Picture this: You’re on vacation in some remote corner of the world when you are bitten by a raccoon. It draws blood and you’re worried about an infection or even rabies. Or imagine you’re living abroad, and you suddenly have severe abdominal pain that might be more than last night’s spicy dinner.
While we all hope to stay healthy while traveling or living abroad, there are times when a trip to a doctor or hospital might become necessary. And since healthcare can be so expensive – both at home and in many countries abroad – it can be helpful to know ahead of time if your health insurance will cover you if you get sick or injured while traveling.
Prudent Layperson Standard
Standard health insurance policies typically cover medical emergencies when you are traveling abroad. To determine what qualifies as an emergency, insurance companies refer to the prudent layperson standard: if a reasonable person thinks the condition might lead to death or permanent damage, it is a covered emergency, regardless of the diagnosis.
So, for example, if you experience chest pain and go to the emergency room thinking you might be having a heart attack (which is, of course, exactly what you should do), you will be covered even if it turns out to be nothing more than indigestion.
Paying for Care
Even if your insurance covers your medical expenses, chances are you will still have to pay up front for any care you receive abroad. Keep in mind, hospitals and doctors overseas cannot bill your health insurance company directly since they are not in your network.
When you return home, you’ll have to file a claim and submit your receipts for reimbursement. The expenses may be covered the same way they would be if you were home, but there may be higher co-pays, deductibles or co-insurance.
What About Emergency Evacuations?
According to the U.S. Department of State, a medical evacuation can easily cost $10,000 or more, depending on where you are and your medical condition. Very few health insurance companies cover medical evacuations or any costs associated with getting you back to the U.S. for additional treatment.
A temporary travel health insurance policy can provide this type of coverage for a relatively small cost (see The Basics Of Travel Insurance). Some credit cards even provide travel insurance that could help (see Credit Cards With Travel Insurance).
What About Medicare?
In general, Medicare only covers services you receive in the U.S., which includes the 50 states; Washington, D.C.; and U.S. territories (e.g., Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands and American Samoa).
There are three situations, however, when Medicare may pay for services you receive outside the U.S.:
- You have a medical emergency in the U.S., and a foreign hospital is closer than the nearest U.S. hospital.
- You have a medical emergency in Canada while you are traveling by direct route between Alaska and any other state, and a Canadian hospital is closer than the nearest U.S. hospital.
- You live in the U.S. and a foreign hospital is closer to your home than the nearest U.S. hospital (applies to emergencies and non-emergency care).
The Bottom Line
Health insurance policies vary greatly, so it’s important to check with your insurance company or agent ahead of time to find out what exactly your policy covers – and what it doesn’t – while you are traveling abroad. Be sure to ask about:
- Deductibles – the amount you owe for covered services before insurance kicks in
- Co-payments – a fixed amount you pay for a covered healthcare service
- Co-insurance – your share of the costs of a covered healthcare service.
Many health insurance policies cover medical emergencies when you travel abroad, and you can purchase a travel insurance policy to cover other medical expenses and evacuations. If you have a credit card with travel insurance, or plan to purchase travel insurance for your trip, be sure to check exactly what the policy covers.
In addition to making sure you are adequately covered, there is something you can do before even leaving home that can prevent or reduce certain risks: Get vaccinated, especially for illnesses prevalent in that location. Some countries require foreign visitors to carry an International Certificate of Vaccination (aka Yellow Card) or show other proof of having certain inoculations or medical tests in order to enter the country.
Before you travel, review the Country Specific Information available from the U.S. Department of State and check with the embassy of the country or countries you are planning on visiting for current entry requirements.
You can learn about recommendations – and not just requirements – for vaccinations and other travel health precautions by visiting the Travelers’ Health section of the U.S. Centers for Disease Control (CDC) website.