Vacations are supposed to be stress-free — blissful even. Whether it’s skiing the Swiss Alps or lounging on a white-sand beach somewhere, regardless of your destination, going to the doctor likely isn’t on your itinerary. But there’s always a chance your vacation could take an unexpected detour, and you’ll find yourself in need of medical care.
Research shows that 6 to 87 percent of individuals get sick during an international trip. And there’s a wide range of pesky issues you could experience.
COVID-19 is still prevalent worldwide. Dr. Eric Cioe-Peña, M.D. MPH FACEP, the director of global health at Northwell Health, says mosquito bites in the southern hemisphere can cause yellow fever. Bacteria in running water and food can bring on bouts of traveler’s diarrhea. Depending on the destination, rates of traveler’s diarrhea can range from 5 to 50 percent, per a 2007 meta-analysis. The analysis found that you were more likely to contract the issue in northern Africa, Latin America, the Middle East and Southeast Asia.
If you’re not venturing out of the US, staying stateside doesn’t necessarily mean you’ll stay healthy. For example, tick-borne illnesses, like Lyme Disease, are common in the northeast. And Cioe-Peña says it’s also possible anywhere to sustain an injury that requires medical attention, whether you slip by the pool or while hiking somewhere remote.
It sounds scary, but preparation can help you navigate medical care away from home. Experts shared some tips on navigating medical care in the U.S. and abroad. They also offered prevention strategies to avoid needing medical care in the first place.
Accessing Care in the US
Healthcare locations for domestic U.S. travelers
If you need medical assistance on vacation, it’s likely not routine.
“Hospital emergency rooms and urgent care centers or clinics should be your first go-to in the event of an emergency,” says Christian Worstell, a licensed insurance agent at MedicareAdvantage.com.
Where you’re traveling will also play a role in what type of care you can access.
“It’s certainly easier to find help in a more populated area where more resources are available,” Worstell says.
In other words, you’ll have an easier time finding multiple hospitals and urgent cares in New York City than on the Appalachian Trail.
“Whenever traveling to remote places, do your homework before you leave home to locate hospitals, urgent care clinics and other healthcare centers in or near the area,” Worstell says. “Note their hours of operation. It’s not uncommon for rural locations to have more limited hours.”
Your insurance company may have a 24/7 hotline that allows members to call and speak with a nurse about an injury or illness. They can provide more insight on what it might be, whether you require medical care and where to get it. You can find out if your company offers a hotline on its website or by calling the member services number on your card.
Be sure to have a copy of your insurance card and any medical records on pre-existing conditions. Worstell says it may be challenging to access them online in a remote location.
Navigating healthcare costs while traveling in the U.S.
By law, insurance companies must:
- Cover emergency room services for medical emergencies
- Match out-of-network copayments or coinsurance to match in-network rates.
“In the event of an emergency, it’s not necessary to visit an in-network provider,” Worstell says.
But there’s a catch: Other out-of-network charges may arise.
“While emergency care is covered even when obtained outside of your plan’s network, other services received may not qualify as ‘emergency care’ and therefore would not be covered or not covered as much by your plan,” Worstell says.
For instance, the initial care for a rock-climbing fall may be covered. But if you are kept overnight for concussion monitoring, that may not be covered.
Worstell suggests reviewing your policy before you go, so you know what is covered and how. You can also see if any hospitals in the area you are traveling are in-network by calling the insurance company or searching the directory on its website.
Should you receive medical care while traveling in the U.S., Worstell advises people to keep the following in a safe place:
- Medications the doctors prescribed
- A phone number to follow up with the hospital or care center
- Dates and times of any follow-up appointments
- Test results, including information on how and when you will receive them
- Billing or claims information
- Other discharge information, like instructions on diet, exercise and activities
Worstell suggests having written documentation of all of the above items.
“It can be easy to forget them at a time when you may have just endured…stress or are experiencing effects from pain or medication,” Worstell says. “Billing and claim information is important to keep in case you have to file a claim or appeal.”
Accessing care abroad
Typically, travelers can access public or government-funded hospitals or urgent care in countries outside. The quality of care and the best location to choose will depend on your destination.
Cioe-Peña says higher-income nations, like those in the United Kingdom, France, Spain, Canada and eastern Asia, typically have government-funded hospitals on-par with — if not better than — U.S. care. Physicians are available in urgent care centers and emergency rooms 24/7, and the hospitals have modern equipment and supplies to treat everything from cardiac arrest to a broken leg.
If traveling to counties such as Kenya or the Dominican Republic, Cioe-Peña recommends seeking a private hospital or urgent care. He says government-funded facilities may not have all the needed supplies, and an employee may need to go to a nearby pharmacy to purchase the IV solution you need. The hours can also vary.
“You may get to a hospital, and the doctors are not there in the afternoon,” Cioe-Peña says.
Locating healthcare
Cioe-Peña says most U.S. Embassies can help you find healthcare while abroad. Check the U.S. State Department website for more information.
Other resources to find medical care while overseas include:
- International Society of Travel Medicine for listings of recommended doctors and travel clinics
- Joint Commission International (JCI) for medical centers and hospitals that have met the standards for the JCI Gold Seal of Approval
- International Association for Medical Assistance to Travelers for English-speaking doctors in your destination
What to know about insurance abroad
Your insurance plan may or may not cover emergency care abroad. Before leaving, you’ll want to check your coverage. If international care is not covered, you’ll want to consider travel insurance. Cioe-Peña says travel insurance covers emergency services while abroad, namely if you develop a medical condition while overseas that requires attention, such as chest pains, or get injured, such as breaking a bone while hiking.
Routine care you can receive at home, like a pap smear, probably won’t be covered.
If you don’t have an underlying condition and are only going overseas for a two or three-day conference, Cioe-Peña says you can probably skip this expense. But if you have an underlying condition, will be overseas longer or plan to take part in a risky activity like rock climbing, Cioe-Peña advises getting traveler’s insurance just in case.
Travel insurance typically costs 5 to 10 percent of your total trip cost. If your trip costs $10,000, expect to pay between $500 and $1,000 for insurance. It may seem like a hefty cost, but it’s usually worth it.
“If you go into a hospital abroad without traveler’s insurance, you will likely get a bill from the bed, every doctor or specialist who sees you, like an ICU doctor and orthopedic surgeon,” Cioe-Peña says. “Any devices or medical system that the hospital doesn’t keep, such as a tube for a ventilator, but not the ventilator, will probably cost you.”
Cioe-Peña says total costs will depend on the country and medical needs, but care without health insurance can creep into five and six-figure numbers without traveler’s insurance.
Whether you have traveler’s insurance or not, you will want to save copies of:
- Discharge paperwork
- Any prescriptions given to you while receiving care
- Receipts from bills you paid
You may need this information later if you have a question on billing or at follow-up appointments with your doctor back home.
It’s rare that it also includes medical evacuation insurance. This insurance will get you home in the case of an emergency. Cioe-Peña says it’s essential if traveling to a lower-income country, such as South Sudan, rural Kenya or Somalia, where the standard of medical care is low. Evacuation can cost hundreds of thousands of dollars out of pocket compared to a couple hundred dollars in insurance fees. Globalrescue.com has quotes on medical evacuation services.
Finally, consider trip cancellation insurance. This insurance will reimburse you for some if not all of your trip costs if you need to cancel your trip for an unforeseen reason, including injury, illness or death.
How is the quality of medical care abroad?
Cioe-Peña says in many countries, such as those in western Europe or eastern Asia, medical care is just as good if not better than the U.S.
- Higher-income countries. In the U.K, France and Spain, Cioe-Peña says travelers can expect to have fully-equipped public and private hospitals with reputable physicians.
- Middle-income countries. “Countries like the Dominican Republic, Ecuador and Barbados generally have very good private health services,” Cioe-Peña says. “There may be some things they don’t do, like robotic cardiac surgery, but you can get most things tourists need [such as treatment for rock-climbing injuries] done very well.
- Lower-income countries. Countries like southern Sudan and rural Kenya don’t provide access to modern, quality healthcare facilities, even privately-owned ones. “You’d have to be evacuated [to receive care],” he says.
The country you’re in isn’t the only factor in determining what type of healthcare is readily available to you. Travelers hiking a remote area of Thailand will have a harder time accessing facilities than someone who twists an ankle perusing a Bangkok night market.
Cioe-Peña advises travelers to discuss their plans with an insurance agent when purchasing traveler’s insurance. If you’re going to be in a remote area of a country, evacuation insurance may be necessary no matter what.
Preparing for your trip
Pack a first aid kit
Bringing your own emergency kit can reduce the need to rely on a medical care facility for supplies. Worstell says pre-made kits sold online and at pharmacies are generally sufficient, but you should check what’s in them before purchasing. Items you’ll want to have include:
- Over-the-counter cold and cough medications
- Gauze
- Bandages
- Medical Tape
- Braces
- Slings
- Splints
- A flashlight
- Non-perishable food
- Water
- Insect repellent
Get all necessary vaccines
When traveling overseas, you may be required to show proof of vaccination for diseases like polio or yellow fever, according to the U.S. Dept. of Health and Human Services. These vaccines keep you safe and healthy as you travel.
You’ll want to get vaccinated four to six weeks before traveling and can do so at:
- A travel clinic
- Your doctor’s office
- Some pharmacies
Your state health department has more information on where to get these vaccines.
If traveling to Africa, you won’t need a malaria vaccine. But your doctor will likely give you antimalarial drugs in tablet form. The mosquito-borne illness is prevalent in some areas there.
Some countries, like Austria, require travelers to be fully vaccinated against COVID-19. In the U.S., some places, including New York City, require proof of COVID-19 vaccination to enter indoor entertainment and dining facilities. Worstell and Cioe-Peña both recommend bringing your COVID-19 vaccination card, as policies may vary by country, city, state and even establishment.
The CDC has a list of required vaccinations for travel.
Do your research
Preparation is the best form of prevention. Your pre-vacation research should include ways to avoid care and what happens if you need medical assistance. The sooner you receive services, the less likely it is that your condition or injury worsens. To avoid care, look into the following:
- Disease risk. You may need to get vaccinated against specific diseases, take an antimalarial drug, or use insect repellent in areas with increased risk for illnesses.
- The elements. You’ll want to dress to impress based on the conditions and weather in a destination. For example, you’ll want sturdy shoes for hiking to mitigate falls and a warm ski jacket if you’re headed to see the Northern Lights in December to avoid frostbite.
You’ll also want to be prepared to receive prompt care, just in case. Know the local medical landscape. Where are the best hospitals in your area? What is the standard of care? Your insurance company (traveler for abroad, regular insurance if staying in the U.S.) can provide this information before your trip. Keep numbers and addresses for local healthcare facilities handy, such as printed out and in a folder, in case Internet access is shoddy.
Bring items you need
In addition to all of the above, make sure that you remember to bring the basics. Everyone will want to bring:
- An insurance card, including traveler’s insurance and medical evacuation information as applicable
- Phone numbers for local healthcare facilities
- Phone numbers and addresses for doctors and specialists you see back home, in case local physicians need to get in touch with them
If you have an underlying condition or allergy, you’ll want to make sure you have what you need when you need it so you don’t have to get one from a healthcare facility. These items might include:
- An EpiPen
- A letter from your doctor describing your condition and treatment, including medications you can and should not take
- Blood glucose monitor for diabetes
- Prescription medication in the original bottles
- Any foods that help you manage diabetes or high blood pressure
- Medical ID bracelets
Keep these items in a consistent location, such as a pocket of your backpack, so you don’t have to dig for them in an emergency.