Does Your Health Insurance Cover Medical Treatments Abroad?

Does Your Health Insurance Cover Medical Treatments Abroad?

Years ago, Americans traveling abroad for non-emergency medical treatment were either wealthy or uninsured. Fast forward to today and the landscape has changed. Health insurance companies, like their customers, are just as eager to save on costs.

Among these insurers, BlueCross/BlueShield forayed into medical tourism, piloting a medical travel program for their policyholders which included Elizabeth Kunz.  In 2009, Kunz was looking at $10, 000 of out-of-pocket expenses for dental procedures. Through BlueCross/BlueShield’s program, she decided to hop on a plane to Costa Rica for her procedures. Dental work consisted of the replacement of eight crowns, a tooth filling and a root canal. After insurance, the South Carolina resident shelled out just $2, 800.

And it’s not only individuals and insurers who have taken note of the rising healthcare expenses, U.S. employers are looking for ways to cut back on costs as well, without sacrificing their employees’ health or safety. According to the Institute for HealthCare Consumerism (IHC), an estimated 15 percent of the country’s 50 largest employers including Wal-Mart now offer the benefit option of medical travel.

U.S. health insurance and medical tourism

International health care plans

Medical tourism is moving from being a fringe option to a first option in healthcare, as a number of U.S. health insurers have started to cover medical procedures performed abroad. Some maintain an international network of doctors and hospitals. Aside from Costa Rica, BlueCross/BlueShield offers international plans in Panama, Uruguay, Puerto Rico, and the U.S. Virgin Islands. Other health insurance companies that have international health care plans include:

  • GeoBlue
  • Cigna
  • Aetna
  • International Medical Group
  • United Group Programs

Expect these providers to differ in terms and actual policies. Most likely they offer travel medical insurance and cover medical attention needed while you’re outside the U.S. Elective medical procedures may be another matter.

Your current health insurance policy and health care abroad

If you already have health insurance, learn what your policy covers overseas before flying out. Remember to bring your insurance policy identity card as well as a claim form, if they do offer coverage.

Here are some guide questions as advised by the U.S. Bureau of Consular Affairs, when asking about health coverage abroad:

  • Does this insurance policy cover emergency expenses abroad such as returning me to the United States for treatment if I become seriously ill?
  • Does this insurance cover high-risk activities such as parasailing, mountain climbing, scuba diving and off-roading?
  • Does this policy cover pre-existing conditions?
  • Does the insurance company require pre-authorizations or second opinions before emergency treatment can begin?
  • Does the insurance company guarantee medical payments abroad?
  • Will the insurance company pay foreign hospitals and foreign doctors directly?
  • Does the insurance company have a 24-hour physician-backed support center?
  • Senior citizens may wish to contact the American Association of Retired Persons (AARP) for information about foreign medical care coverage with Medicare supplement plans.

As part of the 90% of Americans now with health insurance, you still have to think about deductibles, coinsurance, and copayments when a medical emergency arises. It’s going to be tougher if you’re considering elective medical procedures such as an angioplasty, weight loss surgery and infertility treatment. If your medical procedure is considered immediately medically unnecessary, it can be classified as elective, and you either get greatly reduced coverage or no coverage at all.

If you’re likely to need medical treatments currently deemed ‘elective’ under your policy, consider getting a more comprehensive health care plan that includes medical travel options.

Employer-sponsored medical tourism

If you have health insurance through your job, your policy could be a traditional fully-insured plan, which is availed through an insurance carrier. You will need to get in touch with your company’s provider for details on possible coverage for treatments abroad.

In some cases, companies opt for self-insured health plans and pay out-of-pocket health costs of employees as these are incurred. Some self-insured employers offer medical tourism as a health care option for their employees.

One such company is HSM Solutions, a North Carolina-based manufacturing company that introduced the idea of medical tourism to its 2, 500 U.S.-based employees in 2007. At the start, many balked, but as of 2013, about 250 employees and dependents have used the benefit.

Among these employees was Joy Guion, who had severe chronic obesity and a family history of diabetes and heart disease. She opted for elective weight loss surgery under HSM’s program and flew to Costa Rica with Gary Halwell, a retired HSM manager who was getting a knee replacement. In the U.S., both would have had to pony up $3,000 out of pocket even with insurance. Through their medical tourism program, their travel costs, surgeries and post-op recovery were all footed by their employer.

Through HSM Solutions’ health benefits program, employees get free medical care abroad, as well as a bonus equivalent of 20 percent of the company’s savings incurred by paying for the procedure outside the U.S. According to their director of benefits, Tim Isenhower, the program was put in place because of high healthcare costs in the U.S. “and the poor-quality care in the remote areas where HSM operates.”

Your employer may also be offering medical tourism as an option under your company’s health plan and benefits. Ask your human resource officer about your health benefits and care packages about this.

Health insurance in different countries and getting medical treatment abroad

Healthcare systems in different countries and local private health insurance companies could provide other, possibly better, options for getting treated overseas or across borders. If you’re moving to the UK or Europe, you might consider applying for a European Health Insurance Card (EHIC), which is free. The card entitles you to medical treatment in state-run hospitals in some European countries including Iceland and Norway. To be eligible for an EHIC, you will need to be ordinarily resident in the UK and of British, European Union (EU), European Economic Area (EEA) or Swiss nationality.

The EHIC can be helpful during emergencies, but does not work as a substitute for insurance. EHIC holders may be eligible for free or reduced-cost treatments, depending on which country you’re availing treatment in. Holders pay the same cost for treatment as a local — if it’s free for that country’s residents, it’s free for you. Otherwise, you will still have to shoulder the costs.

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