Care costs abroad

Paying

• Expect to pay up front for care abroad and ask for reimbursement afterwards. Receiving care usually means a cash or credit card payment at the point of service, sometimes before care begins, which can be difficult for very expensive care.
• Some insurers arrange with hospitals to guarantee direct payment. The page lists this as a feature to look for.
• Identify providers at your destination that are in-network for your insurance before you go.
• Nationalised healthcare at a destination does not necessarily cover the healthcare costs of non-residents.
• The US State Department might be able to offer limited emergency medical assistance loans to US citizens who cannot pay and cannot arrange a transfer of funds. They must be repaid, and until a loan is repaid in full the State Department will generally not issue a new passport. Consular officers can help with transferring funds from the US.

Evacuation

• Medical evacuation costs range from USD 25,000 for transport within North America to more than USD 250,000 for distant or remote locations, and more for critically ill patients or those needing complex infection control.
• The decision to evacuate is at the discretion of the insurance company, not made at the traveller's request. Typically the traveller must be hospitalised, with more hospital days expected or specialised care needed that is not available locally.
• Medical evacuation insurance on its own is relatively inexpensive and can save thousands if evacuation is needed.

Your cover

• Some US health plans cover emergencies abroad, but domestic plans may only cover medical expenses for an illness or injury under specific circumstances.
• Travel disruption insurance might not cover medical expenses abroad or medical evacuation. Credit card travel benefits nearly all require a formal claim process with no reimbursement guarantee, and should not be treated as a substitute for dedicated insurance.
• Conditions that required hospitalisation or direct treatment in the 90 days before departure are often excluded. Cover for underlying conditions is harder to get; people over 75 should research specialised policies early.
• Original Medicare generally does not cover care abroad or medical evacuation. The page says some Medigap plans cover some emergency care abroad if it begins within the first 60 days of travel, with a yearly deductible and a lifetime maximum; Medicare Advantage plans usually do not cover care outside the US.

Claims

• Obtain copies of all charges and receipts and give the insurer copies of bills and invoices so reimbursement can start. Confirm your insurer will reimburse out-of-pocket payments made to providers abroad.
• In one study insurers fully paid only two-thirds of claims. The main reasons for refusal were preexisting illness and poor documentation.

• Will you pay the provider directly, or do I pay and claim back?
• Do you guarantee payment to hospitals, and how do I start that from abroad?
• Which hospitals at my destination are in-network?
• Who decides on evacuation, and where would you take me?
• Does my current plan pay for emergencies outside my home country?
• Does my card pay for medical care or evacuation, or only trip disruption?
• Is any condition I already have excluded, and what is the look-back period?
• If I have Medicare, which extra plan covers me abroad?
• What documents do you need to reimburse me?