Special Report: Health Care Abroad
Getting medical treatment when you're traveling can be more complicated—and expensive—than you think. Here, how you can better prepare yourself
By Barbara Benham
Having the right health insurance coverage is essential no matter where you are. Consider the retiree who fell down a manhole in Oaxaca. The college student with appendicitis who had to be evacuated by helicopter from Papua New Guinea. The IT executive whose hot-air balloon crashed in Kenya.
Yet, by some estimates as few as 5 percent of American travelers have health insurance coverage while they're abroad. According to Larry Akey, spokesman for the Health Insurance Association of America, most U.S. insurance plans—even the more comprehensive point-of-service plans—do not reimburse you for any medical expenses outside the country.
For this reason, travel agents, tour operators, cruise lines, and clinics across the United States sell a host of supplemental travel health insurance plans to cover you when your regular provider doesn't. But is extra coverage always necessary?And how do you know what kind of plan to get?
WHEN TO BUY
To determine if you need travel health insurance, first check with your insurer about whether you have international coverage. Mercifully, this is a more straightforward question than you'd think: the answer tends to be a simple yes or no (it's usually no).
Supplemental coverage isn't just for international travelers, either. Some insurance plans divide the United States into geographical "markets"—if you receive care from a doctor who accepts your insurance but isn't in your market, you might not be covered, and the doctor wouldn't necessarily be aware of this. Also, many plans do not extend to U.S. territories, such as Puerto Rico and the U.S. Virgin Islands. Although emergency treatment is sometimes exempt from such restrictions, it's a good idea to check on the rules with your insurance company before you travel, especially if you're in an HMO.
Separately, if you're insured through your employer, you should ask whether the company has already taken out travel insurance coverage. Your regular insurer might not know about this, since travel insurance is sometimes arranged through a different company.
If you find out you're not covered abroad or in a particular region of the country, it is prudent to consider purchasing supplemental insurance. And if you're going to a remote area or a country where medical standards are not high, you might also think about signing up with a medical evacuation service, which will help arrange and finance transportation to a hospital. See "The Fine Print," below, for more on how to evaluate your options.
WHAT TO BUY
Supplemental travel health insurance generally comes in three forms:
• A per-trip or annual plan, to cover medical expenses and/or evacuation, that you purchase directly from a provider.
• A customized plan, typically including trip-cancellation insurance and sold by a tour operator or cruise line you've booked with. One of the biggest providers is BerkelyCare, which designs plans for companies such as Tauck World Discovery and Silversea Cruises.
• A bundled package—travel health and trip-cancellation insurance—that you buy yourself from a large travel-insurance firm such as Travel Guard International.
Prices vary but tend to be based on your age, the length of your trip, and the amount of coverage. Location can also be a factor, especially with custom plans. The State Department publishes a useful guide to insurance options (available on-line at travel.state.gov/medical.html); see also "A Guide to Travel Medical Providers," below, for basic plans from leading companies.
Seeking Treatment: What to Expect
By Michelle Andrews
For the most part, health care in foreign countries is not regulated to the extent that it is in the United States. Physicians are less likely to be trained as specialists, so board certification is uncommon. And many countries are just beginning to put hospital accreditation programs in place.
"Accreditation procedures aren't very advanced in Central and South America or Asia and Eastern Europe," says Paul vanOstenberg, executive director of accreditation for the Joint Commission International (JCI), the overseas arm of the organization that accredits U.S. hospitals. "But we've been working with countries on accreditation." Those include France, Spain, Ireland, Portugal, Germany, and Brazil.
A hospital accredited by the JCI meets standards equivalent to those in the United States for infection control, blood-banking practices, patient assessment and care, and ensuring the competency of medical personnel, among other criteria. Go to www.jcrinc.com and click on Joint Commission International to find a list of the 40 or so hospitals worldwide that meet these standards.
If you're traveling in an area where you don't have access to a JCI-accredited hospital, you can probably find one with similar standards by checking with the American Embassy or Consulate where you're staying. They can typically refer you to an English-speaking doctor or a hospital that they recommend for their own employees. Some travel insurers and medical assistance companies also maintain lists of approved doctors and facilities that you can access if you've purchased their plans or services.
Even if you have health insurance that covers medical care in a foreign country, you'll almost always need to put money on the table to receive treatment—and that often means cash, not a credit card. In many cases, you'll have to pay up front, even in an emergency, although travel health insurance and medical assistance providers may be able to help by guaranteeing payment.
Individual doctors and smaller clinics are the most likely to have a cash-only policy for foreigners, even in developed countries such as Japan, Australia, and Spain. Hospitals are more likely to accept credit cards, though they may demand that you surrender your passport and/or make a cash deposit before they'll treat you.
The Germans calculate fees based on, among other things, the services received and the patient's finances. But prices elsewhere are not so predictable. In fact, travelers may be charged inflated fees. The State Department cautions that travelers to Mexican resorts like Cancn, for instance, have been charged exorbitant rates and been billed for services not provided. The best advice: whenever possible, agree on a price before you agree to treatment.
If you've forgotten your prescription drugs or lose them while traveling in Europe or any developed country, you can most likely get the same medicine you use at home. In developing countries, that may be more difficult. Either way, know what to ask for: drugs overseas will probably have different names from the ones you're used to. The antacid Prilosec, for example, is called Losec in Canada and Gastroloc in Germany. So ask for a drug by its generic name—in this case, omeprazole. (Go to www.drugstore.com and type in a drug to learn its generic name.) Note that dosages may differ as well; the 20-milligram pill you take may come only in 40-milligram strength overseas.
Although you should always carry prescription information for any necessary medications, many can be obtained over the counter abroad. "In Brazil, 'dispense only with a prescription' isn't really the law, it's a recommendation," one pharmacist there recently told Paul Doering, a pharmacy professor at the University of Florida.
When an overseas doctor writes you a prescription, be aware that many drugs used in other countries have been rejected or pulled from the market here. For instance, a heartburn drug with the generic name domperidone that's commonly prescribed in other countries has been repeatedly rejected in the United States because of its side effects. If you get a prescription for an unfamiliar drug, ask the doctor whether it is available in America. If it's not, request one that is or ask for an explanation of why the proposed drug is an equally good—and safe—choice.
The Fine Print—Understanding Insurance Coverage
Things to look for when choosing a travel health insurance plan:
Preexisting conditions Many plans won't cover them. However, some will waive the exclusion if you purchase insurance shortly after you put down a deposit on your trip. The grace period typically runs between 7 and 15 days. Be sure to check how the plan defines a preexisting condition, and whether you might be off the hook if your diagnosis was made a few years ago.
Age Check for any special limitations on older travelers. Some plans won't cover those 75 or older; others go up to age 80.
Medical services The best plans offer round-the-clock assistance, referral and translation services, and a network of accredited health-care providers.
Adventure sports If you have an accident while engaging in a "high risk" activity—anything from scuba diving to hot-air ballooning—you'll usually need to have purchased a "sports rider" to be covered. Inquire about specific activities: some plans exempt parasailing, for example, while others don't. If you're traveling within the United States and are covered by your own health insurance, this isn't an issue; injury caused by any legal activity tends to be covered.
Pregnancy/childbirth Most travel health plans do not cover pregnancy-related episodes or childbirth. Those that do usually have restrictions.
Credit cards Some gold and platinum cards offer medical evacuation assistance. That usually means arrangements to get you to a hospital, but not the expense (though you might get your credit extended).
Medical evacuation The most comprehensive plans cover transport to the nearest high-quality medical facility as well as repatriation—that is, the trip back home. Watch out for plans that cover only "medically necessary" transfers, since this may mean you can't choose where you're treated.
Wire transfers/direct payment Some plans will wire cash or pay a hospital or doctor directly; others will not.
Prescription drugs Most plans will help you fill a prescription overseas or replace a lost one from the States. Some also offer limited reimbursement for prescriptions.
A Guide to Travel Medical Providers
INSURE MY TRIP
The Product 30 travel health insurance plans from 11 providers
What's Covered Typically, medical expenses, evacuation, and repatriation
The Cost Based on age, length of trip, and amount of coverage—anywhere from $20 for a standard single-trip plan to $250 for an annual plan
The Product TravelGap Vacationer
What's Covered Up to $100,000 in medical expenses and $50,000 for evacuation
The Cost Based on age and length of trip—a 15-day plan for travelers in their forties is $65; for those ages 60 through 74 it would be $87.50
INTERNATIONAL MEDICAL GROUP
The Product Patriot Travel Medical Insurance
What's Covered Up to $100,000 in medical expenses, evacuation, and repatriation costs
The Cost Based on age and length of trip—a 15-day plan for travelers in their forties is $37
TRAVEL GUARD INTERNATIONAL
The Product Cruise, Tour and Travel plan
What's Covered Up to $10,000 in medical expenses and $50,000 for evacuation
The Cost Based on age and cost of trip—averages between 5 and 7 percent of trip cost (higher for older travelers)
The Product MEDJET Assistance program
What's Covered Medical transport, including repatriation, for one year as long as you're at least 150 miles from home
The Cost $195 for individuals 75 and under; $295 for a family plan (up to seven people)
Traveling for Elective Surgery
For years, Jane Shealy, 45, had been thinking about liposuction. "I wanted to be able to buy jeans and not need to have them professionally altered," she says, noting that her size 12 legs were out of proportion to her size 6 waist. Still, the $11,000 to $14,000 she'd been quoted was just too high.
Then Shealy learned about a South African company, Surgeon & Safari, that promises top-notch plastic surgery at low rates, capped by a safari. The price for liposuction: $2,800. She booked a ticket to Johannesburg.
After the procedure, Shealy spent a night at a clinic and three days recuperating at a luxury hotel. Following a post-operative visit, her doctor said she was clear for a safari in Kenya. "It was more like a vacation," says Shealy. "I could get my mind off any discomfort I felt."
More and more countries like South Africa, Thailand, Mexico, and India are marketing themselves as "medical tourism" destinations for procedures such as plastic surgery, lasik eye surgery, and dental work. Surgeon & Safari, which serves about 30 clients per month, is small compared with Bumrungrad Hospital in Bangkok, a pioneer in medical tourism that treated 264,000 international patients from 144 countries last year. Bumrungrad is internationally accredited, and a third of its 600 doctors are trained overseas and/or board-certified. "We knew that we'd have to instill confidence in consumers," says Ruben Toral, the hospital's director of international operations.
If you're considering surgery abroad, be sure to evaluate the facility and the surgeon. Ask whether the doctor has completed specialty training and is licensed to perform procedures both in private practice and at a public hospital. A trained anesthesiologist is equally important. Membership in either the International Confederation for Plastic Reconstructive and Aesthetic Surgery or the International Society of Aesthetic Plastic Surgery is a good benchmark for plastic surgeons. If possible, use an internationally accredited hospital (see "Medical Standards," above) as well as one that has an intensive-care unit. And keep in mind that, should something go wrong, chances are you won't have legal recourse in the United States.