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Do you need special medical insurance while abroad?

Do you need some special medical insurance when you’re outside the U.S., and do you have to buy an expensive trip-cancellation policy to get it? Travel insurance is an issue that vexes many travelers, especially when they hear horror stories about big bills and declined claims. One reader put it this way:

“Can travelers buy medical insurance a la carte for trips outside the U.S., or is it available only in bundled policies?”

The short answer is “yes, you can buy a la carte.” If you don’t need to protect heavy prepayments with trip-cancellation insurance, most travel insurance companies sell separate travel medical insurance (TMI) without the requirement to buy any of the other coverage you find in most comprehensive travel policies. Here’s some detail on medical insurance for travelers.

Do you actually need extra insurance?

Before you start thinking about TMI, first find out what sort of coverage your regular health policy includes when you’re away from home. Many health programs&#8212including HMOs&#8212cover your medical expenses worldwide.

You might still consider TMI, however, even if your regular health program nominally covers you outside the U.S. The reason is that many&#8212perhaps most&#8212regular policies don’t pay up front for foreign medical services. You have to pay on the spot, often in cash, then apply for reimbursement after you return home. Those up-front payments could prove difficult, maxing out your credit card or requiring long-distance negotiations with your home bank for a wire transfer of funds. A TMI policy that offers primary foreign coverage eliminates those problems.

TMI is even more important if your regular health program does not cover you outside the U.S., or if you don’t have health insurance at all. Medicare definitely does not, and even if you have a supplement, the overseas benefit is meager. You might well need something, or something extra.

One other separate coverage you might want to consider: emergency evacuation (medevac). Many regular TMI policies include some medevac coverage, but it might not be enough in a major emergency. You can buy insurance that will cover even the most expensive emergency evacuation from the site of an accident or illness to a suitable hospital. Some policies limit this to the nearest hospital qualified to treat you; others return you to the U.S. if you wish. Their promotional materials are full of horror stories about travelers who had to charter helicopters to get them out of a bad situation or private jets to get them home, often at costs ranging up to $100,000. If you’re really concerned, take a look at a separate medevac policy.

TMI by the trip

Most travelers buy medical insurance by the trip. Probably a majority bundle it in a comprehensive package policy that includes trip cancellation. But if you don’t face heavy cancellation penalties, buy it separately. All of the big online travel insurance sites sell it, including One Travel Insurance,,, Squaremouth,, and Total Travel Insurance. Enter your personal data, trip particulars, and what kind of insurance you want, and the site displays a whole bunch of policies and their detailed terms. Prices depend on your age, the amount of coverage you select, the length of your trip, and other such factors.

TMI by the year

If you travel a lot, consider buying a full-time policy. Typically, that means by the year, but some policies are offered for shorter periods. The online agencies listed above sell extended policies as well as by-the-trip. In addition, several other organizations specialize in full-time worldwide TMI and medevac policies, including Europ Assistance USA, International SOS, and MedjetAssist. Although those organizations focus on corporate policies covering a group of employees, they sell individual policies, too. As with by-the-trip policies, prices depend on your age and travel patterns.

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