Health Insurance Abroad: Where US and UK Cover Stops

Neither Medicare nor the NHS Global Health Insurance Card (GHIC) will fly you home. The US State Department says medical evacuation by air ambulance back to the United States can cost from $20,000 to $200,000, and that most health plans do not pay for it. The NHS says the GHIC does not cover being flown back to the UK either. In the UK, the Association of British Insurers (ABI) reports that medical expenses made up 34% of travel insurance claims in 2024, and one member paid more than £1 million for emergency treatment in the US and repatriation. Health insurance abroad stops short of the most expensive event. This guide shows what US and UK cover does and does not pay, how to size the gap, and what to ask before you book.

What does your health cover do abroad?

Health insurance abroad is limited: Medicare generally does not pay outside the US, the UK's GHIC covers only state healthcare in participating countries, and most plans do not pay to fly you home. Add your uncovered medical share to the evacuation cost your plan excludes, then compare that total with your savings.

Item	US	UK
Core cover	Original Medicare generally pays nothing outside the US, with limited exceptions (Medicare.gov)	GHIC: necessary state healthcare in the EEA and some other countries, on the same basis as residents (NHS)
Add-on	Medigap foreign travel emergency: 80% after a $250 deductible, $50,000 lifetime limit (Medicare.gov)	Travel insurance, advised alongside the GHIC (NHS)
Flight home	Most plans do not pay for air ambulance back to the US (State Department)	Repatriation not covered by the GHIC (NHS)
Private facilities	Depends on the plan	Not covered by the GHIC (NHS)
Complaint route	State insurance department	Insurer first, then the Financial Ombudsman Service (FOS)

How do you size the gap on a US plan?

Formula: uncovered exposure = (medical bill − amount your plan pays) + evacuation cost your plan excludes. Compare it with your savings and with the price of travel cover.

Medicare.gov says most Medigap plans cover foreign travel emergency care that begins in the first 60 days of a trip. They pay 80% of billed charges after a $250 yearly deductible, up to a $50,000 lifetime limit. AARP notes that Medigap plans A, B, K, and L cover nothing abroad. Medicare Advantage plans vary, so check yours.

Hypothetical: Grace, 68, has Original Medicare and a Medigap plan with the foreign travel benefit. On day 12 of a $6,000 trip, she needs emergency hospital care billed at $30,000. Her insurer flies her home at a cost of $80,000, which her plan does not pay. The State Department's range for such a flight is $20,000 to $200,000.

Inputs and arithmetic:
Medigap pays: 80% × ($30,000 − $250) = $23,800. Grace pays the $250 deductible plus 20%: $250 + $5,950 = $6,200.
Lifetime limit used: $23,800 of $50,000, leaving $26,200.
Uncovered exposure: $6,200 + $80,000 = $86,200.
Result: Grace faces $86,200 in uncovered costs. The CDC says comprehensive travel insurance can cost up to 8% of trip cost, which is $480 on a $6,000 trip, or 0.6% of her exposure. Her decision depends on her savings and her plan's written terms, not on the average claim.

Private US plans are less uniform. The CDC notes that some US carriers cover emergencies abroad, and the State Department says some plans cover typical medical costs. Ask your insurer in writing before you book, because the answers differ by plan. For related gaps, read The Health Insurance Gaps You Won't See Coming in 2026.

What does the GHIC leave out? The UK view

British terms and dates apply in this section. The NHS says the GHIC gives you necessary state healthcare on the same basis as a resident of the country you visit. That includes emergency treatment and A&E visits. It does not replace travel and medical insurance, and it does not cover repatriation, treatment in a private medical facility, or ski or mountain rescue. The NHS advises holding a GHIC and private travel and medical insurance for the whole trip. Outside the countries where the GHIC applies, it offers no help, so check the relevant country guide on GOV.UK.

The ABI's latest data shows the scale. Insurers paid £472 million across more than 500,000 travel claims in 2024. Medical expenses made up 34% of claims, up from 29% in 2023, and totalled £262 million, with an average payout of £1,528. The ABI also reports a single payout of more than £1 million for US hospital treatment and repatriation.

Hypothetical: Isla, a Bristol traveller, needs state hospital treatment in Spain billed at £25,000. Assume local rules reimburse 80% and she owes 20%. Her repatriation costs £30,000.
Arithmetic: GHIC share: 80% × £25,000 = £20,000. Isla pays 20%, which is £5,000. Add repatriation: £5,000 + £30,000 = £35,000.
Result: Isla's uncovered exposure is £35,000, about 23 times the ABI's average medical claim of £1,528. A policy with enough medical and repatriation cover closes that gap. For the private side of UK health cover, read Critical Illness Insurance vs. Private Health Insurance: What's the Difference (US & UK).

Which type of cover closes which gap?

The CDC separates travel insurance, travel health insurance, and medical evacuation insurance. Travel health insurance is a short-term supplemental policy that covers healthcare costs incurred abroad. Medical evacuation insurance covers emergency transport to a high-quality hospital, which the CDC says could otherwise cost more than $100,000. Depending on the policy, general travel insurance may or may not cover medical expenses abroad, so confirm that the policy you buy lists both medical and evacuation benefits, each with a limit. UK travellers should check that medical expenses and repatriation each appear with a limit too.

What should you check about conditions, activities, and credit cards?

Declare pre-existing medical conditions. The ABI tells travellers to disclose all pre-existing conditions, prescribed medications, and treatments when they apply for cover, since emergency medical treatment is the biggest cost insurance is designed to meet. The CDC advises asking whether a policy has exclusions for pre-existing conditions or adventure activities. It also says travellers should not treat credit card benefits as a substitute for a travel health or medical evacuation policy.

What belongs on a health-cover-abroad checklist?

1. Written confirmation from your insurer that care abroad is covered, and whether emergencies only.
2. Your plan's limit for foreign care, such as Medigap's $50,000 lifetime limit.
3. Whether the plan pays for evacuation or repatriation, in writing.
4. Your uncovered exposure, written beside your savings.
5. For UK travellers, a valid GHIC and a policy with medical and repatriation cover.

Use the Shield and Strategy Coverage Gap Checklist alongside this list.

FAQ

Does Medicare cover me outside the United States?
Generally no. Medicare.gov says coverage outside the US is limited and that in most situations Medicare will not pay for care or supplies abroad. There are narrow exceptions, such as certain hospital situations near the border. Medigap plans C, D, F, G, M, and N offer a foreign travel emergency benefit. Medicare Advantage plans vary, so confirm with your plan.

How much does Medigap pay for emergency care abroad?
Medicare.gov says most Medigap plans pay 80% of billed charges for certain medically necessary emergency care outside the US, after a $250 deductible for the year. Coverage applies to emergency care that begins in the first 60 days of a trip, and the lifetime limit is $50,000. Care that Medicare covers otherwise is handled separately.

Does my US health plan pay to fly me home?
The State Department says most plans do not pay to bring you back to the US by air ambulance, which can cost from $20,000 to $200,000 depending on where you are and your condition. The CDC says some US carriers cover medical emergencies abroad. Ask your insurer for written confirmation that includes evacuation before you travel.

What does the UK GHIC cover?
The NHS says the GHIC gives you necessary state healthcare in the EEA and some other countries on the same basis as a local resident, including emergency treatment and A&E visits. It does not cover repatriation, private medical facilities, or ski and mountain rescue. The NHS advises holding a GHIC and private travel and medical insurance together.

How common are medical claims on UK travel insurance?
Very common. The ABI reports that medical expenses made up 34% of UK travel insurance claims in 2024, up from 29% in 2023. Medical claims totalled £262 million and averaged £1,528 per claim. One ABI member paid more than £1 million for US treatment and repatriation, which shows how far a single case can exceed the average.

What should you ask your insurer before you book?

Put three questions to your insurer and get the answers in writing: does the plan pay for care abroad, what is the limit, and does it cover evacuation or repatriation? If any answer is no, compute your uncovered exposure with the formula above. In Grace's case it was $86,200, and in Isla's it was £35,000. Compare your own figure with your savings, then decide whether to buy travel medical cover.

Written by Olukunle Fashina.

Sources & References

1. US Department of State, Medicine and Health: air ambulance evacuation costing $20,000 to $200,000, most plans not paying for it, and some plans covering typical medical costs abroad.
2. Medicare.gov, Medicare Coverage Outside the United States: limited coverage abroad, and the Medigap foreign travel emergency benefit (80%, $250 deductible, $50,000 lifetime limit, first 60 days of a trip).
3. AARP, Does Medicare cover me outside the US?: Medigap plans A, B, K, and L cover nothing abroad.
4. CDC, Yellow Book 2026: Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance and Travelers' Health: Travel Insurance: the three types of cover, the up-to-8% cost of comprehensive policies, evacuation above $100,000, the credit card caution, and exclusions to check.
5. NHS, Get healthcare cover abroad with a UK GHIC or UK EHIC: what the GHIC covers and does not cover.
6. Association of British Insurers, Eight to Embark: travel insurance tips (21 August 2025): the £472 million, 34%, £262 million, £1,528 average, the £1 million claim, and the advice to disclose conditions.
7. Financial Ombudsman Service, How to complain: complaining to the firm first and the six-month referral window.

This article is for general information and education only and is not medical, insurance, tax, or legal advice. Plans, benefits, limits, and costs differ by insurer, country, and trip, and the UK content applies to the United Kingdom only. Consult a licensed insurance agent, broker, or regulated adviser before you travel or change a policy.