Travel Insurance for the United States: What a Health Scare Really Costs on a Road Trip

On a rental agreement in Las Vegas, Los Angeles or Denver, the rental company routinely offers a Loss Damage Waiver (LDW/CDW) and Supplemental Liability Insurance (SLI/LIS). Our article on US rental car insurance covers exactly what these options include — but it needs to be said plainly: they protect the vehicle and third parties in a road accident, nothing more. They won't reimburse a stomach bug in Moab, a fall while hiking in the Grand Canyon, heatstroke crossing Death Valley, or a medical evacuation.

The travel insurance discussed here is a separate policy, taken out before departure, covering the traveler's own health, medical treatment and any evacuation, whatever the cause — road accidents included. The two policies are complementary and both essential for a road trip that mixes long-distance driving, high-elevation hiking and extreme heat in the Southwest's parks.

The federal EMTALA law (Emergency Medical Treatment and Labor Act, 1986) requires every hospital with an emergency department that participates in Medicare — nearly every US hospital — to screen and stabilize anyone presenting with an emergency medical condition, regardless of nationality, status or ability to pay. Turning away or transferring an emergency patient improperly exposes the facility to steep federal penalties.

But that obligation stops at immediate stabilization: whatever follows — hospitalization, tests, surgery, transport — gets billed in full, with no discount for a foreign visitor with no coverage applicable on-site. Neither a French carte vitale nor a European Health Insurance Card (EHIC) has any validity in the United States: for a foreign visitor, the public system simply doesn't exist beyond that emergency stabilization.

The United States has the highest healthcare costs in the world, and an uninsured patient often pays more than someone covered by a US insurance plan — the negotiated rates insurers secure simply don't apply to them. Here are the ranges to know before you go.

The financial risk of a health scare in the United States isn't a marketing exaggeration from travel insurers: a study by Himmelstein, Thorne, Warren and Woolhandler, published in 2009 in the American Journal of Medicine, surveyed a national sample of 1,032 Americans who had filed for personal bankruptcy in 2007 — in that cohort, medical debt was a leading contributor to roughly 62% of bankruptcies, and 92% of these "medical" debtors owed more than $5,000 in medical bills (study available on Google Scholar: scholar.google.com/scholar?q=Himmelstein+Thorne+Warren+Woolhandler+Medical+Bankruptcy+United+States+2007+National+Study).

That figure, whose exact methodology has been debated, still points to a reality confirmed by dozens of later studies: even insured Americans can be financially ruined by an unplanned hospitalization. For a foreign traveler with no local coverage at all, the exposure runs at roughly the same scale — without even the partial safety net residents have.

Since January 1, 2022, the No Surprises Act has protected patients against surprise bills from out-of-network emergency care and air ambulance transport: the provider can no longer charge more than the patient's usual in-network rate. A study by Chhabra and colleagues, published in 2020 in Health Affairs using 2013-2017 data from a large national insurer, had documented the scale of the problem before the law: 71% of ambulance rides generated a potentially "surprise" bill, with a median of $450 for ground transport and $21,698 for air transport (study available on Google Scholar: scholar.google.com/scholar?q=Chhabra+Most+Patients+Undergoing+Ground+Air+Ambulance+Transportation+Sizable+Out-of-Network+Bills+Health+Affairs).

The detail that matters for a road trip: the 2022 law explicitly excludes ground ambulances from its protection — only air transport is covered. According to a KFF analysis of 2018 data, roughly one in two emergency ground ambulance rides still results in an out-of-network charge. On a remote Utah or Wyoming backroad, though, it's the ground ambulance that shows up first, well before any helicopter.

A serious accident or medical episode deep in the Grand Canyon, on a Death Valley track, or in Yellowstone's backcountry usually calls for a helicopter transport before reaching any real hospital: distance and terrain make ground ambulance transport slow, sometimes unworkable. A regional helicopter evacuation starts around $12,000 and can exceed $80,000 in the most remote areas (Alaska, the Rockies, the desert Southwest) — not to mention a full international medical repatriation, which can reach several hundred thousand dollars in a serious case.

A solid policy covers this cost with no low cap and no deductible, and arranges the logistics itself through a 24/7 assistance hotline — capable of coordinating a helicopter out of a Yellowstone ranger station or an air ambulance from Salt Lake City, something no lone traveler can arrange from a Wyoming backroad.

Premium bank cards (Visa Premier, Gold Mastercard, World or Infinite cards) often include repatriation assistance, provided the trip was paid for with that card. That's a useful backup, but clearly insufficient against US prices on its own: coverage caps rarely exceed €15,000, far short of the tens of thousands of dollars a serious hospitalization or a remote-park evacuation can cost, and several policies explicitly exclude hiking in remote areas or driving off main roads — exactly the terrain of a Western US road trip.

Industry specialists recommend, for a US trip, coverage well above what's advised for most other destinations: at least $100,000 in medical expenses and $100,000-250,000 for evacuation, versus caps often two to three times lower on generic policies designed for Europe or Asia.

Before signing, a few simple checks avoid nasty surprises once you're on a Grand Canyon trail or deep in Yellowstone's backcountry:

This travel insurance is only one piece of preparing a self-drive US road trip: US driving rules and the international permit, the best season depending on the regions crossed, and the rental car insurance itself all deserve just as much planning before you leave.