Travel Insurance Isn't for Everyone. Here's Who Actually Needs It

Medicare open enrollment for 2027 coverage began on October 15, 2026, and the Centers for Medicare & Medicaid Services (CMS) says it ends December 7. The announcement doesn't mention travel, but Medicare's own fact sheet says that in most situations Medicare won't pay for health care you get outside the US, so plan shoppers can check what they would pay abroad. Travel insurance is not "a must" for most trips, though: few countries require it, and it pays off most when your health cover stops at the border or a large nonrefundable bill is at stake.

Key takeaways

Original Medicare usually doesn't cover care abroad. Medigap Plans C, D, F, G, M and N pay 80% of emergency care outside the US after a $250 deductible, up to $50,000 per lifetime.
Fall open enrollment is not a Medigap window: outside your one-time Medigap enrollment period, an insurer can usually turn you down based on your health.
The EUR 30,000 Schengen insurance minimum applies to visa applicants; US citizens don't need a visa for stays of up to 90 days in any 180.
On a $6,000 nonrefundable trip, a 6% policy costs $360. A cancel-for-any-reason (CFAR) upgrade at $504 pays for itself on average only if the chance of a non-covered cancellation tops 3.2%.
The card guide checked here caps emergency medical cover at $2,500 and excludes a change of plans.

What it means for you

On Original Medicare, going abroad: expect to pay yourself unless Medigap adds foreign emergency cover.
On Medicare Advantage: ask each 2027 plan what it pays outside the US.
Booking an expensive nonrefundable trip or cruise: see the worked example.
Relying on credit card coverage: read the covered reasons and medical limits.
Older travelers with pre-existing conditions: the purchase date decides cover; see the timing section.
Taking a cheap, refundable domestic trip: you can often skip a policy.

Medicare and bills abroad

Medicare's travel page says it usually doesn't cover health care while you're traveling outside the U.S. The exceptions are narrow, such as an emergency in the US where a foreign hospital is closer, or travel through Canada between Alaska and another state.

Medicare's April 2026 fact sheet says Medigap's foreign travel benefit pays 80% of billed charges for certain medically necessary emergency care outside the US, after a $250 yearly deductible, with a $50,000 lifetime limit. The care must begin in the first 60 days of the trip, and only care Medicare doesn't otherwise cover counts. Medicare's 2026 Medigap guide shows the 80% benefit on Plans C, D, F, G, M and N. Plans C and F are closed to people new to Medicare on or after January 1, 2020.

Illustrative example: on a $40,000 emergency hospital bill abroad, the plan pays 80% of $39,750 ($40,000 minus the deductible), or $31,800, and the traveler pays $8,200. Medicare describes this benefit as emergency care abroad, not as paying for a flight home.

Timing matters. The Medigap guide says you're guaranteed a policy only during your one-time 6-month Medigap Open Enrollment Period, starting the first month you have Part B and are 65 or older, or with a guaranteed issue right; some states add other enrollment periods. Otherwise the insurer can refuse you based on your health. Insurers also generally can't sell Medigap to someone in a Medicare Advantage plan. Before leaving Advantage for the travel benefit, confirm a Medigap policy will be issued.

The CDC says Medicare Advantage plans do not usually cover treatment outside the US, though some cover emergency care.

Evacuation is the large exposure. The CDC puts a medevac at USD 25,000 for transport within North America to over USD 250,000 for distant or remote locations. The National Association of Insurance Commissioners (NAIC) says most US health insurers won't pay for repatriation or transport.

When insurance is required

Few destinations require a policy, and the list changes. Two examples from official pages:

Schengen visa applicants: the EU lists medical insurance covering emergency care, hospitalisation and repatriation among the visa documents, and a Czech foreign ministry page says minimum coverage must be EUR 30,000, valid across the Schengen Area for the whole stay. The United States is on the EU's list of visa-exempt countries for short stays, so this mainly affects US residents traveling on a passport that needs a visa.
Cuba: Singapore's foreign ministry says all travellers to Cuba must bring digital or printed proof of medical insurance (checked October 15, 2026). Separately, US sanctions restrict travel to Cuba; the Treasury's OFAC Cuba page sets out the rules.

Check the destination's embassy or consulate for the current rule.

What your card may cover

The Chase Sapphire Reserve is one documented example; other cards differ. Its Guide to Benefits (PDF, 2026) limits trip cancellation and interruption cover to $10,000 per covered traveler, $20,000 per trip and $40,000 per 12 months per account. Covered reasons include illness or injury where a physician advises cancelling, and certain severe weather. A change in plans is excluded. So is a pre-existing condition, meaning medical advice or treatment in the 60 days before the booking or first deposit.

Medical cover is thin: emergency medical and dental pays up to $2,500 after a $50 deductible, and only after other insurance. Evacuation is covered up to $100,000. The service provider must authorize and arrange it in advance. The trip must last 5 to 60 days and be more than 100 miles from home, and at least part of it must be charged to the card. The guide warns that evacuation may not be available in countries with a State Department travel warning or US sanctions.

A card can cover a $6,000 trip cancelled for a listed reason, yet pay nothing if you simply decide not to go. The NAIC says most homeowners policies cover property lost or stolen during a trip, and that some airlines and tour companies allow cancellation outside an insurance policy, so check both before paying for duplicate cover.

Worked example: a $6,000 trip

Illustrative example. A traveler prepays $6,000 in nonrefundable costs. Assumptions: a policy at 6% of trip cost, which the policy seller Squaremouth reports as the 2026 average (typical range 4% to 10%); a CFAR add-on raising the premium 40%; and CFAR reimbursing 75% of prepaid, nonrefundable costs. Squaremouth's CFAR page gives 50% to 75% reimbursement, with 80% of the CFAR plans it lists at 75%, and a 40% to 60% premium increase. These are a seller's figures, not one policy's terms.

comprehensive premium   = 6% x $6,000     = $360
CFAR premium            = $360 x 1.40     = $504
CFAR extra cost         = $504 - $360     = $144
CFAR refund, any reason = 75% x $6,000    = $4,500
break-even probability  = $144 / $4,500   = 3.2%

Break-even is the chance of cancelling for a reason the base policy won't cover at which the expected CFAR refund equals the extra premium. At a 1% chance the expected refund is $45, below the $144 cost; at 5% it is $225. Squaremouth also says CFAR adds about 3% of trip cost on average; at $180, the break-even is 4.0%.

Outcome	Comprehensive ($360)	With CFAR ($504)
Trip goes ahead	Out $360	Out $504
Cancel for a covered reason (claim paid in full)	Out $360	Out $504
Cancel for a reason not covered	Out $6,360	Out $2,004

For covered reasons the cheaper policy does the same job, so CFAR matters only for cancellations it would not cover. If the plan reimbursed 50%, the break-even rises to 4.8% ($144 / $3,000). Squaremouth says CFAR usually must be bought within 14 to 21 days of the first trip payment and must insure 100% of prepaid costs. The trip must be cancelled 2 to 3 days before departure, and availability varies by state.

Educational note: this article is general information, not insurance, medical or legal advice. Policy terms, eligibility and state rules vary, so read the certificate of insurance and ask the insurer, a State Health Insurance Assistance Program counselor (for Medicare questions) or your state insurance department.

Pre-existing conditions and timing

The NAIC lists pre-existing conditions as a common exclusion. Squaremouth says many plans waive it if you buy early: generally within 14 to 21 days of the initial trip deposit, insuring the full trip cost, being medically stable and having primary health insurance. Keep proof of the deposit date.

The CDC adds that conditions needing hospitalization or direct medical intervention in the 90 days before departure are often excluded, and that people over 75 should start researching specialized policies early. Weather timing matters too: the NAIC says a policy bought after a winter or tropical storm is named won't cover claims related to that storm.

On price, the CDC says comprehensive policies can cost up to 8% of trip cost for listed reasons and up to 15% with cancellation for any reason. The NAIC's travel insurance page gives 5% to 10%, so a $5,000 trip runs roughly $250 to $500.

Frequently asked questions

Does a policy cover a pandemic or epidemic?

Usually not for cancellation. The NAIC says policies typically exclude epidemics and pandemics and treats COVID-19 as a known event, though medical coverage may still pay for illness during a trip.

Will the insurer pay the hospital directly?

Not always. The CDC says to expect to pay upfront and claim later, and the NAIC advises checking whether the policy requires prior approval before care.

Can the State Department help if I cannot pay a foreign hospital?

The CDC says the department may offer limited emergency medical assistance loans to US citizens who cannot pay and cannot arrange a transfer of funds. After a loan, it limits the passport and generally won't issue a new one until the loan is repaid.

Can I cancel a policy I just bought?

Often, yes. Squaremouth says premiums are generally refundable during the free look period, roughly 10 to 21 days after purchase; the certificate gives the exact period.

Who regulates travel insurance and where do I complain?

State insurance departments. The NAIC adopted a Travel Insurance Model Act in December 2018 and says 38 states had enacted it as of April 2026. Non-insurance extras sold with a policy are not overseen by those departments.

A checklist before you pay

List what you already have: Medicare or plan terms for care abroad, your card's benefit guide, home insurance and supplier refund rules.
Note the date of the first trip deposit and put day 14 on the calendar for any CFAR or pre-existing condition waiver.
If a visa or the destination requires proof of cover, confirm the minimum on the official embassy or consulate page.
Insure the full prepaid, nonrefundable amount, and compare the evacuation limit with the $25,000 to $250,000-plus range.
For a short, refundable, domestic trip with health cover that works in the US, a policy may add little.