How to get health insurance for visitors in USA?
The USA is the most popular country for international visitors and people travel to the US on various occasions. Be it higher studies, jobs, research, or visiting the family, the US is the first option for most people. People need to buy best medical insurance for temporary US visitors before their departure from their home country to the US due to the expensive healthcare cost in the US. US citizens living abroad too need to consider this health insurance to cover them in the US during their visit to the US.
There are chances that people do not take this seriously and this could be due to the unfamiliarity with visitor health insurance and the role they play when you are outside your home country. It is now mandatory to have a private health insurance plan and is not an option anymore. Here are the important points about the medical health insurance that temporary USA visitors should know to make the right purchase of the plan.
Let us quickly look at these highlights that are covered by best temporary health insurance for US visitor:
- Unexpected sickness and injuries
- Emergency medical evacuation
- Repatriation
- Trip Interruption
- Baggage loss and delays
- Outpatient expenses
- Acute onset of pre-existing conditions
The insurance plan covers many other specific benefits but the first point " Unexpected sickness and injuries" is one of the major reasons people buy the insurance. When people travel outside their home country, they can get sick due to the change in the weather or food they eat. Similarly, people can meet with an accident or injury in an unknown place. Then the cost of hospital bills in a country like the US can go anywhere from $200 to $1,000,000 depending on the severity of the injury or the illness. The hospital might admit the patient without asking anything initially, but you will have to make payment before leaving the hospital and clear that bill out of your pocket. The solution is to have an insurance plan which will take care of the huge hospital expense.
Knowing some insurance terms and conditions that will help the temporary visitors to USA make the right choice
Deductible: This is the amount that you can choose while purchasing the plan. The customer needs to pay this amount before the insurance plan starts making the payment for the total cost. This amount can range from $100 up to $5000 or more. It is up to the customer.
Copay or Copayment: Copay is the amount you pay after a doctor's visit to the provider's office. It is a fixed amount. If the fixed amount for copay is $20 for in-network doctors, you pay that amount every time you visit the doctor's facility. This amount is regardless of the consultation charge in the doctor's office. Co-pay amount varies depending on the type of service.
Coinsurance: This is the percentage amount that the customer pays after the deductible amount is satisfied. This amount is paid on top of the co-pay. It is usually 20% of the total cost of the medical bill. You can't know the amount unless you see the final bill of the Coinsurance is applicable up to a certain dollar limit which is usually $5000 in most of the plans after which the insurance company pays 100%. Some plans waive the coinsurance if the customer visits a provider who is within the PPO network supported by the insurance company. PPO networks are the provider networks that accomplish the network of doctors under certain geographical areas.
Travelers can review the
temporary health insurance glossary for visitors to the USA to understand other terms and also check the
travel insurance guide for easy understanding.
PPO Network: It is important to understand the in-network and out-of-the-network concepts. PPO networks are the provider networks that accomplish the network of doctors under certain geographical areas. If you go to a doctor associated with a provider network, you will be getting the benefits of in-network. Likewise, the insurance plan also provides coverage out of the network. In that case, a visitor insurance plan will cover you with any doctor in the US.
If your visitor insurance plan has a PPO network, then it is always recommended to consult a doctor with the in-network doctors. This might waive the coinsurance amounts or the provider will be interested in directly billing the insurance company in case of claims. If you go for an out-of-network doctor, the coinsurance amount is applicable for the most part, and chances of direct billing are very less, although you can contact the insurance company for reimbursement.
Each insurance company has its own rules for dealing with out-of-network doctors. Some insurance companies need precertification from the customer before they go in for any treatment. Precertification is to get in touch with the insurer and let them know about the illness or the treatment they will get.
Fixed benefit plan vs Comprehensive plan:
A fixed benefit plan has a fixed amount that the plan states for a particular benefit. The plan will cover that amount in case a claim is incurred. On the other hand, the comprehensive plan covers up to the policy maximum for almost every benefit and does not have a predetermined amount specified in the brochure of the plan.
Given this, a Fixed plan might work well for small expenses but in case of major medical expenses, it is better to opt for a Comprehensive Plan. Here is a chart that shows the difference between fixed and comprehensive insurance for visitors on temporary visit to USA:
| Features |
Fixed plan |
Comprehensive plan |
| Coverage |
1. Specifies a fixed amount for a benefit and it can be different from the policy maximum.
2. It is normally very less than the policy maximum
|
No specific amount is mentioned and covers up to the policy maximum
(less deductible and coinsurance)
|
| Covid Coverage |
Covered as any other illness |
Covered as any other illness |
| Cost |
1. More affordable and cheap but with less coverage
2. This works for small illnesses and is inadequate for major expenses
|
1. Expensive but flexible coverage up to policy maximum provides adequate coverage for major medical expenses
2. The plan pays after the deductible and coinsurance. |
| Payment process |
The insured pays the initial deductible for every new sickness and injury and the plan pays the rest of the expenses
|
The customer needs to satisfy the one-time deductible and 20% coinsurance applicable up to the first $5000 of the expense and the plan pays 100% up to the plan maximum. Coinsurance percentage can vary from 10-20% on the plan |
| Provider network or PPO network |
Customers can visit any hospital or doctor as there will be no discounted rates with no coinsurance. The plan pays the defined specific amount specified for the benefit |
Comprehensive plans have a PPO network. You can visit both in-network or out-of-network doctors. However, it is recommended to visit the doctor within the PPO network to get the discounted rates in the coinsurance and facilities such as direct billing services are made available |
| Trip expenses coverage |
Usually not covered
|
Covers trip cancellation, baggage loss and delay. |
| Plan names |
Visitor Secure, Visitor’s Care, Safe Travels Elite… |
Atlas Travel, Patriot America Plus, Safe Travels USA Comprehensive, Travel Medical Plus… |
Coverage for pre-existing conditions in visitor/travel insurance plans
Pre-existing conditions are one of the important benefits that are requested by most customers after the age of 60. A pre-existing condition is any kind of illness or health condition that exists in a person before the insurance becomes effective. Many common diseases are considered pre-existing conditions, namely blood pressure, diabetes, arthritis, asthma...Insurance companies usually do not cover this particular benefit and pre-existing conditions are normally under the exclusions. Chronic conditions such as Cancer, and Alzheimer's disease are some of the pre-existing conditions which the insurance company completely excludes from their coverage.
Insurance companies clearly outline the list of diseases and coverages that are excluded under "Exclusions". You can scroll down the company brochure of the plan to see the "Exclusions". If you have any of these conditions and you need them covered, it is important to first filter the plans to see this particular benefit.
Visitor Insurance plans do not need a medical checkup to be done before buying the plan to see the eligibility. But some of them do not cover Pre-existing conditions. However, they cover "Acute onset of a pre-existing condition".
Acute onset of a pre-existing condition is referred to as a sudden recurrence or unexpected recurrence or an outbreak of the condition which needs immediate emergency medical attention or can get worse very quickly. At the hospital, if the illness does not say it is an acute onset, then the insurance company might not cover it as per the plan benefits.
The temporary health insurance coverage for acute onset of pre-existing conditions limit this benefit to people under the age of 70. Fewer plans cover this after the age of 70 up to the age of 89.
Unexpected incidents like injury and sickness can happen anytime. It is still important to buy visitor health insurance even with an existing condition so that you are covered for all the other unexpected incidents other than the pre-existing condition. To attract customers, there may be insurance plans that indicate they cover pre-existing conditions, but there might be limitations on the coverage
Please read the brochure of the plan carefully in the fine print to avoid the wrong notion.
Choosing the right plan for ages 70 and up
There are still plans that provide coverage for pre-existing conditions for age 70 and above for a reasonable price. Travelers must understand that the price is definitely going to be high for people above the age of 70 and more so for those above 80. Fixed benefit plans such as Inbound USA Basic that provide a policy maximum of $100,000 for people above age 70 up to 99. The Inbound USA Choice plan is equally good and provides coverage for the acute onset of a pre-existing condition where it provides coverage of $75,000 for those below 70 and $25000 for those above 70 up to the age of 79. There are comprehensive plans as well that provide coverage for acute onset of a pre-existing condition for those above 70 namely Safe Travels USA Comprehensive, and INF Elite.
Purchase Restriction of plans in certain specific States
Some of the states in the US restrict the purchase of certain visitor health insurance plans. Some of the states that have this kind of purchase restriction are California, Maryland, Washington, Kentucky, Colorado, New York, and South Dakota.
Travelers can check US state health insurance for temporary visit restrictions for insurance restrictions. The restriction is only for the purchase of the plans. If you have the billing address of a restricted state and you are not purchasing the plan with that address, you can still use the plan in that state in case you need coverage.
Common Exclusions in a visitor insurance plan
Here is a list of services that will not be covered in a visitor health insurance plan:
- Pre-existing conditions
- Dental Care except for dental emergencies
- Skin Treatment or Cosmetic Surgeries
- Yearly routine check-up, immunization, vaccination
- Preventive Care Services
- Vision Care
- Childbirth, Pregnancy, and Maternity Care
- Chronic illness
- Injuries and accidents due to terrorism and War Acts
- Mental health care
- Injuries due to drugs and alcohol
Pre-approval request prior to getting treatment
Pre-approval is also known by the terms pre-certification, and pre-authorization and is one of the requirements that need to be fulfilled in some of the insurance plans in order to get treatment for the illness. It is basically sending a notification or making a call to the insurance company and letting them know that they need cover for a certain sickness or injury.
You can go to the in-network providers where they can contact the insurance company regarding the treatment for the sickness and they will cover the sickness. If you visit an outside doctor or a facility that is out-of-network, then you might have to pay for the expenses first and the insurance company will reimburse the amount.
Can the insurance plans be extended or renewed
Most of the insurance plans can be renewed for a year or two. There is an anniversary date that these are associated with. Even if the plan has been purchased for more than a year, the deductible will reset on the Birth Date. If your plan expires, then you will have to purchase a new plan and will not be able to renew the old plan. Renewability of the US temporary travel insurance needs to be done before the expiration date.
In case of cancellation, refund of the premium
- Trip cancellation is one of the major cases after the pandemic. Make sure that the baby is five.
- Depending on when the cancellation is being done, there may be a cancellation fee.
- If the plan is canceled before the effective date of the plan, then a full refund of the premium can be achieved.
- If you cancel the plan after the effective date of the plan, then the unused portion of the premium can be refunded.
Traveling to the US or other countries can be a fun activity or experience only when you are insured for unexpected incidents. Domestic healthcare within the US is very expensive. This can lead to emergency situations and paying out-of your pocket can be risky.
