Chapter 6 Health Care Abroad
Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance
Severe illness or injury abroad may result in a financial burden to travelers. Travelers can substantially reduce their out-of-pocket costs for medical care received abroad by purchasing in advance specialized insurance policies for their trip, regardless of whether or not they have a domestic health insurance plan. The 3 types of policies are travel insurance, travel health insurance, and medical evacuation insurance. Each provides different types of coverage in the event of an illness or injury and may be of particular importance to travelers with preexisting medical conditions.
Basic accident or travel health insurance may be necessary for travelers with certain itineraries. For example, although cruise lines employ health care staff, the cost for medical treatment delivered on board a ship may not be included in the price of a passenger’s ticket; travelers on cruise ships may wish to consider investing in specialized insurance policies.
DOMESTIC HEALTH INSURANCE AND OVERSEAS TRAVEL
Some health insurance carriers in the United States cover medical emergencies that occur when policyholders travel internationally. Encourage patients to contact their insurer before traveling to learn what medical services, if any, their policies cover. Table 6-01 includes suggested questions travelers should ask their insurance company.
Table 6-01. Coverage requirements, potential exclusions, and preexisting medical conditions: questions travelers should consider asking their insurance company when deciding whether to purchase supplemental insurance coverage
PREEXISTING MEDICAL CONDITIONS
Do I need preauthorization before receiving treatment, hospital admission, or other medical services?
Does this policy include/exclude coverage for treatment of injuries sustained while participating in high-risk activities (e.g., skydiving, scuba diving, and mountain climbing)?
Does this policy cover exacerbations of preexisting medical conditions?
Do I need a second opinion before I can receive emergency treatment?
Does this policy include/exclude coverage for psychiatric emergencies?
Does this policy cover complications of pregnancy and/or neonatal intensive care?
What are company policies regarding coverage of care received “out of network”?
Does this policy include/exclude coverage for treatment of injuries related to terrorist attacks, acts of war, or natural disasters?
Does the company provide policyholders access to a 24/7/365 physician-backed support center?
Include a discussion of insurance options as part of the pretravel consultation. Suggest that all travelers consider purchasing supplemental medical insurance coverage, particularly those going to remote destinations or places lacking high-quality medical facilities. Strongly encourage supplemental medical insurance coverage for any travelers planning extended international travel, those with underlying health conditions, and anyone who anticipates participating in high-risk activities overseas. 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. This is especially important when the traveler is severely ill or injured and requires a medical evacuation.
Even with a supplemental travel health insurance policy in force, receiving medical care abroad usually requires cash or credit card payment at the point of service. This can result in sizable expenditures of thousands of dollars. US citizens paying for health care received overseas are advised to obtain copies of all charges and receipts and, if necessary, to contact a US consular officer, who can assist them with transferring funds from the United States. The existence of nationalized health care services at a given destination does not ensure that health care costs of nonresidents are covered.
Travel insurance protects the financial investment in a trip, including lost baggage and trip cancellation. A traveler who becomes ill in advance of departure may be more likely to avoid or postpone travel if they know their financial investment in the trip is protected. Depending on the policy, travel insurance may or may not cover medical expenses abroad, so travelers need to research carefully the coverage offered to determine their need for additional travel health and medical evacuation insurance.
SUPPLEMENTAL TRAVEL HEALTH AND 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 in conjunction with medical evacuation insurance. Frequent travelers can consider purchasing annual policies or even policies that provide coverage for repatriation to one’s home country. Some recommended features to consider when purchasing supplemental travel health and medical evacuation insurance include the following:
- Arrangements made with hospitals to guarantee direct payment
- Assistance via a 24-hour physician-backed support center (critical for medical evacuation insurance)
- Emergency medical transport to facilities equivalent to those in the home country or to the home country itself (repatriation)
- Specific medical services, such as coverage of high-risk activities
Although travel health insurance covers some international health care costs, the quality of care may be inadequate, and medical evacuation (sometimes referred to as “medevac”) from a resource-poor area to a hospital delivering definitive care may be necessary. The cost of medevac can exceed $100,000. 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 do; travelers may want to ask about a company’s resources in a given region, especially if planning trips to hard-to-reach locations in that region. Even if travelers select their insurance provider carefully, unexpected delays in care may still arise, especially in remote destinations. In special circumstances, therefore, if the health risks are too high, it may be advisable for a traveler to postpone or cancel their international trip.
FINDING AN INSURANCE PROVIDER
The following organizations (not an all-inclusive list) provide information about purchasing travel health and medical evacuation insurance:
- Department of State (www.travel.state.gov)
- International Association for Medical Assistance to Travelers (www.iamat.org)
- US Travel Insurance Association (www.ustia.org)
- American Association of Retired Persons (www.aarp.org)
SPECIAL CONSIDERATIONS FOR 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 two-thirds of claims. Preexisting illness and poor documentation were the main reasons for coverage refusal.
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 those records with a medical assistance company. Instruct travelers to obtain letters from their health care providers listing all medical conditions and current medications (including their generic names), written in the local language, if possible. Transported medications should be in their original bottles and packed in carry-on luggage; to facilitate ease of entry through customs, travelers are advised to check beforehand with the destination country’s embassy to ensure that none of the medications they are bringing with them is considered illegal there. Anyone with a known heart condition should carry a copy (paper or electronic) of his or her most recent electrocardiogram.
SPECIAL CONSIDERATIONS FOR MEDICARE BENEFICIARIES
Except in limited circumstances, the Social Security Medicare program does not provide coverage for medical costs incurred outside the United States. Medigap (Medicare supplement insurance) plans C, D, F, G, M, and N cover some emergency care 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. There is a $50,000 lifetime maximum. International travelers can find more information on Medicare and Medigap options at www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-Stat.pdf. 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.
CHECKLIST FOR DISCUSSING INSURANCE WITH TRAVELERS
Travel health providers can use the following points to guide the supplemental insurance discussion during the pretravel consultation:
- Determine travelers’ health profile, including underlying medical conditions.
- Identify potential medical needs abroad, including health risks based on itinerary/destination, duration of travel, method of transportation (plane, ship, ground), lodgings/accommodations, and planned activities.
- Instruct travelers to review domestic health policies to identify gaps in coverage for identified potential medical needs.
- Discuss the differences between the 3 types of supplemental insurance (travel, travel health, and medical evacuation), and explain how to choose supplemental policies that cover potential medical needs abroad.
- Remind travelers of the steps to take should they require medical care abroad.
Traveler responsibilities regarding supplemental health insurance before and during travel include the following:
- Carefully review domestic health insurance policies to determine what medical services are and are not covered overseas.
- Purchase supplemental travel health insurance coverage based on potential medical needs and health risks.
- Identify medical service providers at destination. (See www.iamat.org for a directory of English-speaking providers.)
- Check with insurance company/companies to confirm international health care providers accept the policy as payment for medical services rendered.
- Carry insurance policy identity cards (including supplemental travel health insurance) and insurance claim forms.
- Have contact information of medical providers at destination(s).
- Keep copies of all charges and receipts for medical care received.
- American Association of Retired Persons, Education and Outreach. Overview of Medicare supplemental insurance. Washington, DC: American Association of Retired Persons; 2010 [cited 2018 Feb 21]. Available from: www.aarp.org/health/medicare-insurance/info-10-2008/overview_medicare_supplemental_insurance.html.
- Centers for Medicare and Medicaid Services. Medicare coverage outside the United States. Baltimore: CMS; 2016 [cited 2018 Feb 21]. Available from: www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-Stat.pdf.
- Flaherty G, De Freitas S. A heart for travel: travel health considerations for patients with heart disease and cardiac devices. Ir Med J. 2016 Dec 12;109(10):486.
- Leggat PA, Carne J, Kedjarune U. Travel insurance and health. J Travel Med. 1999 Dec;6(4):243–8.
- Leggat PA, Leggat FW. Travel insurance claims made by travelers from Australia. J Travel Med. 2002 Mar–Apr;9(2):59–65.
- Teichman PG, Donchin Y, Kot RJ. International aeromedical evacuation. N Engl J Med. 2007 Jan 18;356(3):262–70.
- US Department of State. Insurance providers for overseas coverage. Washington, DC: US Department of State; 2016 [cited 2018 Feb 21]. Available from: https://travel.state.gov/content/passports/en/go/health/insurance-providers.html.
- Page created: June 24, 2019
- Page last updated: June 24, 2019
- Page last reviewed: June 24, 2019
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