11 MIN READ
If your loved ones are visiting the United States, it’s a good idea to make sure they are covered by health insurance. With the high cost of healthcare in the US, it would be expensive to fall ill or become injured during a US trip. US emergency rooms are required to treat all patients who need emergency care without regard for their ability to pay but that won’t prevent them from trying to collect payment, regardless of where a person resides.
Emergency bills and other sudden expenses can be a huge financial burden. Visiting an urgent care or the emergency room can cost anywhere between $150 to $1,000,000 depending on how severe your injuries are. For ambulance or helicopter services, costs can be as high as $25,000 and critical care can be as much as $1,000,000 if injuries or illness are very severe and require lengthy hospitalization.
If you’re unfamiliar with visitor health insurance, we’ve created a primer that provides tips for finding the best policy.
1. Understand Basic US Healthcare Terms
If you’re getting a visitor health insurance, it pays to know what benefits you’ll get from it. Health insurance can save you from spending a lot of money if you encounter a medical emergency.
Insurance policies and terms differ from one country to another. If you’re unfamiliar with US insurance terms, it’s best to know what they mean to help you compare insurance policies and find one that suits your needs.
Here are some of the common insurance terms you will encounter when shopping for visitor health insurance.
Deductible is the amount you have to pay for care before your insurance starts to pay for your healthcare services and the copay or coinsurance applies. If your deductible is $1,000 - you need to pay for medical fees up to that amount. After which, you will only be liable for the coinsurance amount or copay. Some policies have deductibles, others do not.
Copay or copayment refers to the fixed amount you pay right away at the counter when you receive a healthcare service. For instance, if your copay is $30 for in-network doctors, you’ll only have to pay $30 for the service at the time of the visit with an in-network doctor no matter how much the doctor charges your insurance for the consultation. You need to pay this amount each time you use a certain service. Copay amounts could vary depending on the type of service you avail. So, for instance, the copay for seeing a primary care doctor can be $30 and the co-pay for filling a prescription might be $15.
Coinsurance is similar to copay, but instead of paying a fixed amount, you will be liable for a certain percentage of the total cost of your medical fees. If you have a 20% coinsurance, you have to pay for 20% of the total cost of the visit. This may be on top of a copay. For coinsurance, you might not know exactly how much you have to pay until you receive the billing.
In network vs. out of network is an important concept to understand. Some visitors insurances cover any doctor that you visit in the US. Others take part in what is called a PPO network in which they consider only select doctors “in network” and the rest “out of network." If your visitors’ insurance policy is a PPO, it’s better to select an in-network healthcare provider if you can because they will likely bill your insurance company directly and it will be cheaper for you. For out-of-network transactions, you may not be covered or you may have more trouble filing a claim: you would most likely pay for the full amount yourself although you can report the transaction to your insurance company and request for reimbursement for those expenses. Insurance policies will set specific rules on how to deal with out of network transactions. If your insurance company offers a PPO, they will provide a list of in-network healthcare facilities if you ask for it. In many cases, you can find the list on your insurance provider’s website.
You may have to get a pre-approval from your insurer whether you are dealing with an in-network or out of network healthcare facility. It’s also best to get in touch with your provider when in doubt. Receiving a pre-approval can make it easier to get an approval when you file a claim with your insurer or a medical emergency relate to an acute onset.
2. Learn How Fixed Coverage Plans Differ From Comprehensive Coverage Plans
Fixed coverage plans are the cheapest visitor insurance available, and they specify a predetermined coverage amount that the insurance will pay for each type of medical procedure. This is ideal for small ailments, but you will pay more for major medical expenses.
If you want more benefits from your insurance, it’s better to opt for a comprehensive plan which covers expenses up to the plan maximum less co-insurance and deductible.
Check out this comparative chart on how fixed coverage plans and comprehensive coverage plans differ.
Predetermined benefit limits for different medical expenses covered
Usually covers 75 to 100% of the bill after the deductible and up to the policy maximum
Healthy visitors planning to stay for a short time
Visitors with pre-existing conditions
Patriot America Plus, CoverAmerica – Gold, Liaison Travel Economy
ChoiceAmerica, Inbound USA, Inbound Guest
You can check out Visitors Coverage to compare visitors health insurance plans.
3. Check If Pre-existing Conditions Are Covered and What to Do if They Are
Pre-existing conditions are medical conditions, whether diagnosed or not, which existed before an insurance policy became effective. These conditions often include asthma, heart ailments, high blood pressure, kidney disease, cancer, diabetes, and other chronic ailments. It’s important to know if you or your visitors have one of these conditions prior to purchasing a policy so that illnesses relating to this condition are not excluded from coverage.
Typically, your insurance provider will outlines terms and conditions related to a pre-existing condition. This clause often provide a non-exhaustive lists of diseases considered as pre-existing. For visitors insurance, you don’t have to undergo any medical examination. Your insurer will rely on the information you provided and from your medical history. Usually, there is a "look back" period which is usually from 30 to 180 days. The underwriter considers this period as relevant to your state of health.Most visitor insurance plans do not cover pre-existing conditions, but they may cover acute onset of pre-existing conditions. Acute onset of pre-existing conditions refers to an unexpected and sudden recurrence or outbreak of the pre-existing condition without advance warning which is rapidly progressing and requires care within 24 hours. If your illness is considered as pre-existing and doesn’t qualify for acute onset, the insurance company can deny any claim you file with them.
The insurance policy document outlines conditions and situations considered to be acute onset. Your policy also outlines the proper steps on how to use your policy, like when you will need to seek pre-approval. If the policy covers pre-existing conditions, it may have requirements that insured follow recommendations to manage the pre-existing condition. For instance, a person who has suffered heart attacks in the past would be required to take regular dosage of the maintenance drug in order to qualify for acute onset coverage. Most companies that cover acute onset provide fixed or limited coverage up to a maximum limit and often are only available for individuals under 70 years old.
It’s worth noting that most health problems while traveling involve sickness due to change in food habits and weather. Accidents are also common travel injuries. Even if a visitor has a pre-existing condition, there’s still good reason to be covered, even if a policy excludes pre-existing conditions. Some insurance companies also offer pre-existing condition waivers to attract buyers. These plans are also subject to limits imposed by the provider. Read the fine print!
4. It’s Possible to Find Cost-Effective Coverage for Visitors Above 70, Here’s How!
Travelers who are 70 and above are more susceptible to illness and are high risk for insurance providers. You should expect to pay higher premiums for this age group and some travel insurances may refuse coverage to people over 70.
However, there are still insurance providers who are willing to insure people in this age group.
Some companies also provide comprehensive insurance to visitors over 70 that pays 100% after the deductible and covers acute onset of a pre-existing condition up to a certain amount. Companies offering this plan include CoverAmerica-Gold and Patriot Platinum.
5. Understand State Limitations on Travel Insurance
There are no federal regulations for travel insurance but every state has specific rules involving policies.
Restricted states have specific rules on insurance. Maryland, for instance, prevents state residents and people whose mailing address is in the state from buying insurance plans like VisitorsCare and Patriot America. The restriction will also apply if the primary destination you provided is a restricted state. Other states with similar restrictions to some insurance providers are Washington, New York, South Dakota, and Colorado. You can check insurance restrictions on popular providers here.
The restriction will only prevent you from purchasing the insurance. You can still use it within the state. If your billing address is in a restricted state or when you are visiting the restricted state and you are not purchasing the plan while in the state, you will still be able to avail the plan.
6. Things to Watch Out for When Buying Visitors Health Insurance
When it comes to visitors insurance, it’s useful to look into the details. Here are some useful information nuggets to help you gain a better understanding of this insurance policy.
Usually, visitor health insurance will not cover the following:
- Pre-existing conditions
- Dental care unless except for dental emergencies
- Skin care treatment and dermatological problems
- Vision care except for treating eye injuries
- Preventative or routine care (check ups, vaccines)
- Injuries and illness due to terrorism or war
- Childbirth, pregnancy, and maternity issues
- Injury from high-risk sports
- Mental health care
- Injuries related to drugs and alcohol
Requesting for Pre-approval for Hospital Visits
Pre-approval, also known as prior authorization, pre-certification, and pre-authorization, is a notification sent to your insurance company to obtain authorization for a prescription or treatment. Insurance providers may not cover the cost of your healthcare without a pre-approval.
For in-network providers, the hospital, doctor’s office, or facility will often offer to notify your insurance and confirm that your care is covered.
If you are dealing with an out-network provider, you may need to notify your insurance company by contacting them directly to obtain authorization. In this case, you likely have to pay upfront and request for reimbursement.
In most cases, visitors and their healthcare providers have to request pre-approval in order to get insurance coverage for the following:
- Overnight stay at the hospital
- Major surgery
- Prescription of costly drugs or drugs with serious side effects
- Referral to a behavioral, physical, speech or occupational therapist for treatment
Note that your specific plan may require pre-approval for everything and anything - it’s best to check with your insurance carrier before seeking treatment.
Can plans be renewed if you extend your trip?
Yes. If you extend your trip, you can either extend or renew the insurance on or before it expires. Take note that an extension and renewal is different.
Insurance policies often have an anniversary date when the deductible resets. Even if you have insurance coverage of up to two years, the deductible will reset on the anniversary date.
If the original insurance coverage is six months, you may be able to extend it month by month until the anniversary date. Once it reaches the one-year mark, the deductible will reset and at this time, you have to renew the policy.
Remember that policies on extending or renewing insurance will vary depending on your insurance provider. Consult your insurance provider for details on how to extend or renew the insurance.
Can plans be refunded if you cancel your trip?
Yes, you can cancel your insurance and get a refund. Some companies will only allow a cancelation before the policy’s start date. Some providers will allow you to claim a refund provided that you haven’t filed a claim. Check this summary of common visitors insurance cancellation policies for more details.
It Pays to Be Prepared!
Traveling to the United States can be an exciting experience whether you are a traveler or a family member plans to visit the country. However, it’s always prudent to make advance preparations as unexpected things can happen during the trip.
Bills can quickly add up if you run into a medical emergency. Insurance may seem like just another expense, but it can help you avoid a huge financial burden. However, you should also be careful in choosing a plan that meets your needs and your budget.
Related Article: How Much Money Can I Bring On A Plane Into the US?