Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance

Introduction

Severe illness or injury abroad could cause a financial burden to travelers. Some U.S. health insurance plans cover medical emergencies that occur when policyholders travel internationally; however, the exact type of coverage can vary. Travelers can substantially reduce their out-of-pocket costs for medical care received abroad by purchasing specialized insurance policies in advance of their trip. These policies—travel disruption insurance, travel health insurance, and medical evacuation insurance—each provide different types of coverage in the event of an illness or injury. Each may be purchased together (bundled) or purchased separately; each may be used in combination with, or separate from, domestic health insurance. Specialized insurance policies might be particularly beneficial to travelers with preexisting medical conditions, those who are pregnant, over the age of 65, and those planning extended time abroad (<1 year; see Travelers with Chronic Illnesses and Pregnant Travelers chapters). For expatriates and those planning >1 year abroad, there may be alternative options available than those covered in this chapter (see Long-Term Travelers and Expatriates chapter). Besides protection against costs, the insurance might also help travelers obtain medical care abroad or keep 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.

Basic accident or travel health insurance might be necessary for travelers with certain itineraries. For example, although cruise lines employ healthcare professionals, 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 (see Cruise Ship Travel chapter).

Credit card companies may offer travel protection benefits under specific conditions. These benefits vary widely in whom and what they cover. Some benefits require travelers to enroll in the service, and nearly all require a formal claim process with no reimbursement guarantee. Travelers should carefully review the credit card's guide to benefits to understand their coverage. Travelers should not consider credit card benefits as a substitute for a travel disruption insurance, travel health insurance, or medical evacuation insurance policy.

Types of insurance for international travel

Before traveling internationally, all travelers should understand what existing insurance coverage they have (if any) and what additional coverage they may need given the circumstances of their trip. This step can substantially reduce the financial burden for international travelers in the event of illness or injury. Types of insurance for travel include: (1) domestic health insurance; (2) travel disruption insurance; (3) travel health insurance; and (4) medical evacuation insurance.

Domestic health insurance while traveling

Some U.S. health insurance carriers cover medical emergencies that occur when policyholders travel internationally. However, domestic health insurance may only cover medical expenses for an illness or injury under specific circumstances and may not cover other costs associated with canceling all or a portion of the trip. Encourage travelers to contact their insurer before traveling to learn what medical services, if any, their policies cover. When paying for care in another country, travelers should expect to be required to pay up front—which can be difficult for very expensive care—and submit for reimbursement later. Box 5.1.1 includes suggested questions travelers should ask their insurance company.

Box 5.1.1

Travel disruption insurance

Travel disruption 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. Travel disruption insurance may also provide protection when a family member in the traveling party gets sick or injured, but plans vary in cost and coverage. Many companies, including airlines, cruises, and third-party travel preparers (e.g., travel agencies, tour operators), offer travel disruption insurance as an option for purchase at the time of booking, or it may be included in the cost of the trip. Many tour operators have links on their website to a specific travel insurance company policy, or it can be purchased separately.

Depending on the policy, travel disruption insurance might not cover medical expenses abroad or medical evacuation, so travelers need to carefully research the coverage offered to determine their need for additional travel health and medical evacuation insurance.

Travel health insurance

Travel health insurance is a short-term supplemental insurance policy that covers healthcare costs incurred while abroad. Many commercial companies offer travel health insurance. Travelers can purchase such policies separately or together with travel disruption and medical evacuation insurance. Costs for travel health and medical evacuation insurance plans can vary depending on whether travel disruption insurance is included. Such "comprehensive" policies can cost up to 8% when cancellation for a list of reasons is met and up to 15% of the cost of the trip for cancellation for any reason.

Medical evacuation insurance

Although travel health insurance covers some international healthcare 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 cost of medevac insurance, by itself, is relatively inexpensive and can save travelers thousands if medevac is necessary. The total cost of a medevac varies by location, ranging from USD 25,000 for transport within North America to over USD 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. The decision to medically evacuate is at the discretion of the insurance company; it is not made at the request of the traveler. Typically, the traveler must be hospitalized with anticipation that multiple additional days of hospitalization will be required or specialized surgery or treatment is needed that is not of comparable quality at the current destination.

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.

Some recommended features to consider when purchasing 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 (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.
• Covers medical services related to high-risk activities (e.g., scuba diving).

Paying for health services received abroad

During the pre-travel consultation, discuss the traveler's current health insurance plan (if they have one) and determine what health services (if any) it may cover in the event of illness or injury abroad. Suggest that travelers consider purchasing travel disruption insurance, travel health insurance, or medical evacuation insurance coverage for any unmet need (see Box 5.1.2 for a discussion checklist). Travelers should research their policy thoroughly and identify potential healthcare professionals and facilities at their destination that are "in-network" for their insurance coverage. The U.S. embassy or consulate website for each city that has a U.S. diplomatic post has a list of local hospitals and doctors that can also be used for identifying potential healthcare professionals and facilities abroad.

Nationalized healthcare services at a given destination do not necessarily cover healthcare costs of nonresidents. Even with a supplemental travel health insurance policy, 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. U.S. citizens paying for health care abroad should obtain copies of all charges and receipts and, if necessary, contact a U.S. consular officer, who can assist the traveler with transferring funds from the United States.

The U.S. Department of State might be able to offer limited emergency medical assistance loans to U.S. citizens who experience a medical emergency abroad but have no means to pay at the 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 U.S. citizens and their qualified dependents. Once a loan is issued, the U.S. Department of State will limit the traveler's U.S. passport and, in most cases, will not issue a new passport until the loan is paid in full. U.S. citizens should contact the nearest U.S. embassy or consulate or the U.S. 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.

Box 5.1.2

Finding an insurance provider

Several organizations provide information about purchasing travel health and medical evacuation insurance, including but not limited to:

• U.S. Department of State
• International Association for Medical Assistance to Travelers
• U.S. Travel Insurance Association
• American Association of Retired Persons
• Third party websites that allow side-by-side comparison of available policies, such as InsureMyTrip and Squaremouth.

CDC does not endorse any provider or medical insurance company.

Travelers with underlying medical conditions

Travelers with underlying medical conditions (see Travelers with Chronic Illnesses chapter) should discuss any concerns with the insurer before departure. Persons over the age of 75 years should start research for specialized policies early, as coverage for underlying conditions is harder to obtain. Travelers should understand that underlying conditions that have required hospitalization or direct medical intervention in the 90 days prior to departure are often excluded from being covered. In a study of international travelers with travel health insurance claims, insurance companies fully paid only two-thirds of claims. The main reasons for coverage refusal were preexisting illness and poor documentation of expenses incurred.

Beyond purchasing travel health insurance coverage, encourage travelers with medical conditions to take additional steps before departure (see Travelers with Chronic Illnesses chapter). 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 healthcare professionals 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 U.S. embassy in the destination country or the International Narcotics Control Board website before departure to ensure that none of the medications they are bringing are considered illegal in that region (see Traveling with Prohibited or Restricted Medications chapter). 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 use Medigap plans to supplement their current coverage. Medigap plans C, D, F, G, M, and N cover some emergency care received outside the United States. These plans may cover emergency care if it begins during the first 60 days of international travel. After meeting the yearly USD 250 deductible, plans may cover 80% of the billed charges for certain medically necessary emergency care. The coverage has a USD 50,000 lifetime maximum. Of note, Medigap plans C and F are no longer available for those who turned 65 on or after January 1, 2020, and for some people under age 65. Plans C and F may be available for those eligible for Medicare before January 1, 2020, but not yet enrolled. International travelers can find more information on Medicare and Medigap options.

Medicare Advantage plans are a popular option for Medicare beneficiaries compared to original Medicare and Medigap. Medicare Advantage plans do not usually cover medical treatment outside of the United States, but some plans may include coverage for emergency care. Medigap plans cannot be used in conjunction with a Medicare Advantage plan. International travelers with a Medicare Advantage plan should evaluate their policy closely to see what is covered and consider supplementing it with travel disruption insurance, travel health insurance, and medical evacuation insurance.