Health Insurance benefits differ from policy to policy. Some cover emergency care outside the USA while other plans will only cover care inside the USA. Almost none cover international medical evacuation though. Thus, there is no simple answer to will your policy cover international care, due to the numerous different policies available.
International care is broken down into a couple of different care categories. First is emergency care, which is the most often covered international care because it is unplanned and necessary care. Routine care is something almost no policies cover on an international basis. Thus, going out of the country for a check-up or procedure is typically not covered. Frequently emergency care outside of the USA is far less expensive than that received in the USA, which is another reason most carriers do not have a problem paying for such care. The insured likely will have to pay out of pocket and seek reimbursement though as opposed to the provider directly billing the insurer like here in the USA.
Another way of getting a better idea about your coverage or lack thereof is to know the kind of payor (insurance company) involved. Medicare, for instance, which is for those 65 and over, who have paid into the system long enough (at least 40 quarters to qualify for premium free part A) or the disabled who were granted Social Security Disability and subsequently Medicare for the disabled, and Medicaid are the two largest government plans. The government generally does not pay for any care outside of the USA. (Some special exceptions occur along the border.) Other insurance comes thru employer sponsored group health plans or individual health plans. With these private insurance plans it is important to investigate to be sure if your plan will or won’t they cover emergency care outside the USA. Beyond emergency coverage will take even further investigation to fully uncover if you can seek “routine” care outside the USA and have coverage for the cost of that care.
Virtually all Indivdual major medical health plans will cover emergency care outside the USA. Group plans also generally cover emergency care outside of the USA, especially when the plan is fully insured. Self insured groups (those plans where the employer puts aside money to cover care) have more liberty in how they define covered services. The self insured plans may opt to not provide coverage for emergency care outside the USA, assuming instead that a covered individual will choose travel insurance when going abroad. The best way to know for sure is to ask the employer or review your certificate of coverage. Or if you have individual coverage ask your agent.
In the event the health insurance does not cover emergencies outside of the USA, it is important to get travel insurance that includes adequate emergency care coverage while on the trip. Without insurance travelers can be out of pocket and often the providers will require payment before treatment, especially outside the USA. This could be financially devastating to most travelers. There is definitely value in having travel insurance to cover emergencies even with medical insurance that provides emergency care outside the USA, because nearly all will refuse to pay for medical evacuation back home.
Of course some people want to travel internationally for lower cost good quality care. There are several areas in the world where US quality care is available at facilities and providers all trained in the West. Most who seek care in this manner are paying cash, and often seek this care due to the significant savings over what would be paid for the same services here in the USA. Insurance generally does not cover care of that nature, because until recently it has been difficult to ensure the quality of care is on par with that in the USA.
There are a few international healthcare facilities that have achieved JCAHO certified facility status. This is a critical step towards being able to get US based insurance companies to recognize that the facility meets the same quality markers as US based facilities. This helps in the efforts undertaken by these facilities to facilitate direct payment from insurance carriers. Even where not directly paid, these facilities that hold JCAHO status can make it easier for the member/patient to get reimbursed.
Because of the travel costs and follow up care requirements, the insurance carriers are a bit timid to rush into paying for this care. Several are looking at ways to offer a “centers of excellence” style benefit for care outside the USA. These kinds of programs generally are limited to specific medical procedures include airfare for the patient and often one escort. Lodging is often covered as well for the time period pre-operation thru the required follow up visits at which time the patient returns home or picks up the tab for additional time away from home.
As we see more facilities and programs around the world obtain JCAHO certification, we will likely see a growing list of programs the care can be received overseas. Generally the care is surgical and includes regularly performed medical procedures. Most require several days from initial pre-operative consultation thru completion of treatment, some of which is at the hospital and some of will be hotel based recovery. The reason insurance carriers are looking towards adding these programs is that the price for many of these care programs is a small fraction of what would be paid at a hospital in the USA.
Coverage for international care is generally limited and tends to be provided only by private insurance companies and even then only for emergency care. The US government does not pay for care outside the USA, except in very rare circumstances, so travel insurance is important when embarking on international travel, otherwise it will become a, cash at the time of service, situation for the traveler who needs care. Further, routine care outside the USA is seldom covered however more recently some surgical procedures are being covered where big cost savings are achieved by getting the services outside the USA.
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