Medical Insurance Tutorial and Recommendations

You might find the info you need in this article by Chris Elliott, a consumer advocate with a great deal of related travel advice experience https://www.elliott.org/ultimate-consumer-guides-smart-travelers/how-find-best-travel-insurance/.

I have used www.Squaremouth.com to research policies but having a good grounding as Chris provides is useful.

Medicaid/Medicare do not cover you out of the US so you are wise to research.

If the deteriorating health of your wife’s parents are a concern and which might cause you to come home prematurely from your trip, you need a policy that covers more than medical for you and your wife. When my husband and I started traveling internationally way back when we got a policy that included trip interruption in the event that we needed to come home earlier than planned to tend to our aging parents. Luckily that never happened. Now we are the elderly people who may have to come back earlier than planned. LOL! And even if you and your wife are in good health, accidents can happen causing you to come home early as well. It would be a good idea to factor these into your search for a policy. Also be aware that policies that include preexisting health conditions for you and your wife need to be purchased within 15 days of your initial trip deposit. If you want to include your cost of airfare into your policy but haven’t purchased it at the time you have purchased the policy, you can add it on later for an additional cost of course. I hope this helps.

I'm not even concerned about medical evacuation. These are all just expenses that I can pay in the unlikely event I need to.

Medical evacuation is the only thing I am concerned about; I am 65+, on Medicare, and have a Medigap Plan G supplemental that does provide some coverage for emergency care abroad, and I have a Medjet evacuation policy for me and my wife. I otherwise do not bother with medical insurance when I travel - I "self insure", will pay out of pocket for any health care we require and will see what Plan G covers when we get home, but in case of something serious, Medjet will cover evacuation to the US.

My point is are you sure you understand how much medical evacuation costs, vs self insuring for basic medical stuff? Medical evacuation can run into 6 figures...

One potential complication. My wife's parents are in Memory Care and Assisted Living. My wife is their Health Care Power of Attorney. There is some possibility that we might be called home if they deteriorate.

Had a similar situation with my wife's father about 10 years ago, and we decided to deal with any such issues from abroad, left explicit contact instructions with the assisted living facility, had our phones "turned on" full time. We reasoned there is very little one can't deal with via the phone, including emergency hospitalization, or an untimely death. Someone else will have to advise you on the kind of "any reason" insurance you need to return home, if indeed insurance like that is even available, versus having insurance that would allow you to cancel a trip for any cause before going, in case of some emergency with her parents prior to the trip.

Over a number of years and trips, I have had good experience in getting information and choosing policies from a marketplace company called Aardy (previously Aardvark). They offer numerous policies from a large number of different insurance companies. Fortunately, I have not had to file any claims, so I don't know how good they are at that stage. What I have found helpful is that it is very easy to get someone on the phone who will factor in any and all of your concerns and then offer several options as well as explain anything that is not totally clear in the policies. You can start out getting quotes using their website, but I have found the phone conversation to clarify details most helpful. There are also other marketplace sites that operate similarly such as Travelersinsurance.com. In my experience, the Aardy folks found the best price for the coverage I needed.

Some things to look out for: Different insurance policies have different number of days (7, 14, or 21 are typical) after your first covered expense such as airline tickets that you have to buy the insurance. Often, the longer you wait the more it costs. Different policies treat pre-existing conditions differently. It is good to find out exactly what, if anything, your regular health insurance covers when you are abroad. If your insurance has no international coverage at all, then your travel policy can be what is called "secondary" which may be cheaper. But in my case, for example, my medigap plan does offer very minimum international coverage but with a sizable deductible; therefore I wanted a travel policy that was "primary" so I wouldn't be required to use my medigap first.

You give a great deal of detail but omit one important point- have you checked what your current health insurance policy covers overseas? Many do offer coverage for “urgent and emergency care.”
Be sure you know exactly what is already covered before purchasing more.

Another place to check for current coverage is with your credit card. What travel insurance perks do you already have and what are the conditions associated with them?

Finally trip interruption and evacuation are big ticket items. I also have a Medjet policy and hope it is never used…..

My power of attorney had “back ups” (my siblings) in case I was unable to be present. We made all major decisions together anyway so it worked for us. We just made sure one sibling was always available.

Another vote for you to re-think the evacuation coverage. I never go without one. If, somehow, you need to get back home for care, medical evacuation can easily cost $100,000.

When we were in Amsterdam this year, we were talking with a man whose wife had fallen and broken her hip on day one of their trip. She had surgery in an Amsterdam hospital and was stuck there indefinitely due to a post-surgical blood pressure issue. He had no insurance at all and no plan for what to do.

While lots of travel medical policies cover medical evacuation, they only cover to the nearest good medical facility. So in Germany, they’d transport you somewhere in Germany etc. I want coverage that brings me home and so I buy from only these two companies:
https://airmed.com/
https://medjetassist.com/

We pay about $350 a year for a policy for the two of us.

Valerie gave you a good link to Medjet for evacuation insurance. They will get you home instead of to the nearest facility.
For medical only, check out https://www.geobluetravelinsurance.com/mobile/index-2.cfm

For our medical needs only, we do same as horsewoofie. For grins, we know someone who was evacuated(by insurance) from a small town in the neighboring state of Georgia to the medical school in AL!

I used GeoBlue for medical evacuation insurance this year, as it was recommended by BCBS, who I have a Medigap plan with. The cost was around $150 for just me.

I agree with Jojo in that many Medigap plans cover emergency medical care abroad, so the concern should be to get back to the states. I pay nothing out of pocket for my medical expenses in the states, so it makes sense to me that I would want to be evacuated back here for medical care, rather than racking up fees abroad.

While lots of travel medical policies cover medical evacuation, they
only cover to the nearest good medical facility.

I have purchased over a hundred different evacuation policies over the years from various companies that offer this and have never come across a policy that didn't cover evacuation back home for recuperation or further treatment. The "nearest medical facility" clause that appears in all these policies simply refers to the initial incident. For example if you were to twist your ankle it prevents you from calling the insurance company and demanding to the be flown home the next day to be seen by your primary doctor in the US.
If the medical problem is serious and you need further treatment/recuperation closer to home, that is covered by different clauses further down in the policy.
I've come across some inferior policies that limit evacuation costs to the price economy ticket, but most will cover the six figures for a serious incident that a doctor and the insurance policy deem medically necessary.

I am always amazed by the many medical insurance questions posted on this Forum and the frequent responses that recommend the purchase of special travel policies. IMO most of these policies provide little benefit or are duplicative of existing coverage or are not necessary for the following reasons.

Medical facilities and personnel and treatments in Western Europe are similar in quality to the USA so your illness or injury can be treated there without the need for costly evacuation to your home hospital or doctor.

Although Medicare does not cover treatment abroad, most Medicare Supplement and Medicare Advantage plans include some coverage for foreign medical care. Likewise, for those not yet eligible for Medicare, many group plans include some overseas coverage. Also, most Western European countries have socialized state health systems that will provide free emergency treatment to foreign visitors.

Medical evacuation insurance sounds good and is frequently mentioned on the Forum yet I have never read a post from someone who actually used it. Be aware that evacuation must be “medically necessary” as defined in the policy. You can’t just elect to be flown to your hometown hospital.

Finally, many posters blur the line between pure medical issues and trip interruption or cancellation caused by illness or injury. These are very different situations and would not usually be covered by the same insurance policy.

My advice to the OP is to determine existing coverage through current policies and credit cards, then estimate out of pocket costs for most likely occurrence, then consider some amount of self insurance before spending money on travel insurance or medical policies. And speaking of the real world experience sought by the OP, I have traveled in Europe every year since 2014, except 2 Covid years, and have never purchased travel insurance or travelers medical policies or evacuation insurance. Like most travelers, I have experienced a few health and travel issues abroad which I handled at my own expense for far less than the cost of insurance.

Hope this is helpful information.

To follow up on Simpgolf’s comments, do not assume you won’t be charged for emergency care in Europe. We just received our bill from the Government of France for my spouse’s medical visit to a Paris ER. Granted the bill was not high but he also didn’t need diagnostics etc. He had already done blood work at a lab, prescribed by another doctor in another town, for which he was also charged. The ER visit was because the first doctor didn’t feel comfortable treating the ailment (her English was limited and my spouse has a couple of pre-existing health issues).

In terms of medical evacuation, the reason for that isn’t because you won’t get comparable care but because if you have had a serious medical emergency ie a major stroke, when you are medically stable enough to be on a plane, you are likely to want to return to your home city and family for your remaining recovery/rehab etc but you may need a medical escort for that trip, thus the coverage.

It’s not the small ailments like a broken bone that warrant emergency medical coverage, it’s the big stuff: heart attack, stroke, major fall. And any of those can happen while travelling.

I'd like to thank everyone for their thoughtful and timely responses. I see a lot of good resources for for me to research. I've really got to dig in on the features of my own coverage.

I do have a couple of observations.

1. I may be overthinking this. Maybe I should just pay the money and sleep better at night. Chances are that I won't need it. I have the financial resources to self-insure for all but the most horrific eventualities. (I find that I distrust insurance companies. They don't actually produce anything and I think that they all have a whole department of people whose job it is to figure out how not to pay me when I make a claim.)

2. I stand by my disinterest in medical evacuation. I'm going to England. I can't envision a injury or illness that it would be better for me to endure a 6-hour flight and a 2-hour ambulance ride in order to be "home" versus going to the nearest hospital in Scotland/England. Of course, should I ever become ambulatory I'll take a commercial flight home. I might have a different opinion if I was going to Africa, Central America or a remote third-world locale. If I don't recover, I'll need actual medical coverage more than evacuation.

Again, thanks so much for all your help.

I can't envision a injury or illness that it would be better for me
to endure a 6-hour flight and a 2-hour ambulance ride in order to be
"home" versus going to the nearest hospital in Scotland/England.

Here's a scenario:
You slip in your hotel's bathroom and suffer severe leg or hip fracture. You are treated for this injury in the UK but must remain horizontal for several weeks to heal. Most people would prefer this recuperation to occur either at home or a facility close to home. Evacuation coverage will pay the big bucks for the air ambulance, and nurse who accompanies you.

Personally if I didn't get coverage and something like this happened to me, I would have to raid my retirement account to cover the expense, and my traveling days would be over.

Or you're innocently traveling in a taxi or bus that's involved in a vehicle accident. Unfortunately, you are seriously injured and need long-term rehab. Do you want to spend months in a foreign country, recovering your ability to function? Are you confident the UK's problems with NHS capacity don't extend to rehab facilities? My answers to those questions would be "No" and "No".

If you'd answer the same way, can you pay (possibly) $150,000+ to get yourself home, accompaned by appropriate medical personnel?

I've always self-insured for basic medical expenses (not the right decision for everyone; my insurance covers me overseas and I can afford to pay for any ordinary medical services that aren't reimbursed). Medical evacuation is a completely different issue; it's vastly more expensive.

It's quite unlikely that my condominium will be destroyed by fire, but I also have homeowner's insurance that would cover a fire loss.

While I agree with Michael that most people would “prefer” to recuperate at home in the scenario he posited, I doubt that the medical evacuation insurer cares about your preference. Be sure to read the fine print in any policy you purchase.

OP. You said you researched and read all the threads on health insurance. Yet, here you are. Those threads are frequent and usually with the same sort of information. Nothing new. You had all the info.
You seem to have a bit of a cavalier attitude towards a couple aspects of health care, evacuation and actual coverage despite a policy.
You say you can self insure. You mention you are on Medic Aid. What is that? Is that Medicaid?
Seems like you are willing to rely on the English system to get you through your trip.
You seem to think that going home to care for a deterioration of a parent is maybe job number one for you. That is not medical care,
OK, you said you wanted real life use of a policy. Here goes then. Wife had a stroke in Laos, on a bus. Long ways from anywhere. I had to get her ASAP to care. We got to Bangkok. Two days in hospital and a plethora of tests. We had Allianz. They covered the bill on discharge. I had no money out of pocket. Wife could not fly for two weeks, had to follow up and get a letter, fit to fly.
Afterwards we submitted other receipts for hotels, etc. All went well with Allianz. During wife’s time in hospital Allianz called several times for follow up on how she was doing.
There you have it.
Make you choice.

If you have an extended stay in any hospital, it will be on your dime very quickly, even if the ‘emergency’ part of your medical cost is covered by the local hospital (that won’t last long believe me). If you have emergency medical insurance paying the bills, they will be repatriating you home as quickly as you are considered medically stable as they don’t want to pay more than they have to (they want your personal medical coverage to take over paying). If medical evacuation is part of the package, they will approve it; again they don’t want to pay more than they have to.

I know most commenting here are American with very different approaches to medical coverage at home and abroad. Those of us living elsewhere know that it is very risky to leave our home country without ensuring we have emergency medical coverage while we travel (or some type of reciprocity within the EU for example). I have needed to access it a few times over many years of travel without any difficulty having my claims approved.

As a retired health care professional believe me when I say for a serious medical emergency and recovery, you want to be in familiar surroundings, AND in a familiar healthcare system as quickly as possible. And it won’t necessarily be your call that you are medically stable enough to fly on a commercial airline.

You say you can self insure. You mention you are on Medic Aid. What is that? Is that Medicaid?

Glad someone asked about this, because it puzzled me, too. Something not adding up here with the original post and his subsequent responses.

If he can afford to self insure as he claims, not sure why he is bothering with any of this. I effectively self insure, but with the knowledge that my Medicare supplement covers emergency care abroad, with a deductible. Prior to medicare, we had excellent private insurance that had similar coverage. Knock on wood, in over 40 years of travel, I have never needed medical care while away from home.

Medical evacuation insurance is the best bang for the buck coverage one can get, and I have gotten that through Medjet for many years. What I see as a "no brainer" given the exorbitant costs associated with medical evacuation.

I am one of those people who have dealt with a serious medical emergency of a family member abroad. Fortunately, for the first time we did buy travel insurance for that trip. Knowing what I do now, I would never travel without it again. I also insist that any traveling companion be insured as well, because of course it would be my responsibility to handle the situation if my companion is lying in hospital.

Yes, as it turned out we could have paid out of pocket for the week long hospital bill and surgery. And, yes we could have paid the up charge to rebook our flights. What we could not have done on our own was navigating the very complex issues of handling all of this in a foreign country. Our insurance company took care of everything, guided us through the process, and provided services that we needed but hadn't even considered. They dealt with the hospital to guarantee payment, offered translation services (not needed in our case), intervened when an outside provider overcharged us and wanted cash payment, arranged ambulance transport to the nearest airport, contacted the airline to arrange and pay for an upgrade to first class for both my parents to accommodate my mother's knee brace, and reminded us that she would also need ambulance transfer from our final destination airport to their home, then arranged and paid for that.

So to the OP or anyone considering not buying travel insurance, I would ask: If something happens to you, are you really going to leave your friend or loved one to deal with all of that on their own to save a couple hundred dollars for an insurance policy?

Linda, excellent response and very true. It's not always just about us.

I do as Jojo does. Medjetassist gets me home without my daughter, who is very busy with child, work, home, etc. having to jump on a plane and attempt to 'rescue' me. All she has to do is pick a hospital in Boston or more local, depending on my problem and I'll be flown there. Also, I'd rather use my money in another manner than expensive evacuation.

I have also found GeoBlue to be useful as they would direct pay my medical bill. However, I don't always bother with the health insurance as I am covered by my health insurance enough for me to stabilize to get home, but I always get Medjetassist.

Wray, that sounds like a good plan. I always buy the comprehensive that covers medical and evacuation. However you have reminded me that I should to double check my Medicare supplement policy for possible elements of coverage abroad.

Medically necessary *emergency care services** beginning during the first 60 days of each trip outside the United States*
80% up to a lifetime maximum benefit of $50,000 After :First $250 deductible each calendar year."

The above are the terms of my Plan F Medicare Supplement Plan
Plan G has the same.
Many private policies have similar limitations. These are the highest amounts available with ant Medicare supplement plan.
Limited amount of emergency care only
That's it.

So in reality if we rely on this coverage we are OK for minor issues.
What is unclear is if we take out additional medical travel insurance ,what is the appropriate amount of coverage to be meaningful? In the US 50K can be used up in a matter of days with hospitalization. In Europe and elsewhere things are much more reasonable but still for a major event.... ?

MATraveler,
Interesting! My main question though is whether the Medicare supplement policy would be a direct pay or a later reimbursement. The guarantee of direct pay from our travel insurance company turned out to be a big deal when we arrived at the hospital in the event I described above.

My main question though is whether the Medicare supplement policy would be a direct pay or a later reimbursement.

My assumption is that since your supplemental policy, at least in the US, processes after a Medicare claim is first submitted, that it will not be a direct pay to the hospital or provider in a foreign country by the supplemental, so maybe you have to cover the bill and seek reimbursement for yourself? Now whether or not the provider would require you to pay and seek your own reimbursement, I don't know, but many people have described the process with emergency services in Europe as being mailed a bill at some point afterwards. This may have been in France, but who knows how it would work in different countries.

If someone has gone through this process, please let us know. In other words, when you have an emergency abroad, do you present your Medicare card as your primary insurance? And if you have a supplemental plan (F or G), do you also present that? When are you presented with the "bill" for services?

Maybe in the fine print of the G and F supplementals this process is described. I am curious, but not going to dig into it, will deal with whatever comes if I find myself in this situation on a future foreign trip.

One additional thought: I need to look at the Medjetassist policy I have more closely but I believe that you are required to contact them asap when you have had an emergency, and it is likely they can guide or advise someone on what to expect with Medicare supplementals that cover emergency care abroad.

We just went through the analysis of an upcoming trip to Europe (primarily Italy) where we will be for just under 2 months. It is a very confusing maze, but once you look at enough articles (current) and read through a number of policies the issue and solutions, while requiring Advil do start to fall into place. Also, each traveler’s expenses and situation will vary and have different needs. Here is what we decided to do:

1. For trip cancellation/interruption we are “relying” on our Credit Card included travel protections (Sapphire Preferred). We get $10,000 pp - aggregate max for the 2 of us of $20,000. There are also some baggage and delay coverages as well. Reading through the terms and conditions it appears acceptable for our risk tolerance.
2. We purchased a Medical travel coverage - you may have to include $100 or so of trip cancellation but we have $100,000 (secondary to our Medicare Gap rider (just a few dollars per month) that provides 80% coverage up to max of $50,000 for up to 60 days), small amount of dental and I believe $500,000 medical evacuation. They also provide some delay, missed connection and baggage coverages. We purchased the policy within the timeframe to include pre existing coverage. Cost was about $250.
3. While there may be some things not covered, we will handle those out of pocket. Sure, you can spend thousands for more “comprehensive?” policies but not sure they offer all that much more. So, do some homework - that said until you file a claim you never know what is really covered. The devil is in the details, definitions and legalese fine print.

For a total of $345 (credit card is $95/year but we get good travel rewards, no foreign exchange fees and a very decent initial welcome credit) we feel it is money well spent. Peace of mind is also important. We also book hotels with cancellation and keep pre payments for lodging to a deposit until we arrive. That way our worst case travel exposure is basically airline tickets.

We have travelled to Europe several times and have tried to keep this cost within reason and worry to a minimum. Though, as we get older it will be more costly and in a few years our travel insurance may have many limitations.

Linda and flyfisher11, who did you use for your medical coverage?

In the end, I chose GeoBlue. Here’s hoping that I never have need to use the policy.

EXCELLENT thread, thanks to all of you who've contributed! Will call provider to check about Medicare supplemental coverage abroad. I wondered if anyone has used AAA Premier and needed the international component? It also offers 100 miles of free towing which was the original reason I bought it... https://mwg.aaa.com/membership/aaa-premier. Coverage includes - Up to $1,500 in trip interruption protection, Up to $500 in lost baggage coverage, Travel accident insurance ($300,000; worldwide for travel purchased through AAA), and the biggie for us, Emergency medical transportation coverage ($25,000). PS, Obviously, this isn't a replacement for GeoBlue or other medical policy, but it's only about $100 for 2 of us, and I added it mostly for 100 miles of free towing but it does have a bit more going for it!

For those that asked about Medicare Supplement Insurance and direct bill:

I recently wrote to Blue Shield which provides my Plan F Supplement insurance. The response was that I would need to file a claims form . I suspect this is true for most if not all supplement plans.

I had to file a claim a few years back when I was still on my wife's employer policy. It was not difficult, but I had to be sure they described the procedure correctly and not just by the code. The codes there will not work.

When I travel I do take out medical insurance with the assumption I would have to file a claim. GeoBlue advertises that they have some sort of worldwide network but I have no experience with that. I do expect to sign up for an annual policy for my October trip. Hopefully I will have nothing to report.

For those of you who have used GeoBlue did your primary insurance deductible (US based health insurance ) get applied/used first before GeoBlue covered anything medical? From what I am reading on the GeoBlue site it looks like they are a secondary insurance and therefore they fill in the gaps once you have reached your deductible on you primary plan. I may be wrong, hence why I'm asking.
Our US based health insurance (Florida Blue) has a huge deductible. So if GeoBlue only provides coverage after you have reached all the "limits" on your primary plan, we will have to look elsewhere. There are other medical insurance plans that act as primary plans and provide coverage in place of your US based plan. That's my take on things. Please educate me if I am understanding this wrong. I hate insurance but it is necessary - yuk!

Marty,
I used Travel Guard and was extremely happy with them. They covered everything abroad, and they continued to pay any out of pocket expenses we incurred for a year after the accident. As a caveat, I will say that this event was almost 20 years ago, and things can change. However I have used them many times since and have always felt that they dealt with some more minor issues (ex.a canceled trip) fairly.