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July 6, 2021

Emergency medical coverage is one of the most important parts of a travel insurance plan, and one of the most misunderstood – especially when it comes to the issue of whether traditional health insurance or Medicare plans cover international travel.

Basically, it boils down to this: you can help protect yourself against unplanned, often catastrophic emergency medical expenses when traveling when you purchase a travel insurance plan that includes emergency medical expense coverage.

It’s a lot to unpack, so let’s break it into these areas:

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If you want to know how your traditional health insurance plan covers you – or doesn’t cover you – when you travel internationally, try this: Go to your health plan’s provider directory on their website and search for an international provider.

Can you even get to a point where you can specify a foreign country to see if they have network providers? Probably not. And that applies to private insurers as well as Medicare, which has one of the broadest networks of any health carrier.

Very few health plans include international providers in their coverage, meaning that any treatment you would receive from an overseas provider may at best be considered out-of-network, and would be reimbursed according to those rules.  

When in doubt, call your health insurance plan provider and ask specifically about coverage for the countries in which you will be traveling.

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Pay first, service later

Okay, out-of-network is not terrible. However, it means you may still be on the hook for a larger percentage of the emergency medical expenses you incur when traveling outside the United States. Some balance-billing, some out-of-pocket, often up-front payments to get the treatment you need. You could conceivably work with that. But here’s where things take a turn. 

Very often foreign providers ask for payment up front – either with charging your credit card or requiring a cash payment. It’s not really a function of you being a foreigner in their home country, but rather the nature of single-payer medicine. 

If you’re seeking treatment in a country where the government pays for everything, you need to realize that the payment systems simply aren’t set up to accommodate anything other than billing the government or asking for payment up front.

In your case, the government’s not paying, so you have to…in advance. Call your health insurance provider and ask specifically about coverage for the countries in which you will be traveling; if you're not covered, find a travel insurance plan that includes emergency medical expenses when traveling.

Pre-authorization vs. prepayment

While that’s rough, even that doesn’t seem like a dealbreaker … until you realize that’s diametrically opposed to the way American health insurance works.

If you’re seeing an out-of-network provider, American health insurers may more often than not want to pre-authorize the emergency medical services you seek when traveling and pre-authorize payment in advance – creating more undue stress on your vacation. 

So sure, you could rely solely on your traditional health plan to cover you when you travel internationally – or you could protect yourself with a travel insurance plan that includes emergency medical expenses.

That’s why so many travel advisors – and even the U.S. State Department – recommend that travelers buy travel insurance that includes emergency medical expense coverage.

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Stripped to its basics, emergency medical coverage in a travel insurance plan is only good for a fixed duration with defined trip dates and protects you when you travel away from home – for most travel insurance plans, that means more than 100 miles from your home.

It typically can cover the most important expenses related to emergency medical treatment, including:

  • Services of a physician or registered nurse
  • Hospital charges
  • X‐rays
  • Local ambulance services to or from a hospital
  • Artificial limbs, artificial eyes, artificial teeth, or other prosthetics
  • Emergency dental treatment

Emergency travel medical insurance is either primary or secondary coverage in a traditional travel insurance plan.  This coverage doesn’t typically concern itself with networks and deductibles or copays. It pays up to its limits listed on the policy for covered expenses, and when it hits its limits, it stops paying. Simple as that.

Because it is so simple, emergency medical travel health insurance can avoid some of the complications of conventional medical insurance. Payment to a provider can be activated with a phone call or electronic communication, so treatment can commence immediately, even if the travel insurance plan you purchased lists medical expense coverage as secondary. 

If the coverage is primary and the medical condition is severe, the emergency medical insurance can buy time until pre-authorization processes are completed and the patient’s primary health plan can kick in.

Finally, medical case-management specialists who work with travel insurance companies often can act as liaisons between the treating providers and the patient’s primary health plan, making it easier to coordinate care and coverage.

In all, emergency travel medical insurance can play a vital role in securing and paying for crucial emergency medical treatment overseas.

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What travel medical insurance doesn’t cover

However, emergency travel medical coverage, at its core, is still insurance, and not a carte-blanche-covers-everything plan.  There are often medical expense coverage exclusions listing things it doesn’t cover.

Every policy is different and you need to read your policy for the full list, but it’s important to understand before you leave if your travel insurance plan covers: 

  • Routine physical exams (hint: most don’t)
  • Pregnancy and childbirth
  • Mental health care
  • Alcohol or substance-abuse treatment
  • Experimental treatments
  • Prescription drugs
  • Replacement of hearing aids, eyeglasses, contact lenses, or sunglasses
  • Medically unnecessary procedures
  • Travel for the purpose of receiving medical care 

If you have questions about what’s covered, it’s important to ask those questions before you leave – and ideally before you buy, so that if a plan doesn’t cover everything you want covered you can shop around for a different plan.

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Primary vs. secondary

The concept of primary vs. secondary coverage is one of the core features of all insurance, even travel insurance. 

Travel medical coverage is often secondary to a traveler’s traditional health plan, meaning your traditional health plan would pay first applying copays and deductibles and other factors – if it even covers travel medical expenses internationally  and then the travel medical coverage of your travel insurance plan (because it is secondary) can kick in.

While that makes sense on a basic level, travelers often grapple with their traditional health plan providers on what is covered and what is not.  The ideal is to actually consider purchasing a travel insurance plan that lists the medical coverage as primary, so it can handle all the upfront covered costs and efficiently coordinate care, and then have your traditional health plan on standby in case costs blow through the travel health plan’s limits.

Key tip:  Securing your travel emergency medical expense coverage as primary with most travel insurance providers often requires customers to buy immediately, generally within two weeks of making their initial trip deposit.

If a traveler knows they’re going to buy travel insurance for a trip, it may make sense to buy it within this two-week window just for this alone. It can be a big deal.

Pre-existing conditions

Travel insurance is most popular among travelers over the age of 55 – who just happen to be the starting and continual age demographic most likely to have pre-existing conditions that could affect their travel.

Travel insurance could certainly provide much-needed protection against medical emergencies that flare up from pre-existing conditions while traveling, it’s just important travel insurance purchasers understand that coverage is typically tied to buying a travel insurance plan within two weeks of an initial trip deposit.

Coverage for pre-existing conditions by buying travel insurance immediately after making an initial trip deposit can be a no-brainer. 

Medical evacuation helicopter

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Emergency medical evacuation

Emergency medical evacuation coverage helps coordinate and pay for a qualified medical evacuation of a traveler to an appropriate care facility if they have a medical issue while they’re traveling.

Sometimes this evacuation is simple and inexpensive – an ambulance ride across London to a hospital, for instance. At other times it can be extremely dangerous, delicate, and complex, with costs pushing well over $250,000.

As with just about everything else in insurance, coverage varies by provider and from plan to plan. What you’re looking for is:

  • A coverage limit amount that you feel most comfortable with based on where you're traveling
  • Coverage for transport to an adequate medical facility, not just the nearest facility
  • Coverage for a traveling companion as the patient is transported to a treatment facility
  • Emergency travel services with assistance that will coordinate all of this for you

How do you determine whether your plan has this coverage? Read your policy or call your travel insurance provider to ask.

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Read your policy or call your travel insurance provider.

Really, there’s no substitute for diving into your policy and reading the fine print, unless you can get your travel advisor to do it for you.  

You need to study plan documents before you buy, paying special attention to the medical-coverage portions of the plan.

In particular, you should look for:

  • Dollar amounts of medical and medical-evacuation coverages, and whether buy-ups are available
  • Emergency dental coverage, if any
  • How primary vs. secondary is handled
  • How pre-existing conditions are handled
  • Definitions of key terms like:
    • Physician
    • Hospital
    • Caregiver
    • Medically Necessary
    • Reasonable and Customary
  • The section that outlines the plan (or plan’s) exclusions

Then, if still not clear, don’t panic. Call a reputable travel insurance provider like Berkshire Hathaway Travel protection and ask all your “what if?” questions before you buy. Ask how they cover medical emergencies internationally. While no travel insurance plan covers everything and anything, all your questions should be answered to your understanding so you are confident with the plan you are purchasing.

For many people, travel medical coverage is the single most important facet of a travel plan, because of how it covers emergency medical expenses. For that reason, it pays to be informed and knowledgeable – and that can require some legwork.

However, the payoff can be a plan that covers you when you need coverage the most – and for that, there’s no substitute.

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Questions About Travel Insurance?

Check out our online guide, "What Is Travel Insurance All About?" We've provided in-depth answers to all your travel insurance questions, starting with the basics.

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