Your Health Insurance Covers Almost Nothing Abroad. Here’s the Actual Gap That’s Costing People Thousands.

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A woman in her mid-50s fell on a hiking trail outside Dubrovnik. She fractured her wrist and needed surgery. She had Blue Cross Blue Shield through her employer. She assumed she was covered.

The bill came to €7,400. Her insurer reimbursed her €900 — after she paid the deductible, after they applied the out-of-network calculation, after the exchange rate adjustment, after the claim review took four months. She paid the rest out of pocket.

This is not an unusual story. It’s a representative one. And for the roughly 65 million Americans on Medicare who travel internationally — it would have been even worse. Medicare would have paid exactly nothing.

What Your Employer Health Plan Actually Does Overseas

Most American employer-sponsored health plans provide some form of international coverage, but “some form” is doing a lot of work in that sentence.

• Emergency-only coverage: The majority of plans cover emergency care abroad — meaning a life-threatening situation — but not routine care, not follow-up care, not elective procedures you had planned before traveling. If you get food poisoning that requires IV fluids, whether that qualifies as an “emergency” under your policy is an actual debate you may have to have with your insurer from a hospital bed.
• Out-of-network calculations: In most countries, there is no in-network provider. Every foreign hospital and doctor is out of network. Your insurer will apply your out-of-network deductible and coinsurance — which for many employer plans means you pay 40–50% of covered costs after a $2,000–$5,000 deductible. “Covered” can still mean you owe thousands.
• Reimbursement, not direct payment: Almost no American insurer pays foreign hospitals directly. You pay upfront — in full, in local currency — and then file a claim for reimbursement. Foreign hospitals will not wait for your American insurance to pay. You need access to funds to cover the bill immediately.
• Claim documentation requirements: Reimbursement requires itemized bills, often in English translation, often with specific diagnosis codes. Getting this documentation from a hospital in rural Thailand or coastal Croatia is not always simple.

Some plans — typically more generous employer plans — do have true international coverage with lower out-of-pocket maximums. Check your summary of benefits specifically for “international” or “overseas” language before you assume.

Medicare Abroad: The Coverage Is Zero

Medicare — Original Medicare, the program covering roughly 65 million Americans — does not cover healthcare outside the United States. There is no emergency exception, no “it was really serious” exception, no exception for U.S. territories except for limited situations in Puerto Rico, Guam, and a few others.

Zero. You pay every cent.

There are three narrow exceptions written into law:

1. If you’re in the U.S. but a foreign hospital is closer and can treat an emergency faster than a domestic one — this might apply to someone in a Montana border town needing a Canadian hospital.
2. If you’re on a ship within U.S. territorial waters (within 6 hours of a U.S. port) when a medical emergency occurs.
3. If you’re traveling directly between Alaska and another U.S. state and must pass through Canada.

Those three situations do not apply to 99% of international travel.

Medicare Advantage plans — the private insurance alternative — may include some international emergency coverage. About 40% of Medicare Advantage plans offer some emergency international benefits as of 2024. But “some” again means emergency-only, out-of-network rates, and typically a cap of $50,000 on covered costs, which is not reassuring when a medical evacuation to the U.S. alone can cost $100,000.

The Real Cost of an Emergency Without Coverage

People underestimate foreign healthcare costs because they assume the absence of American-style billing means it’s cheap. That’s true for routine care in many countries — a doctor visit in Thailand or Mexico is genuinely inexpensive. But emergencies are different.

• Cardiac event in France: ICU for 3 days plus intervention: €15,000–€30,000. That’s at French public hospital rates. Private facility: higher.
• Appendectomy in Germany: €8,000–€15,000 including a 3-day hospital stay.
• Broken femur in Japan: Surgery plus two-week hospitalization: ¥2,000,000–¥3,000,000 (approximately $13,000–$20,000 USD).
• Medical evacuation — any country — to the U.S.: $50,000–$200,000. A medevac from Thailand to the U.S. on a properly equipped air ambulance runs over $100,000. A commercial stretcher transport from Europe: $20,000–$50,000.

The evacuation number is the one that floors people. If you’re seriously ill or injured in Southeast Asia or South America and need to be transported home to receive ongoing care — or if the local facility can’t provide what you need — you’re looking at a six-figure bill that standard travel insurance covers but standard health insurance does not.

What Travel Health Insurance Actually Covers

Travel health insurance (distinct from trip cancellation insurance) fills the gap your domestic plan leaves. A comprehensive plan typically includes:

• Emergency medical treatment with no out-of-network penalty
• Direct payment to foreign hospitals (no upfront out-of-pocket)
• Emergency medical evacuation — this is the line item that matters most
• Repatriation of remains if the worst happens
• 24/7 assistance lines that help coordinate care and navigate foreign hospitals

For a healthy 35-year-old, a comprehensive plan for a two-week international trip runs $40–$80. For a 60-year-old, more like $100–$180. For a 70-year-old, $200–$350 or more depending on destination and pre-existing condition coverage.

The pre-existing condition question is critical and frequently misunderstood. Most travel health plans exclude pre-existing conditions by default. Getting a “pre-existing condition waiver” — which extends coverage to those conditions — typically requires purchasing within 10–21 days of your initial trip deposit and being medically fit to travel at time of purchase. Miss that window and your diabetes, heart condition, or recent surgery is excluded.

Medical Evacuation: The Line Item That Changes Everything

If you buy nothing else, buy medical evacuation coverage — or consider a dedicated MedEvac membership.

Global Rescue and MedJet are the two most commonly used medical evacuation membership programs. They operate differently from insurance:

• Global Rescue: Provides field rescue and evacuation to the hospital of your choice in the U.S. Annual membership starts around $329 for individuals. No per-incident billing.
• MedJet: Focuses specifically on hospital-to-hospital transfers. If you’re admitted to a hospital overseas, MedJet will transport you to your hospital of choice in the U.S. Annual individual membership around $350.

These are not insurance plans — they don’t cover your medical bills. They cover the transport. But given that transport is often the most expensive single line item in an international medical emergency, the membership math is compelling.

How to Actually Fill the Gap

Here’s the practical framework:

1. Call your insurer before any international trip and ask specifically: Does my plan cover emergency care abroad? What’s my out-of-network out-of-pocket maximum for international claims? Does it pay providers directly or require reimbursement?
2. If you’re on Medicare, buy travel health insurance for every international trip. There is no version of Medicare that covers you overseas. This is non-negotiable.
3. Use a comparison platform: InsureMyTrip.com and Squaremouth.com both aggregate travel insurance plans and let you filter by medical benefit amount and evacuation coverage. Look for at minimum $100,000 in emergency medical and $250,000–$500,000 in evacuation.
4. Consider an annual travel insurance policy if you travel more than twice a year. Annual multi-trip plans from companies like Allianz, IMG, or GeoBlue run $200–$500 per year and cover every trip under 30–45 days.
5. Travel with a credit card that includes travel health benefits: Some premium cards (Chase Sapphire Reserve, Amex Platinum) include emergency medical evacuation coverage. Read the specific terms. These are supplements, not full replacements for a dedicated plan.

The one thing you absolutely cannot do is assume your American plan covers you the way it covers you at home. It doesn’t. The gap is real, it’s large, and it tends to reveal itself at the worst possible moment.