How to Avoid Big Medical Bills When Traveling Abroad

Getting seriously sick or injured while traveling outside the country can threaten not just your life, but also your life savings.

The cost of a rescue from a mountaintop or ship at sea can run into tens of thousands of dollars, or even six figures if you need a long-distance air ambulance. And while medical care is generally cheaper outside the United States, a prolonged hospital stay could far exceed the cost of your trip.

While some U.S. health insurance companies cover members when they’re traveling overseas, others don’t or provide limited coverage. The good news is it’s fairly easy—and relatively affordable—to get travel medical insurance that will pay for emergency medical care, evacuation, and repatriation when you’re outside the country. 

Travel medical insurance is typically included in comprehensive travel insurance, but these policies can be expensive because they also include “trip cancellation” insurance, which reimburses your prepaid, non-refundable travel costs if you cancel a trip before you leave home for covered reasons. Comprehensive policies usually cost 3% to 10% of the total trip cost you’re insuring, on average, says Jenna Hummer, a spokesperson for Squaremouth, a travel insurance marketplace.

If you don’t want trip cancellation insurance, you can buy a standalone travel medical policy for less than comprehensive coverage. “The odds of you canceling a trip are a lot higher than the odds of you getting sick or injured,” says Kevin Brasler, executive editor of Consumers’ Checkbook. 

But no two policies are alike, and there's a lot of fine print and confusing jargon. 

Here’s how to choose the best travel medical insurance coverage for you.

1. Find out what your existing insurance covers.

Before venturing abroad, call your health insurance provider and find out exactly what it will and won’t cover, the dollar limit for each type of coverage, whom to call if you need care, and how expenses will be paid or reimbursed. If that seems inadequate, consider purchasing travel medical insurance.

Original Medicare (Parts A and B), for example, provides no coverage abroad, but some Medigap/supplemental and Medicare Advantage plans include some foreign coverage.

Some high-end credit cards offer emergency medical and evacuation insurance, but these cards generally have high annual fees and may not offer the coverage you are looking for.

2. Determine what type of coverage you need. 

Take into account your risk factors, destinations, planned activities, and worst-case scenarios as you consider coverage options.

“The big risk is having to be evacuated,” Brasler says. He relayed a story about a friend who was adopting a child in Uganda and got into a bad accident. She was at risk of dying if she didn't get high-quality care immediately, so she was transported via air ambulance to Johns Hopkins Hospital in Baltimore at a cost of $170,000. 

She didn’t have insurance or that kind of money. "Fortunately, the church community where she works as a children's pastor took care of her,” Brasler says.

Although coverage varies widely, travel medical insurance usually covers emergency medical care and medical evacuation or repatriation for an illness or accident that requires professional medical care outside the country, up to a stated dollar limit for each category. Depending on the circumstances, the insurance company might pay providers directly or require you to pay and submit a claim for reimbursement.

Emergency Medical Care

This covers reasonable and customary charges for doctors, hospitals, X-rays, lab work, and other medical (and often emergency dental) care. This coverage can be primary, which means it pays all covered costs up to your stated limit, or secondary to your domestic health insurance or other insurance, in which case it only pays bills your primary health insurance doesn't. 

Medical Evacuation and Repatriation

This is a standard industry term, but specifics vary by company. At a minimum, this type of insurance will pay to transport you by helicopter, ambulance, or other means to the nearest appropriate hospital or medical facility for immediate treatment.

If the local doctor determines that you need a higher level of care or should go home, the policy generally will pay to transport you—and a medical escort if necessary—to another facility or the United States.

However, if your doctor doesn't sign off on you needing special care to return home following a hospitalization or injury, this insurance generally won’t cover this transportation, Hummer says.

If you are hospitalized, evacuation and repatriation coverage might pay for your spouse or traveling companion’s hotel, meals, and transportation and fly your dependent children home. If you’re traveling alone, it might pay to bring a friend, family member, or nurse to the hospital and accompany you home. This is why it’s important to call the insurer and ask what would be covered under various scenarios. 

If you die, most policies will pay to repatriate your remains to the United States. Some also provide a dollar amount for accidental death or dismemberment.

3. Decide if you want additional coverage. 

Travel medical insurancetypically covers emergency medical, evacuation and repatriation for a single trip, which could be to multiple destinations. If you think you'll take more than one foreign trip a year, it might pay to purchase an annual travel medical insurance policy that covers you for 12 months. The cost increases the older you get. Some annual policies also provide limited emergency medical coverage when you are traveling domestically.

Travel medical insurance policies may include extras, such as trip interruption and trip delay insurance, which pays for hotels, meals, and nonrefundable prepaid travel expenses while you are traveling if your trip is cut short or delayed for covered reasons beyond your control. These benefits might cover your trip home if it isn't approved by your foreign doctor. Comprehensive policies usually include the extras as well.

4. Ask about exclusions.

Most policies won’t cover costs caused by chronic conditions that existed before your policy began. These typically include diabetes, heart disease, asthma, high blood pressure, arthritis, active cancer, pregnancy, or mental illness, Hummer says. 

Some travel medical insurance policies will waive the exclusion for most preexisting conditions if you buy it within 14 to 30 days of making your first trip payment. 

Travel insurance generally won’t pay for an illness or accident caused in whole or part by intoxication or illegal drug use. And if you’re planning to hike to Machu Picchu, skydive, bungee jump, or run a marathon, find a policy that will cover those activities. Most insurers exclude pandemics (and according to the World Health Organization, Covid-19 is no longer a pandemic).

5. Choose primary or secondary insurance. 

Although primary medical coverage might cost a bit more than secondary, it avoids the aggravation of dealing with two insurance companies and gives you access to the insurer’s 24/7 assistance.

Jean Zook of Asheville, N.C.. had insurance through work that covered foreign travel. But when she needed medical care in Costa Rica, “I had to call them and they had to select the M.D. I had to see,” she says. When “they could not find an M.D. to recommend, they told me to go wherever there was service.” When she put in a claim, she found that her insurance company classified the only available doctor as an emergency room—just because he was open 24 hours, she says—and denied the charges. The company also wouldn’t pay for her medicine because it was not on a U.S. formulary, she says.

So when she and her husband went to Switzerland, they took out primary travel insurance through Allianz. While hiking, he developed a heart problem and went to a hospital in Bern for two days, where he had three stents inserted. “We had to guarantee payment before he could be treated,” she says. “We carry a credit card with a $25,000 limit just for that purpose.” 

The bill came to $13,000 and Allianz paid it all. “We didn’t have to file any paperwork. They dealt directly with the hospital,” she says.

6. Look at the dollar limits.

How much insurance you need depends on your age, health, destination, activity, and comfort level. The premium typically goes up along with the limits.

In 2024, the average emergency medical claim paid by Tin Leg, an insurance company owned by Squaremouth, was $1,654, and the highest was almost $62,000. The average medical evacuation claim was $17,086, and the highest was $33,640.

But Robert Gallagher, president of the US Travel Insurance Association, says, “Depending on where you are located and where your home country is, a medical evacuation could cost between $20,000 and $200,000.”

7. Document everything. 

Make sure to carry your policy number and the insurer’s toll-free, 24/7 emergency assistance line at all times on your trip. You need to know how to reach a trained representative who can arrange for your medical evacuation and care or direct you to trusted providers. If you don’t follow instructions or are missing documentation, your claim could be denied.