Chapter 2The Pre-Travel ConsultationCounseling & Advice for Travelers

Katherine J. Johnson, Theresa E. Sommers

INTRODUCTION

Travelers must consider the financial consequences of a severe illness or injury abroad. Basic accident or travel insurance may even be required for travelers to certain destinations. A growing number of people do not have health insurance at home, and these travelers must consider both travel health and evacuation insurance, which can be purchased together or in separate packages. People who have domestic health insurance policies need to determine if any needed medical care abroad will be covered adequately or if supplemental travel health insurance policies are needed. Travelers whose domestic policies provide adequate health insurance abroad should look for potential gaps in coverage: domestic health insurance policies may not cover medical evacuation from a resource-poor area to a hospital where definitive care can be obtained, or the insurance company may not have the resources to help organize such an evacuation. Evacuation-only policies are available to fill this gap. Evacuation by air ambulance can cost $50,000–$100,000 and must be paid in advance by people who do not have insurance.

PAYING FOR HEALTH SERVICES ABROAD

Travelers who receive medical care in other countries will usually be required to pay in cash or with a credit card at the point of service, even if they have insurance coverage in their home country. This could result in a large out-of-pocket expenditure of perhaps thousands of dollars for medical care. Travelers should also remember that the existence of nationalized health care services in a given destination does not ensure that nonresidents will be given full coverage.

When traveling abroad, travelers with any insurance coverage should always carry copies of their insurance policy identity card and an insurance claim form. Travelers should be reminded to locate medical services in areas they plan to visit and carry this information with them (see Obtaining Medical Care Abroad for the Ill Traveler earlier in this chapter). In the event that they must pay out of pocket for care, travelers should obtain copies of all bills and receipts. If necessary, the US consular office can assist US citizens with transferring funds from the United States.

Medical evacuation insurance may only cover the cost to the nearest destination where definitive care can be obtained. Some policies will cover eventual repatriation to one’s home country. The traveler should be sure to understand what coverage is purchased.

EVALUATING DOMESTIC HEALTH INSURANCE POLICIES

Some health insurance carriers in the United States may provide coverage for emergencies that occur while traveling abroad. Travelers should carefully examine their present coverage and planned itinerary to determine exactly which medical services, if any, will be covered abroad and what supplemental insurance is needed. The following is a list of things to consider:

• Exclusions for treating exacerbations of preexisting medical conditions
• The company’s policy for “out-of-network” services
• Coverage for complications of pregnancy
• Exclusions for high-risk activities such as skydiving, scuba diving, and mountain climbing
• Exclusions regarding psychiatric emergencies or injuries related to terrorist attacks or acts of war
• Whether preauthorization is needed for treatment, hospital admission, or other services
• Whether a second opinion is required before obtaining emergency treatment
• Whether there is a 24-hour physician-backed support center

Medicare and Medicaid will not cover services outside the United States, except in limited circumstances.

SUPPLEMENTAL TRAVEL HEALTH AND MEDICAL EVACUATION INSURANCE

Travelers need to evaluate their existing health insurance policies using the list above to see whether they have adequate coverage. Short-term supplemental policies that cover health care costs on a trip can be purchased. Evacuation coverage can be sold separately or in conjunction with travel health insurance. Evacuation companies often have better resources and experience in some parts of the world than others; travelers may want to ask about a company’s resources in a given area before purchase, especially if planning a trip to remote destinations. In general, travelers should purchase a policy that provides the following:

• Arrangements with hospitals to guarantee payments directly.
• Assistance via a 24-hour physician-backed support center (critical if the traveler is going to pay for evacuation insurance).
• Emergency medical transport, including repatriation. Medical evacuation without insurance can be costly, ranging from a few thousand dollars to over $100,000.
• Any specific medical services that may apply to their circumstances, such as coverage of high-risk activities.

Although travel health and medical evacuation insurance are considerations for all travelers, they are particularly important for travelers who will be outside the United States for an extended period of time, have underlying health conditions (travelers should make certain that complications will be covered), and participate in high-risk activities. Even if an insurance provider is selected carefully, travelers should be aware that unexpected delays in care may still arise, especially in remote destinations. In special circumstances, travelers may be advised to postpone or cancel international trips if the health risks are too high.

FINDING A TRAVEL HEALTH AND MEDICAL EVACUATION INSURANCE PROVIDER

The following resources, while not all-inclusive, provide information about purchasing travel health and medical evacuation insurance:

• Department of State (www.travel.state.gov)
• International SOS (www.internationalsos.com)
• MEDEX (www.medexassist.com)
• International Association for Medical Assistance to Travelers (www.iamat.org)
• American Association of Retired Persons (www.aarp.org) (for information about Medicare supplement plans, see below)

SPECIAL CONSIDERATIONS FOR TRAVELERS WITH UNDERLYING MEDICAL CONDITIONS

Travelers with underlying medical conditions may want to take extra precautions in preparing for travel. These travelers should choose a medical assistance company that allows customers to store their medical history before departure, so it can be accessed from anywhere in the world, if needed. Travelers should carry a letter from their physician listing underlying medical conditions and all current medications (including their generic names). They should also pack all medications in their original bottles, checking beforehand with the appropriate international embassy to ensure that none are considered illegal narcotics in the destination country. If possible, travelers may want to carry with them the name of their medical condition and medications written in the local languages of the areas they plan to visit.

SPECIAL CONSIDERATIONS FOR MEDICARE BENEFICIARIES

The Social Security Medicare program does not provide coverage for medical costs outside the United States, except in limited circumstances. Medicare beneficiaries can purchase supplemental travel health insurance to cover medical expenses outside the United States. Some Medigap plans may provide limited coverage for emergency care abroad. As with all travelers, Medicare beneficiaries should examine their coverage carefully to know exactly what will be covered abroad, and supplement with additional travel health insurance as appropriate.

BIBLIOGRAPHY

1. Centers for Medicare and Medicaid Services. Medicare coverage outside the United States. Baltimore: CMS; 2010 [updated 2010 Sep; cited 2008 Jun 30]. Available from: http://www.medicare.gov/Publications/Pubs/pdf/11037.pdf (PDF).
2. US Department of State. Medical information for Americans abroad. Washington, DC: US Department of State; 2010 [cited 2010 Nov15]. Available from: http://travel.state.gov/travel/tips/brochures/brochures_1215.html.
3. US Department of State. Medical insurance. Washington, DC: US Department of State; 2010 [cited 2010 Nov 15]. Available from: http://travel.state.gov/travel/cis_pa_tw/cis/cis_1470.html.