Travel Insurance for International Trips: What It Covers and When You Need It

For an international trip, the cover that matters most is usually emergency medical and medical evacuation, not trip cancellation. Most US health plans pay little or nothing abroad, Medicare usually does not cover care outside the United States, and the State Department warns that most plans do not pay for an air ambulance home. Trip cancellation only protects the prepaid, nonrefundable money you would lose if a covered reason stops you from going. A credit card's built-in protection can be enough for cancellation and delays, but it rarely replaces real medical and evacuation cover.

The three kinds of cover, and what each one pays for

Trip cancellation and interruption

Cancellation reimburses prepaid, nonrefundable trip costs (flights, tours, hotel deposits) if you cancel before departure for a reason the policy lists, such as your own serious illness, the death or illness of a close family member, or certain severe events at home or at the destination. Interruption covers the unused part of the trip and the extra cost of getting home early for a listed reason.

The word that matters is listed. Changing your mind, a work conflict or being nervous about a destination is normally not a covered reason. Some insurers sell an optional "cancel for any reason" upgrade that returns only part of your costs and usually has to be bought soon after your first trip payment. Read the deadline in the policy wording.

Before you buy cancellation cover, check what is already refundable. If the airline cancels or significantly changes your flight, you may be owed a refund without any insurance; our guide to what you are entitled to when a flight is delayed or cancelled covers that. You also do not need to insure money you could get back anyway, such as a hotel with free cancellation.

Emergency medical

Travel medical cover pays for doctors, hospitals and emergency treatment abroad. This is the gap many travelers miss. Medicare's own guidance says it usually does not cover health care while you travel outside the US, with narrow exceptions; some Medicare Supplement (Medigap) plans include foreign emergency care. Private US plans vary widely, so call yours and ask three questions: does it cover emergencies abroad, is it in-network anywhere, and will you have to pay first and claim later?

That last question matters. The State Department notes that many hospitals abroad expect payment up front, and some travel policies pay hospitals directly while others reimburse you afterwards. If yours reimburses, you need a card with enough room on it.

Medical evacuation and repatriation

Evacuation cover pays to move you to a hospital that can treat you, or home to the US, often by air ambulance with medical staff on board. The State Department says most health plans do not pay for this and that the cost can be very high. It can be bought on its own or as part of a travel medical plan. If you are going somewhere remote, on a cruise, or anywhere with limited hospitals, this is the cover to prioritise.

When credit-card cover is enough

Several travel credit cards include trip cancellation and interruption, trip delay, baggage delay and rental car cover when you pay for the trip with that card. For a trip where your main risk is losing a prepaid flight, that may be all you need.

Card cover is usually weaker in the places that hurt most abroad:

• Medical: most cards include little or no emergency medical cover. A few premium cards include evacuation or a small medical benefit, often with conditions.
• Who is covered: benefits may cover only the cardholder and certain family members, and only for the part of the trip paid on the card.
• Caps and limits: there is usually a maximum per trip and per person, and some cards cap the trip length.
• Points bookings: rules differ on whether an award ticket paid partly with the card is covered.

Download your card's "guide to benefits" and read it before you rely on it. A sensible pattern for many travelers is card cover for cancellation and delays, plus a separate travel medical and evacuation policy.

What policies usually exclude

Exclusions vary by insurer, but these show up often:

• Pre-existing conditions. A condition you had or were treated for in a look-back period before buying may be excluded unless you buy within a set time of your first trip payment and qualify for a waiver.
• Known events. Once a storm is named, a strike is announced or an outbreak is public, it is a "foreseeable" event and new policies will not cover it.
• Risky activities. Scuba diving below a set depth, mountaineering, motorbike riding without a license and many extreme sports are often excluded or need an add-on.
• Alcohol and drugs. Claims linked to intoxication are commonly refused.
• Fear of travel. Deciding not to go because you feel unsafe is not a covered reason unless the policy says so.
• Elective or routine care and treatment you traveled to get.

If you take regular medication, carry it in your carry-on with the prescription. Our guide to flying with medication on an international trip covers what to pack and what to check before you go.

How to choose a policy in five steps

1. List what you would lose. Add up only the nonrefundable, prepaid parts of the trip. That is the most cancellation cover you need.
2. Check your health plan and card. Know what they cover abroad before buying anything.
3. Prioritise medical and evacuation limits for long-haul and remote trips. The State Department recommends confirming the policy covers emergency care, medical transport back to the US and any current conditions.
4. Read the covered reasons and exclusions, not the marketing page. The policy wording is the contract.
5. Buy early if you want a pre-existing condition waiver or a "cancel for any reason" upgrade, since both often have a short purchase window.

Before you leave

Save the insurer's 24-hour assistance number in your phone and on paper, and tell a travel companion where the policy is. Many policies require you to call the assistance line before an evacuation or a hospital admission, or the claim can be reduced. Keep receipts, medical reports and the airline's written notice of any delay or cancellation, because claims are paid on documents.

If your trip has several separate tickets, check how each is protected; our guide to what to do when you miss a connecting flight explains why one ticket is safer than two. And make sure your passport meets the destination's rules before you pay for anything: see passport validity and visas before you book.