One in three Americans are unclear whether their domestic health insurance will cover any doctor or hospital visits while traveling outside the U.S., according to a new study by InsureMyTrip. So how can you know for sure if your insurance will cover you abroad?
Before your next trip, do some research. If you discover limitations with your health plan, take the necessary steps in advance to get the coverage you think best meets your needs.
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Call your health insurance company
The first step is to contact your health insurance company to verify whether your emergency medical coverage extends outside the U.S. Contact the customer service department and ask these kinds of questions:
- If I get sick or injured abroad, will my policy cover me?
- Does my insurance cover pre-existing conditions abroad?
- Will I have to pay health expenses abroad out-of-pocket and then file a claim for reimbursement?
“In most cases, you’ll get some coverage for care needed to treat an emergency, but you’ll have to pay out-of-pocket and then submit for reimbursement after you return home,” says Lisa Zamosky, author of “Healthcare, Insurance, and You: The Savvy Consumer’s Guide.”
Zamosky says insurers can and do define things differently from one another and health plans offered by the same insurer often include different benefits. You always want to make sure you understand the specifics of what your particular health plan covers, including exclusions and the definition of emergency — because it may be different than your own.
“Generally speaking, insurers define a medical emergency as one in which a reasonable layperson believes their health would be in real jeopardy without immediate medical attention — think heart attack or a serious accident,” Zamosky says.
And while most big private insurance companies do offer some type of coverage abroad, coinsurance, deductibles and other plan requirements would still apply.
Original Medicare won’t help you
Those with Original Medicare only will generally not be covered outside the U.S., although additional coverage is available. (One exception: in some cases, Medicare will cover necessary care if you are on board a ship within the territorial waters of the U.S.)
“That’s a reason why they want to get a Medigap plan. In some cases, a Medicare Advantage plan [which is different from Medigap plans] may cover urgent or emergency care outside the U.S. Medigap plans C, D, F, G, M and N will cover 80% of the cost of care outside the U.S. during the first two months of a trip,” says Lindsay Engle, a marketing specialist with Elite Insurance Partners, an insurance broker that specializes in Medicare.
What if you need to be evacuated?
Travelers should also consider emergency evacuation insurance. Such a policy prevents you from getting stuck with a whopping bill if you suffer a heart attack abroad, for instance, and need to be transported home or to another hospital. These types of evacuations are expensive and can run $100,000 or more, the Centers for Disease Control and Prevention says.
Although many health insurance companies will pay “customary and reasonable” hospital costs abroad, very few will pay for your medical evacuation back to the U.S., according to the U.S. State Department.
Benefits of travel insurance
Travel insurance can help fill in any coverage gaps in your current domestic health insurance plan and can act as primary or secondary coverage.
For the most protection, you may want to consider a comprehensive travel insurance plan that will provide the following key benefits:
- Trip cancellation. Plans will cover specific reasons for canceling a trip, such as a sickness or injury before you leave. Other reasons may include the death of a family member or unforeseen natural disasters. Be sure to read the fine print of the policy to know exactly what is covered and what’s not.
- Trip Interruption. Plans will cover specific reasons why you must cut a trip short, such as a sickness or injury that forces you to return home. Other reasons may include bad weather or unforeseen natural disasters. But, as with cancellation insurance, be sure to read the policy carefully for specifics on what is covered and what is excluded.
- Emergency Medical Coverage
- Emergency Medical Evacuation
- 24/7 Emergency Assistance. This service provides doctor or hospital recommendations and translation services.
- Baggage Protection. Some plans offer reimbursement or a stipend if your bag becomes lost, stolen, damaged or delayed.
Cost of travel insurance
These plans run about 5% to 8% of your total trip cost. Some plans may or may not cover pre-existing medical conditions; check the eligibility requirements.
Example: For a $5,000, two-week vacation to Aruba, a comprehensive travel insurance plan will cost a couple in their 50s around $200. This includes a $50,000 medical limit, $250,000 for medical evacuation in addition to trip cancellation coverage, according to InsureMyTrip.
Martine G. Brousse with AdvimedPRO, a service that helps patients with insurance claims, says not enough travelers evaluate the financial risk of being uninsured abroad and the value of additional insurance.
“I have seen too many cases where travelers skip on getting travel insurance because of ignorance or to save some money. I have a case of an 89-year-old man with $90,000 in expenses incurred on a trip to visit family which Medicare will not cover. It is easier and cheaper to buy peace of mind with a travel insurance than deal with repercussions later.”
Finding medical help abroad
If you need help finding a local doctor or hospital while traveling, there are some options:
- Contact the local U.S. embassy or consulate (note: it will provide only a list of health resources, not recommendations)
- Visit the International Association for Medical Assistance to Travellers for a list of vetted English-speaking doctors and clinics world-wide
- Contact your insurance company for recommendations
Finally, before your trip, visit the Centers for Disease Control and Prevention website to learn about the health risks and health care system in the country you will be traveling in, including recommended vaccinations.
And be sure to carry your insurance policy identity cards and a claim form.