Travel insurance for US residents: Medicare and health plan gaps
Americans often assume their health plan travels with them. In many cases it doesn't, especially with Medicare. Here is where the gaps tend to be and what US residents should check before leaving.
By the StarHolidays Editorial Team Updated 4 min read
Key takeaways
- Medicare generally doesn't pay for care outside the US, and the US government won't pay your bills abroad.
- Eligible Medigap plans cover 80% of emergency costs abroad after a $250 deductible, up to $50,000 for life.
- The State Department says an air ambulance home can cost roughly $20,000 to $200,000.
- US plans often offer pre-existing condition waivers if you buy soon after your first trip deposit.
On this page
What the US government says
The State Department's position is clear: US health programs such as Medicare and Medicaid generally don't pay for care outside the country, and the government itself won't pay your medical bills abroad. It recommends buying medical evacuation insurance, particularly for higher-risk areas, and says it can be bought separately or as an add-on. It also notes that trip cancellation policies usually don't pay for medical costs abroad.
Medicare and Medigap
Medicare generally won't pay for health care outside the US, apart from some limited situations. Medigap plans may fill part of that gap:
| Medigap foreign travel emergency benefit | Details |
|---|---|
| Plans currently sold that include it | C, D, F, G, M and N, subject to availability |
| Older plans that may include it | E, H, I and J, if bought before June 1, 2010 |
| Coverage | 80% of billed charges for medically necessary emergency care |
| Deductible | $250 per year |
| Lifetime maximum | $50,000 |
| Timing | Emergency care must begin during the first 60 days of your trip |
Medicare's fact sheet may be several years old, so confirm these terms with your insurer. Plans C and F are limited to people who became eligible before 2020. Medicare Advantage plans differ and might include some emergency benefits abroad, so call your plan.
Note what this leaves out: 20% of the bills, anything above the lifetime cap and transport home. If you're on Medicare, read travel insurance for seniors, and consider a medical and evacuation policy.
Employer and marketplace plans
Some private plans cover emergencies abroad, but ask specifically:
- Is emergency care abroad covered, and at what level, in or out of network?
- Will you pay the hospital directly, or will I need to pay and claim later?
- Is medical evacuation or repatriation included?
- How do I get pre-approval, and is there a 24-hour number?
Many plans treat foreign care as out of network. The CDC warns that you may have to pay out of pocket, and you may then have to submit foreign bills to your insurer, which can take time.
How policies work in the US market
Comprehensive plans are common. They combine trip protection with medical cover. Squaremouth reports that these typically cost 4% to 10% of your prepaid, non-refundable costs. See how much travel insurance costs.
Primary versus secondary. A secondary medical benefit requires you to claim from your health plan first, while primary pays first. Primary is generally simpler, so check before you buy.
Waivers. Many plans will waive their pre-existing condition exclusion if you buy soon after your first trip deposit. Commonly quoted windows are 14 or 21 days. See our guide to pre-existing conditions.
Cancel for any reason. Available from many US insurers, with reimbursement often up to 75%. Availability varies, and it isn't sold to residents of every state.
Regulation. Insurance is regulated at the state level. Your state's insurance department is the place to check licensing or to raise a complaint.
How much does it cost?
InsureMyTrip reports an average premium of $184 per person for international travelers in 2026, about 6% of trip cost. Squaremouth's average is about $307 per policy, with a 15-day average trip. Age is a big driver, so older travelers will likely pay more. Our cost estimator gives you a quick benchmark.
Common US-specific situations
Going to Europe. US citizens can make short visits visa-free, so the Schengen €30,000 rule doesn't apply to them directly. But Medicare still won't pay, and you may want cover anyway.
Mexico and the Caribbean. Check hurricane terms and resort activities. Read the exclusions for natural events and alcohol.
Cuba. Check permitted travel categories and what your ticket includes. See our Cuba guide.
Cruises. Medicare's gaps become more obvious on a cruise, particularly once you leave US waters. See our cruise guide.
Credit cards. Premium cards may offer valuable benefits, but check the medical limits, since those are commonly low or absent.
Before you go
The State Department's checklist is a good place to start. Check your passport's validity, enroll in the Smart Traveler Enrollment Program (STEP) if you want to receive alerts, and read the travel advisory for your destination. Carry your insurer's assistance number, and keep some funds available in case you're asked to pay up front.
Frequently asked questions
Does Medicare cover me abroad?
Generally no, apart from limited situations. Eligible Medigap plans offer a foreign travel emergency benefit with an $50,000 lifetime cap. Check your plan, and consider travel medical cover.
Does my US health insurance work overseas?
It depends on your plan. Some cover emergencies abroad, usually with limits, and evacuation is rarely included. Ask your plan directly, and note that you may have to pay first.
Do Americans need travel insurance for Europe?
Short visits are visa-free, so the Schengen rule does not apply directly. But your health plan may offer little in Europe, so cover is still worth considering.
Where do I complain about a US travel insurer?
Start with the insurer's complaints process, then contact your state's insurance department if you cannot resolve it.
Sources we checked
- US State Department: Travel insurance
- US State Department: Medicine and health abroad
- US State Department: International travel checklist
- Medicare.gov: Medicare coverage outside the United States (fact sheet)
- Medicare.gov: Compare Medigap plan benefits
- CDC: Travel insurance
- InsureMyTrip: How much should travel insurance cost?