Does my health insurance cover care outside the USA, such as the discount surgeries in India?

Health Insurance varies from policy to policy. Some will cover emergency care outside the USA while other plans will only cover care inside the USA. Almost none cover international medical evacuation though. Thus, there is no simple answer to will your policy cover international care.

International care is broken down into a couple of different care categories. First there is emergency care, which if any care is covered internationally, usually it is emergency care. Routine care is something almost no policies cover on an international basis. The reason emergency care is covered on many policies, is that it is an emergency endangering life and limb. Also, frequently the emergency care outside of the USA is far less expensive than that received in the USA.

Another break point in getting an idea of if your care is covered or not has to do with the kind of payor (insurance company) involved. Medicare, for those 65 and over who have paid into the system long enough or the disabled who were granted Social Security Disability and Medicare for the Disabled, and Medicaid are the two big government payors.  The government generally does not pay for any care outside of the USA. Other insurance comes thru employer sponsored group plans and yet one other source is individual health plans. These private insurance plan are where you really have to check will or won’t they cover emergency care outside the USA.

Virtually all Indivdual major medical health plans will cover emergency care outside the USA. Group plans more often than not will cover emergency care outside of the USA. The plans where coverage is fully insured by the insurance company generally do cover emergency care around the world however self insured groups (those plans where the employer puts aside money to cover care) have more liberty in how they define covered services. These plans are ones where there is a higher probability you may not get emergency care covered outside the USA, especially if the company does not require any international travel for business reasons. They way you know for sure is to ask the employer or review your certificate of coverage.

In the event your health insurance does not cover emergencies outside of the USA, you should definitely get travel insurance where they provide adequate emergency care coverage while on the trip. You can pick a plan here. Without insurance you can be out of pocket and often the providers will require payment before treatment, especially outside the USA. This could be financially devastating to most travelers.

Of course some people want to travel internationally for lower cost good quality care. There are several areas in the world where US quality care is available at facilities and providers all trained in the West. More often than not those seeking care of that nature are paying cash for the care. Insurance generally does not cover care of that nature. There are a few facilities that have achieved JCAHO certified facility status and that is a critical step towards being able to get US based insurance companies to agree to pay for care like this. Because there are travel costs and follow up care is a bit more difficult, the insurance carriers are a bit timid to rush into paying for this care. 

As we see more facilities and programs around the world get the JCAHO certification, we will likely see a growing list of programs where you can travel for your care. Of course the care involved is typically extensive surgical procedures which for most people take several days from initial diagnosis thru completion of treatment. Of course often these programs include hotel accommodations and sometimes airfare as part of the overall program. The price for many of these programs is a small fraction of what would be paid at a hospital near home, so that is why some carriers do agree to pay for these packages.

As you can see coverage for international care is limited and tends to be by private insurance companies and only for emergency care. Always keep in mind that the government does not pay for care outside the USA so you need to have travel insurance if you have coverage thru the government and plan international travel.