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Medical insurance: the “other” travel insurance

“When I was on vacation in Bongo Bongo, I fell off a cliff and busted my fisteris,” says a typical ad quoting a letter from a traveler, continuing, “The local medical facilities couldn’t fix my problem, so I had to be airlifted back to the U.S. in a private jet, at a cost of $50,000.” The ad’s pitch, obviously, is for emergency medical evacuation (“medevac”) insurance. And although the most common—and commonly needed—form of travel insurance is trip-cancellation (TCI), you should certainly consider medical risks when you’re looking at your travel insurance options.

Who needs travel medical coverage?

The quick answer to that question is, “Anyone who isn’t covered by their regular medical insurance when they’re traveeling.” Specifically, that means:

  • Anyone whose regular health insurance/HMO doesn’t pay for services outside the US. When I first started writing about travel insurance, most private health insurance—and most HMOs—covered you wherever you went. Many included medevac. With relentless cutbacks in benefits in recent years, however, some programs may no longer pay medical bills in foreign countries.
  • Any senior dependent on Medicare. Medicare pays nothing outside the U.S. Even if you have a Medicare supplement that nominally covers foreign travel, benefits are so meager that you might need additional insurance.

Obviously, you should check your benefits before leaving on any foreign trip. And if they’re either weak or totally unavailable, you probably need travel medical insurance.

The medical benefits in many travel insurance policies are secondary, which means the insurance pays only for what you can’t claim from your regular health insurer/HMO. If you already have good foreign-country coverage, additional travel insurance is probably a waste of money.

Bundled medical

Almost all travel insurance bundles include a combination of TCI and medical benefits. For a two-week trip to France my wife and I plan for this fall, the least expensive bundled policy suitable for us provides $2,800 in TCI plus $50,000 in medical/dental emergency costs per person and $50,000 in medical evacuation expenses per person; the total cost for the two of us is $256. As far as I can tell, those limits should cover just about any risks we might face. If we need more, we could buy a policy providing TCI plus $100,000 in medical emergency and $500,000 medevac per person for $309, total.

If you don’t need TCI, you can buy just the medical coverage. On the sample trip I tested, we could buy greatly reduced coverage ($5000 medical, $25,000 medevac) for $98, total. Or we could pay $195 for $100,000 in medical coverage, per person, plus unlimited medevac costs.

For travel to developed countries, my take is that $50,000 in medical and $50,000 medevac would more than cover any foreseeable risks. Travel to less developed areas, with poorer local medical services, might call for slightly higher coverages. It’s your call.

Yearly medical/medevac

If you travel a lot, you might consider buying medical/medevac insurance by the year (or six months) rather than per trip. A low-benefit policy for frequent travelers, offering $10,000 in medical and $25,000 in medevac on each trip, costs $185 a year for two people; a more generous benefit policy, covering $100,000 medical and unlimited medevac per trip, costs $500 a year for two. These policies are designed for travelers who make several short trips each year; policies for long-term overseas trips or extended business assignments are priced differently.

Medevac: the fine print

Most medevac policies I’ve seen call for transport to either the nearest appropriate medical facility or to the U.S. Typically, that means you start at a local or regional hospital. The insurance pays for transport back to the U.S. only when, in the opinion of the attending physician, local/regional facilities are inadequate.

When you need medevac, the insurance company calls all the shots. That means you must, from the beginning, make all arrangements through the insurance company or its local agents. If you jump the gun and make your own arrangements, chances are the insurance company won’t cover them.

Credit card help?

Several premium credit cards promise help in an emergency in a foreign country. Although the language in the card literature seems to promise a lot, however, what you really get is a referral, not any genuine financial assistance.

The fine print for the AmEx Platinum card, for example, says, “Whenever you travel, have peace of mind knowing that you have 24/7 medical, legal, financial, and other emergency assistance while traveling more than 100 miles from home. We can direct you to English-speaking medical and legal professionals and arrange for a transfer to a more appropriate medical facility, even if an air ambulance is required.” Note that it says “arrange for,” not “pay for.” What you get is help in making arrangements; the cost of those arrangements goes right on your credit card bill (unless moving you is deemed “medically necessary”). As far as I know, other cards operate the same way.

Making the choice

The medical risks you face when traveling outside the U.S. are hard to quantify. Basically, the chances of facing a major medical problem are small—very small, for medevac—but the financial consequences of a serious event are potentially quite large. Once again, it’s your call.

Fortunately, prices are not bad. As with all travel insurance, my suggestion is that you check with one or two of the online travel insurance agencies, enter your personal details, trip details, and the coverages you want, and select the least expensive policy that meets your needs. Some of the major agencies include 1Travelinsurance, InsureMyTrip.com, QuoteWright, Squaremouth, and Total Travel Insurance.

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