with Underlying Medical Conditions

Travelers with underlying medical conditions should discuss any concerns with the insurer before departure. In a study of international travelers with travel health insurance claims, insurance companies fully paid only 2/3 of claims, and the main reasons for coverage refusal were preexisting illness and poor documentation of expenses incurred.

Beyond purchasing supplemental travel health insurance coverage, encourage travelers with medical conditions to take additional steps before departure. To facilitate ease of access to health records when overseas, travelers should store copies of their health records with a medical assistance company. Instruct travelers to obtain letters from their health care providers listing all medical conditions and current medications, including generic drug names, written in the local language if possible. Travelers should pack medications in the original packaging in carry-on luggage during transport. To facilitate ease of entry through customs, travelers should check with the destination country's embassy before departure to ensure that none of the medications they are bringing are considered illegal in that region. Anyone with a known heart condition should carry a copy (paper or electronic) of their most recent electrocardiogram.

Medicare Beneficiaries

Medicare beneficiaries are no different from other travelers; they need to examine their coverage carefully and supplement it with additional travel health insurance, as required. Except in limited circumstances, the Social Security Medicare program does not provide coverage for medical costs incurred outside the United States, nor does it cover medical evacuation. Medicare beneficiaries can purchase supplemental Medigap plans to fill gaps, including for travel coverage. Medigap plans C, D, F, G, M, and N cover some emergency care received outside the United States. After meeting the yearly $250 deductible, this benefit pays 80% of the cost of emergency care during the first 60 days of international travel. The coverage has a $50,000 lifetime maximum. International travelers can find more information on Medicare and Medigap options at www.medicare.gov/supplements-other-insurance/medigap-travel.