This is the most expensive place in the world to fall ill and there is no safety net for you. Travel insurance is not optional here.
- There is no reciprocal healthcare agreement between the United States and anywhere. Your national health card, your EHIC, your provincial cover: none of it works here.
- An average emergency room visit is around USD 2,863, a serious one USD 10,000 to USD 20,000 and upwards, and uninsured patients are billed 2 to 10 times what an insurer would pay for the same treatment.
- Check your policy's limit is at least USD 500,000, preferably a million - European policies written for European costs are frequently far too small.
- Urgent care clinics are the right answer for anything that is not an emergency - stitches, infections, sprains, fevers - at a fraction of the emergency room and seen faster.
- Ask specifically for an itemised bill, because the summary version is not enough for a claim, and expect bills weeks later from the hospital, doctor, radiologist and lab separately for one visit.
The number that matters
There is no reciprocal healthcare agreement between the United States and anywhere. Your national health card, your EHIC, your provincial cover: none of it works here.
| What | Realistic uninsured cost |
|---|---|
| Emergency room visit, average | around USD 2,863 |
| Emergency room, minor problem | USD 1,000 to USD 2,500 |
| Emergency room, serious | USD 10,000 to USD 20,000 and upwards |
| Ground ambulance | USD 500 to USD 3,000, plus roughly USD 19 a mile |
| Air ambulance or repatriation | Six figures |
- Uninsured patients are billed 2 to 10 times what an insurer would pay for exactly the same treatment. You are the worst-positioned buyer in the room.
- Comprehensive travel medical insurance with evacuation cover is essential. Not advisable. Essential. A broken leg on a ski trip has bankrupted people.
- Check your policy's cover limit is at least USD 500,000, and preferably a million. European policies written for European costs are frequently far too small.
- Ambulances are usually billed separately and are often outside surprise-billing protections. If it is not an emergency, a taxi to the hospital is a legitimate and much cheaper decision.
Getting treated
- Urgent care clinics are the right answer for anything that is not an emergency. Stitches, infections, sprains and fevers cost a fraction of an emergency room and you will be seen faster.
- Emergency rooms must stabilise you regardless of ability to pay. They will then bill you, and they will pursue it.
- Call your insurer before treatment where you possibly can, and get the pre-authorisation. Doing it afterwards is where claims get refused.
- Keep every itemised bill. Ask for an itemised bill specifically, because the summary version is not enough for a claim.
- Bills arrive weeks or months later, often several separately from the hospital, the doctor, the radiologist and the lab for one visit.
Medicines and the rest
- Bring your prescriptions in original labelled packaging with a copy of the prescription. US pharmacies will not fill a foreign prescription.
- Pharmacies are everywhere and open late, and over-the-counter medicine is cheap. Prescription medicine is not.
- No vaccinations are required for entry. Check routine cover is current.
- Tap water is safe essentially everywhere.
- Ticks carry Lyme disease in the northeast and upper midwest, from spring through autumn. Check yourself after woodland walks.
- The sun at altitude and in the desert is much stronger than it feels. Denver, Santa Fe and the Utah parks catch people out.
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