Health coverage for foreigners traveling in the US

The other day I caught a brief scene from some medical drama (it just happened to be on when I turned on my TV). From what I saw, the plot was thus: A British couple was on vacation in the US when the woman fell ill, ill enough to go to the emergency room at an American hospital. The couple has no insurance, because they have no reason to, because they’re covered by the NHS back home. Paying for treatment out of pocket would basically bankrupt them, the woman wants to just go home and have the NHS deal with it, but the doctor warns that it’s not safe to travel in her condition… And then I fired up the Netflix app so I didn’t see how it turned out.

But I’m wondering, just how realistic was that scenario? Specifically…

  1. Does the NHS not have some way to pay for treatment UK citizens receive at foreign hospitals? Do they only cover treatment you actually receive in the UK?
  2. If they don’t pay for treatment at foreign hospitals, can UK citizens buy insurance that will cover emergency medical care when they travel abroad? Does the NHS encourage people to buy such insurance?

Travel insurance is a standard purchase for people travelling abroad. As well as the obvious cancellation/theft/lost luggage cover, it will include medical cover for necessary treatment abroad and for repatriation costs; once you get back to the UK the NHS takes over.

(When effecting the insurance you nominate what countries you will be visiting. If the USA is on the list the premium will increase dramatically.)

Canadian here, I have out of country coverage included with my work insurance as well as my credit card. Outside of those, I could purchase stand-alone insurance either per trip or on annual basis.

I did purchase stand alone insurance when I travelled to Florida in February because it included full COVID coverage, including cancellation and quarantine, for about $25 for my 3 day trip.

Canadian health insurance would only pay domestic rates if I needed it in the US, which is a fraction of the price.

We once did a trip that included the US, then a few weeks later, to Britain and France.

Even though we were overseas for longer, the US premium was much, much higher.

It is a real issue. I once saw a Canadian truck driver who had severe chest pain while in Florida. He spent two days driving back to Canada where I diagnosed his heart attack. Nice guy. He felt being seen in the US would be too expensive and was probably right, but still…

I am amazed now that when I was young and foolish, I would travel across the USA with no health insurance - on a motorcycle. Travel health insurance for Canadians is readily available, promising to cover most foreseeable medical bills, with conditions. Since we don’t need actual health insurance, medical benefits from work tend to be things like dental and prescription coverage, and travel health (which my wife has for us.) Otherwise, I can buy it retail from insurance brokers, just like accident coverage for rental cars. The show your saw probably refers to the type who don’t bother to get it because “it won’t happen to me.”

There are some obvious limits - for example, I think they only cover the first 30 days of any trip outside the country, unless you buy the extended coverage. It gets more expensive the older you get. It may also include the cost of bringing me back home, since a medical transport will likely be far cheaper than an extended stay in the USA hospitals.

There’s the standard medical provisos - it will not cover many pre-existing conditions and will be more expensive if you are a higher-risk person. An older lady I knew had a mild heart attack, and could not afford the insurance to spend winters in the USA until she’d been healthy for two years. (Another fellow mentioned how his uncle had a stroke in his winter home in Texas, no insurance. His dad got the call from a neighbour who found the guy, flew down there. He took the back seat out of the uncle’s SUV, put him in the back and drove nonstop from Texas to the Canadian border because they could not afford anything else.)

Public Service announcements regularly remind Canadians that travellers should have travel health insurance. Our medicare will only cover up to the rate amount on the provincial health plan for out-of-province care, which tends to be substantially less than what US doctors or hospitals charge for the same treatment. If you don’t have travel insurance, of course and difference becomes a debt; and the hospital or its debt collectors can enforce that debt back in Canada. Could be worse. I hear stories about some third-world countries like Egypt that will not release a patient from the hospital until some arrangement has been made to pay the debt -but at least, they don’t charge what Americans do. (yes, you should have Trael Health Insurance if you travel anywhere outside of Canada.)

I’m not sure with the British couple on the show, but I think that (maybe not now with Brexit?) the European countries had reciprocal agreements so such insurance was not necessary travelling between them - hence the ignorance or complacency?

To echo what’s been said: I have many family members in Canada. They never travel to the US without purchasing travel insurance.

News stories about Canadians getting stuck with a big U.S. hospital bill are a semi-regular occurrence up here. E.g.:

There’s an arrangement in the EU/EEA under which residents of any member state can get a “European Health Insurance Card” which entitled them, in every other member state, to the same public healthcare as residents of that other state get (NB not to the same public healthcare as they themselves would get in their home country). So if you get, say, free prescription drugs in your home country but you are visiting a country where people have to pay for prescription drugs, you’ll have to pay for prescription drugs. And it doesn’t cover repatriation costs because, of course, that’s not a benefit any country offers to its own residents.

For that reason people travelling between EU/EEA countries would still be advised to effect health insurance, to avoid nasty shocks. But the risk of not having it is lower, obviously, than if you are visiting a country where you have no rights as a non-resident.

UK falls out of this arrangement with Brexit, but has negotiated a replacement arrangement with the EU (but not the EEA).

The NHS is a public service - like schools or the Police - importantly it isn’t health insurance, so it doesn’t cover you for treatment abroad. As stated above, we have an arrangement with EU countries for reciprocal healthcare, but that’s a political arrangement, nothing to do with the NHS.

Yes of course, it’s standard practice for anyone - of any nationality - to buy travel insurance, which includes medical cover. Mine actually comes free with my bank account, but it’s trivially cheap if you have to buy it. The average annual cost of travel insurance is less than £40.

The NHS doesn’t tell you to get it, because the NHS is not a health insurance provider. What you do abroad is nothing to do with the NHS.

Forgot to add re: the story in the OP. Any Brit who travels to the US without thinking they need insurance is very foolish or very inexperienced in travel - and all travel insurance includes medical cover of some sort. I can perhaps understand that people who habitually travel to Europe might think they’re covered, but really, every travel booking site, airline and travel agent is constantly pushing travel insurance on us so you’d have to be exceptionally unobservant to miss it. But people do stupid things all the time, right?

It is perfectly possible for a British couple to travel to the USA with no health insurance of any kind. It is relatively expensive, especially for someone with a pre-existing condition, so I would lay odds that many of the British visitors to Disney World cross their fingers and hope for the best.

A British mum has been hit with a £75,000 medical bill after prematurely giving birth by emergency caesarean in the USA. The mum, from Birmingham, was due to fly home on December 13 [2020] but gave birth in Texas two days prior. With no insurance, Amy is left with a £75,000 hospital bill for the delivery and care of her son with the costs set to rocket further to a six figure sum.

If you book through an agent, they will often include insurance as part of the deal, but there is no law to say you have to pay for it.

There is still a reciprocal arrangement between the UK and the EU. Brits in Europe can get a free Health Insurance Card (GHIC) lets them get state healthcare in Europe at a reduced cost or sometimes for free. They are still advised to take out insurance though.

Outside the EU, insurance is strongly advised, but many people take the chance in countries like Turkey, Norway, Iceland and Liechtenstein.

After a trip to Turkey, a couple say that they can’t leave until they pay the full cost of a surprise medical bill. [It was] reported that couple Saul Daly and Kathleen McLean are unable to leave Turkey until they pay the full intensive care medical bill of $18,000 USD (£15,000). Saul was rushed to hospital while on vacation in Turkey where medics found blood in his lungs.

I live in the UK and get wonderful treatment from our NHS.
Whenever I travel to the US, I take out insurance which includes $1,000,000 for health problems.

I believe there is (or maybe now “was”, post-Brexit) a scheme whereby the UK government will reimburse NHS residents for additional payments in EHIC countries that they wouldn’t have to pay for NHS services. There are also limited reciprocal health agreements with some other countries outside Europe, but each is different in detail and no-one should rely on that and not get insurance. You’d need insurance for emergency repatriation, for one thing, and even, say, a simple broken limb is going to mean additional non-medical costs.

Likewise, people visiting the UK shouldn’t imagine they’ll get NHS care: there are periodic media scares about “health tourism”, and quite carefully detailed rules about eligibility for different sorts of visitors*. Emergency care to stabilise/patch you up, or public health requirements, will probably be free, but not follow-up care. A pregnancy such as that mentioned above could well get a pretty massive bill from the NHS.

(*Leading to the “Windrush” scandal, where a fair few people who came to the UK as children under old rules discovered, thanks to Home Office rigidity in applying new rules, found that their documentation wasn’t enough and they’d have to pay thousands for NHS care in their old age).

The official Australian government advice for travelling in the US is:

Get comprehensive travel insurance before you leave.
Your policy needs to cover all overseas medical costs, including medical evacuation. The Australian Government won’t pay for these costs.
If you can’t afford travel insurance, you can’t afford to travel. This applies to everyone, no matter how healthy and fit you are.
If you’re not insured, you may have to pay many 1000s of dollars up-front for medical care.

I’ve heard anecdotally that insurers have told Australians that if they require hospitalisation in the US they should either catch their own flight home or get medivacced, because it will be cheaper for everyone.

Not only should you get insurance, but you should also read the fine print. The couple in the story I highlighted above did have insurance but had an accident on a rented quad bike. This invalidated their insurance on the grounds that they were not covered for “sporting activities”.

Not just the USA. I recall a news item maybe 20 years ago about a Polish woman who gave birth while on a trip to Canada. She got a bill for $20,000 which I thought was shocking at the time, but nowadays seems pretty cheap.

Plus, it’s not something I (or my wife) have to worry about now, but I would not be surprised to find that pregnancy, or at least later stages, is not covered under travel health, as an example of a pre-existing condition.

Both when I lived in Japan and now in Taiwan, the national health insurance for either country does not cover overseas.

When I lived in Japan, I had insurance through a credit card and here in Taiwan, I have supplemental insurance.

A friend of mine emigrated from the UK to the US with his wife. When they discovered the costs involved in having a hospital birth in the US, they decided to fly back to the UK to use the NHS for free. I expect there are rules against this by now given the years of anti-immigrant scare stories that pervade the UK press leading up to Brexit. Not sure how the all the British retirees are faring in the warmer climes of Spain and other EU countries after Brexit. Without a reciprocal agreement on healthcare they will have to buy health insurance cover which may be unaffordable. They too, I am sure, will avail themselves of the cheap flights back to the UK for medical treatment…if they are mobile.

For US travel, I guess it works if you have some kind of health condition that has stabilsed and can be managed. But for accidents and sudden medical emergencies you don’t want to be at the mercy of whichever ambulance arrives at the scene and plunges you into a desperate transaction with the more mercenary branches of the US healthcare system. I guess the young and healthy tend to take a chance, but once you become wise enough to appreciate threats to your mortality, a more cautious attitude prevails.

A quick check on an a comparison website suggest about $200 for a months US insurance cover with no existing conditions. But, of course, that is to draw you in. With insurance, the devil is in the detail and the risk is that you may find yourself fighting your corner from a hospital bed.

Insurance for a month in Spain is about $40 and they have a national healthcare system.

People tend not to think about Health insurance much countries that have public healthcare systems. In the UK, especially, the state pays for healthcare, except for a modest drug prescription charge, so you rarely, if ever, see a bill. This system does not prepare people for the realities of healthcare in systems where it is financed by insurance. All those curious terms that mean you are not covered by your policy and must pay out of your own pocket…

I’m really surprised to see that some tourists have problems with health care.
I travel to the US once a year or so, and always buy travel insurance.
It used to be free, a benefit from my Visa credit card provider, but recently they’ve cancelled that benefit, so I pay like everybody else. And it is no problem whatsoever.

It costs about $5 per day of travel, though my last trip included extra fees for Covid coverage, and I’m over 65–so it cost me $10 per day.

One simple phone call to the insurance company, and I have coverage for up to one million dollars,.
For a two week trip, the insurance cost less than those irritating fees the airlines add for checked bags…
It’s a no brainer