- Ask your insurer for specifics about your coverage away from home.
- If you’re within the U.S., plans generally provide coverage for emergency care.
- Access to in-network coverage outside your home state depends on how you get your coverage.
- Supplemental plans are useful for covering out-of-pocket costs.
- A Medigap plan may provide some coverage for international travel.
- On some regular health plans, life or limb medical emergencies are covered overseas, but check with your insurer.
- Travel health insurance policies are widely available and offer peace of mind when you travel
- Travel health insurance plans are not ACA-compliant.
- Expat insurance is designed for people who live abroad long-term.
- Travel health insurance is not guaranteed renewable.
- Termination of a travel plan does not trigger a special enrollment period for ACA coverage.
Know the specifics of your health plan
“Will my health insurance cover me when I’m traveling?” It’s a question that most travelers have, but the answer varies depending on the type of coverage you have and where you’re traveling.
First things first: Before you plan any trip, it’s wise to contact your health insurer and ask specific questions about your coverage while traveling. Ask them to refer you to written documents (or send them to you), as you’ll want to have details in writing that clarify exactly what is and isn’t covered when you travel. Although we’ll provide a general overview here, there’s no substitute for finding out exactly how your specific policy covers you when you leave your home area.
Travel within the United States
If you’re traveling within the U.S., you’ll generally have coverage for emergency care provided in an emergency room in another state. This is true regardless of your plan’s network structure (EPO, PPO, HMO, or POS) or how extensive the network is.
If you’re traveling outside your home state, your health plan may or may not have in-network providers in your destination state. Employer-sponsored plans (especially those offered by large employers) often have nationwide networks, but individual market plans (the kind you buy on your own, either through the exchange or directly from an insurer) almost invariably now have localized networks that do not include nationwide in-network coverage.
So your access to in-network coverage outside your home state depends in large part on where you get your health insurance.
Assuming that you do not have in-network coverage when you’re in another state, there are a few things to keep in mind:
- Your plan should cover you for emergency care, and should pay a reasonable amount towards the cost of such care. And all non-grandfathered health plans are required to limit your cost-sharing (deductible, copays, coinsurance) to the plan’s in-network amounts, even if the emergency room care is out-of-network.
- HOWEVER — and this is a big caveat — prior to 2022, there is nothing in federal law that prevents the out-of-network emergency room and/or physicians from sending the patient a bill for whatever portion of their charges are above the amount that the insurer considers reasonable. This is in addition to the cost-sharing required by the patient’s health plan. Some states have implemented rules to protect consumers from balance billing in emergency situations, although this varies considerably from one state to another. But federal rules take effect in 2022 that protect consumers from surprise balance billing in emergency situations.
- There is no standard definition of what constitutes an emergency. Insurers can and do dispute the emergency nature of medical care, even if it’s provided in an emergency room. If the out-of-network care is not considered an emergency and your health plan doesn’t cover out-of-network care (HMOs and EPOs generally never cover non-emergency out-of-network care), you can expect to have to pay the full cost yourself. But you also have the opportunity to appeal an adverse decision that your health insurer makes, so don’t give up just because the initial determination from your insurer is that the situation wasn’t an emergency.
Some people purchase supplemental coverage to offset some of the potential costs that could be incurred if a medical situation arises while in another state:
- Accident supplements will typically reimburse a policyholder a flat dollar amount, which can be used to pay out-of-network charges or balance bills in the event of a medical claim that arises from an accident or injury.
- Critical illness plans also reimburse the policyholder a flat dollar amount, although the plan will only pay if the patient experiences a specific covered illness. These plans typically include coverage for things like heart attacks and strokes, so they can be useful to sudden scenarios that can arise while one is traveling and which necessitate emergency care (again keeping in mind that while your health plan will cover the emergency care, you can still be billed by the out-of-network medical providers for any amounts above the “reasonable” amount that your insurer pays them).
Supplemental plans are also useful for covering out-of-pocket costs that arise from in-network and non-emergency situations, so they’re suitable for maintaining as year-round, whether you’re traveling or not. But they should never be relied upon as stand-alone coverage (ie, you still need to have major medical coverage in addition to your supplemental coverage).
And although nobody heads out on vacation planning to end up stuck in the hospital for an extended amount of time, it can happen. This Wall Street Journal article is a sobering reminder that emergency medical situations can sometimes result in long hospital stays with the patient too ill to return home. Out-of-network balance billing can quickly reach unmanageable levels in situations like that, and although the billing can sometimes be resolved with negotiations and mediations, it can also sometimes end up pushing people into bankruptcy.
Will my current plan cover me at all when I’m outside the United States?
It depends on your plan. If you’re enrolled in Medicare, your Medigap plan might provide some coverage for international travel (Original Medicare doesn’t cover care outside the U.S., with very limited exceptions). If you have Medicare Advantage coverage, the plan might include some travel coverage, but this will vary considerably from one plan to another.
If you’ve got private coverage, it depends on your plan. On some plans, life or limb medical emergencies are covered, but the onus is on the patient to prove that the situation was truly an emergency, and the cost of medical evacuation back to the United States is rarely covered by standard U.S.-based health plans. (Travel medical insurance plans generally do cover medication evacuations).
Travel insurance: A widely available solution if you’re traveling abroad
Most U.S.-based health plans do not cover international travel. Fortunately, travel health insurance plans are widely available, inexpensive, and relatively easy to obtain.
Travel insurance plans are not regulated by the ACA, so they can still have annual and lifetime benefit caps, they do not have to cover pre-existing conditions, and coverage is not guaranteed issue. There’s also no requirement that plans cover the ACA’s ten essential benefits.
But travel medical insurance does provide peace of mind if you’re planning a trip abroad. Coverage is available for U.S. and foreign nationals traveling outside their home countries, and a wide range of plans are available to fit every budget.
Expat insurance: When you need coverage abroad for an extended period of time
If you’re going to be living abroad for an extended period of time, your health insurance needs will be different from those of someone who is taking a vacation overseas. If you’ve been hired by a company that is sending you abroad, they may have already made arrangements for your health coverage. But if you’re self-employed, taking a sabbatical, or retiring overseas, you’ll likely need to sort out your own coverage arrangements.
Fortunately, there are insurers that offer plans specifically tailored to the needs of expats and long-term travelers. These policies can be purchased to include coverage in the U.S. as well as coverage abroad, or to only provide coverage outside the U.S. (your needs may vary depending on whether you’re planning to also maintain your U.S.-based coverage). As is the case with general travel insurance, expat/long-term travel plans are not subject to the ACA’s regulations.
Renewing your travel coverage
Travel medical insurance is not guaranteed renewable, which means that if you need another policy after your first one ends, you’d have to reapply and go through medical underwriting again (similar to short-term insurance).
And since travel insurance is not considered minimum essential coverage, the termination of a travel policy does not trigger a special enrollment period to purchase a regular ACA-compliant health insurance plan in your home state. This is an important reason to make sure that your travel policy is purchased to supplement your regular health plan, not replace it.
If you live abroad and then move back to the United States, you’ll be eligible for a special enrollment period, triggered by your move, during which you can purchase an ACA-compliant plan. But be prepared to prove that you were actually living abroad, and not just on vacation (in guidance related to a permanent relocation, HHS has noted that people need to spend “an entire season or other long period of time” in a location in order to establish residency there).
In the past, regular health insurance had many of the same caveats as travel insurance. But the ACA’s reforms have made us more accustomed to guaranteed-issue coverage that doesn’t discriminate against pre-existing conditions or limit coverage for essential health benefits. So it’s important to read the fine print on any travel insurance policy you’re considering, as the nuances of the coverage may be quite different from your normal coverage.
Travel insurance: Read all the fine print
Piper Kan and Reece Huculak-Kimmel both have stories that amount to a cautionary tale about the shortcomings of travel insurance. Both little girls were born prematurely in foreign countries, and the extensive medical bills were not covered, despite the fact that in each case the parents had purchased travel health insurance policies and thought they were covered for any contingency.
The take-away? It’s important to pay careful attention to the written details and exclusions of the plan you’re considering. Don’t rely on verbal confirmations of benefits. But that said, travel insurance is an excellent supplement to your regular policy, and will cover mishaps in foreign countries that would otherwise have to be paid out-of-pocket. Bon voyage!
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.