US embassies and consulates are intensifying warnings to American travelers that a sudden injury or illness abroad can trigger medical and evacuation bills running into hundreds of thousands of dollars, and that the US government will not step in to pay for their care if they are uninsured.
State Department Sharpens Its Message on Health Risks Abroad
In updated guidance and renewed public messaging, the US Department of State is stressing that Americans should not leave the country without robust medical and evacuation insurance tailored to international travel. Officials say too many citizens still assume their domestic health plans, Medicare benefits, or the US government itself will cover emergencies overseas, only to discover in crisis that they are largely on their own.
On its Medicine and Health advisory page, last updated in August 2025, the State Department makes the point bluntly: the US government does not pay medical bills abroad, and travelers are responsible for all hospital and medical costs they incur in foreign countries. In many destinations, hospitals will demand advance payment or a substantial deposit before admitting a patient or beginning treatment, even in serious emergencies.
That warning is now being echoed by US embassies and consulates worldwide, which are using their websites, newsletters, and outreach events to emphasize that consular staff can help locate doctors, contact family and advise on financial options, but they cannot act as an overseas health insurer. The growing urgency of the message reflects both the rising cost of global health care and a steady stream of cases in which Americans have been stranded by medical debts they cannot pay.
The State Department is urging travelers to treat medical coverage as a core part of trip planning, alongside passports, tickets and visas. Officials say that for many Americans, a stand-alone travel medical policy or a comprehensive travel insurance plan with strong medical and evacuation benefits is now as essential as a boarding pass.
Six-Figure Evacuation Bills and Cash-Only Hospitals
The most dramatic financial shocks hit when an injured traveler needs an air ambulance or specialized evacuation to another country or back to the United States. State Department guidance notes that medical evacuation by air ambulance can cost from about 20,000 dollars to as much as 200,000 dollars or more, depending on the location and the complexity of the case. Independent medical and insurance analyses paint a similar picture, with some evacuations from remote or conflict-affected areas reaching several hundred thousand dollars.
Without dedicated evacuation coverage, those costs must be paid out of pocket. In practice, that can mean families scrambling to crowdfund rescue flights, hospitals refusing to release patients until bills are settled, or injured travelers remaining in local facilities that are ill equipped to handle complex trauma or intensive care. Medical experts warn that delays in transferring critically ill patients, sometimes dictated purely by money, can directly affect outcomes.
Even routine hospital stays can be financially devastating. Travel insurers report that emergency medical claims, including short hospitalizations and urgent care visits, routinely run into tens of thousands of dollars in high-cost destinations. Industry data compiled over the past year shows average emergency medical payouts in the low thousands, but outlier claims are far higher, particularly when surgery, intensive care or prolonged rehabilitation is required.
Compounding the problem, many foreign hospitals expect payment up front and often in cash or by international card before treatment. US embassies warn that local providers may decline to accept American insurance cards, especially from smaller networks, and may not release patients or allow discharge until bills are cleared. Travelers who cannot pay face the prospect of mounting debts, legal disputes with hospitals, or being denied follow-up care.
Medicare Gaps and Patchy Coverage Leave Older Travelers Exposed
The State Department and partner health institutions are placing particular emphasis on the gaps affecting older US travelers. Official guidance underscores that Medicare does not cover medical costs outside the United States in most situations, and Medicaid also provides no routine overseas coverage. For retirees who assume their federal benefits travel with them, that gap can come as a shock only discovered in an emergency ward far from home.
Accessibility and health planning pages maintained by the State Department reaffirm that point, recommending that older adults and people with disabilities obtain supplemental medical insurance and medical evacuation plans before leaving the country. Johns Hopkins Medicine and other major health systems echo that advice, warning that a serious illness abroad can leave older patients facing both medical risk and crushing financial liability without an appropriate policy.
Private US health insurance plans may offer limited emergency coverage abroad, but consular officials say the fine print matters. Some policies exclude care outside provider networks, cap overseas benefits at relatively low levels, or require patients to pay costs directly and seek reimbursement after returning home. In a major emergency, where a single hospital bill can exceed policy limits, these partial protections may fall far short.
Officials are therefore urging Americans in Medicare and other restricted plans to speak with their insurers well before departure, determine exactly what benefits apply internationally, and then purchase stand-alone travel health and evacuation coverage to close any gaps. For older travelers with existing conditions, that often means securing a plan that explicitly covers pre-existing illnesses on at least a limited basis, as well as high limits for evacuation.
Embassies Can Help in Crisis, But They Will Not Pay Your Bills
In communications aimed at clarifying expectations, US embassies are drawing a sharp line between the consular assistance they can provide and the financial support many travelers mistakenly expect. According to medical guidance issued by the State Department and major hospital systems, consular officers can help locate appropriate local medical facilities, facilitate the transfer of funds from the United States, and inform relatives in the event of a serious illness or injury.
However, they cannot act as personal advocates with foreign hospitals, guarantee payment, or negotiate discounts on behalf of patients. Nor can they arrange free evacuations for private citizens who simply prefer to return home for treatment. In crisis situations, including wars, civil unrest and natural disasters, the State Department may coordinate special flights, but its own rules require that passengers reimburse the government for transportation costs after the fact.
Recent crisis response advisories make clear that any US government assisted departure generally takes citizens only to a nearby safe location, not directly back to the United States, and that travelers remain responsible for onward tickets and living costs. For medical evacuations triggered by illness or injury rather than a broad security crisis, the expectation is even firmer that individuals must arrange and fund their own transport, typically through private insurance.
This messaging is meant to dispel what officials describe as a persistent misconception that an embassy can serve as a global safety net for uninsured Americans in trouble. Consular staff say that in reality, their role is advisory and logistical, and that financial protection must be arranged in advance through the private insurance market.
Destinations Tighten Entry Rules Around Travel Insurance
US warnings come amid a global shift as more countries make travel medical insurance compulsory, particularly for visitors requiring visas. In Europe, all 29 members of the Schengen Area require visa applicants to show proof of medical coverage that includes emergency hospitalization and medical repatriation, typically with a minimum coverage level in the tens of thousands of dollars.
Some destinations now go further. France requires all travelers to carry medical travel insurance and reserves the right for border agents to ask for proof at entry, regardless of whether a visa is required. In Cuba, visitors without proof of medical insurance can be required to purchase local coverage on arrival or may be denied entry. Ecuador and the Galapagos Islands have also tightened health insurance rules, while countries from Thailand and Turkey to the United Arab Emirates have adopted various forms of mandatory travel coverage for certain categories of visitors.
Industry analysts say this regulatory trend is accelerating as governments confront unpaid hospital bills from foreign tourists and attempt to shield their public health systems from uncompensated care. For American travelers, that means insurance is no longer just a personal safeguard; in more places, it is a legal requirement that can determine whether they are allowed to board a flight or clear immigration.
Travel advisers say US citizens should check entry conditions well before departure and ensure that any policy purchased meets specific country requirements for minimum medical, hospitalization and repatriation benefits. Failure to do so can lead to denied boarding, refused entry or the need to buy often more expensive local coverage at the border.
Rising Claims Underscore the Real-World Costs of Going Uninsured
Data from travel insurers and health agencies highlight how frequently trips are disrupted by medical issues and how costly those events can be. Industry figures from the past year indicate that roughly a quarter of travel insurance claims are now medical related, with average emergency medical payouts in the range of 1,700 to 1,800 dollars per claim. Behind those averages are cases involving cardiac episodes, serious infections, vehicle accidents and high-risk adventure injuries.
Medical evacuation claims, while less common, are significantly more expensive. Analysts report average evacuation payouts in the tens of thousands of dollars, with the upper end of claims surpassing 100,000 dollars when specialized aircraft, critical care teams and long-distance flights back to North America are required. The Centers for Disease Control and Prevention has warned that depending on the traveler’s location and condition, evacuation can range from about 15,000 dollars to well over 200,000 dollars.
US embassies say that these numbers are not abstractions but real bills faced by real citizens. Consular sections routinely encounter cases where uninsured or underinsured travelers are unable to leave foreign hospitals because they cannot pay, or where families back home must quickly raise large sums to secure an air ambulance for a loved one in critical condition. Social media campaigns that spring up in the wake of such emergencies, appealing for donations, have become a familiar feature of the modern travel landscape.
Officials and consumer advocates argue that these cases are largely preventable when travelers secure robust coverage in advance. They point out that even comprehensive policies are often a small fraction of the total trip cost, particularly on long-haul international itineraries, yet can determine whether a medical crisis becomes a short-term logistical challenge or a years-long financial burden.
What US Officials Say Travelers Should Look For in a Policy
While the State Department does not endorse specific companies, its public guidance outlines the core elements it believes Americans should seek in any travel medical plan. First on the list is clear, written confirmation that emergency medical care outside the United States is covered, including doctor visits, hospital stays, surgery, diagnostic tests and prescription medications.
Equally important, officials say, is a strong medical evacuation benefit that covers air ambulance and medically supervised transport to an appropriate facility. In practice, that often means specifying evacuation either back to the United States or to the nearest center capable of providing the necessary level of care, and checking that coverage limits are high enough to absorb worst case costs in regions with expensive aviation or health services.
Travel health specialists also recommend that policies include coverage for emergency dental care, at least limited benefits for pre-existing conditions, and 24 hour global assistance services capable of coordinating care and authorizing payments in multiple languages. For trips planned to remote areas, expedition cruises or adventure activities, they advise checking exclusions around high altitude trekking, scuba diving, motor sports and similar pursuits, and adding specialized coverage if needed.
US embassies encourage travelers to carry policy details, claim forms and insurer emergency contact numbers in both physical and digital form, and to share them with travel companions or family members. That preparation, they argue, can save critical time in an emergency, ensuring that local providers know whom to bill and that evacuation coordinators can mobilize quickly if a transfer becomes necessary.
Embassies Urge Americans to Plan for Health Before They Pack
Behind the sharpened warnings lies a broader push by US officials to reframe how Americans think about travel preparation. Instead of focusing solely on tickets, hotels and sightseeing, consular staff want health planning to move to the top of the checklist, alongside passport validity and visa requirements.
State Department resources now urge travelers to review destination specific health advisories, confirm vaccination and medication rules, and speak with their physicians several weeks before departure about any chronic conditions or special needs. For people with disabilities, older adults and others with higher medical risk, embassies highlight tailored guidance that stresses both personal preparation and the importance of comprehensive insurance.
Officials also promote enrollment in the free Smart Traveler Enrollment Program, which allows US citizens to receive safety and security updates from their local embassy and to be more easily contacted in emergencies. While STEP does not replace insurance, consular staff say it can accelerate assistance when crises occur, whether medical or security related.
For Americans planning trips in 2026 and beyond, the message from US embassies is increasingly clear: a valid passport and a packed suitcase are no longer enough. In a world of rising health care costs, stricter entry rules and unpredictable global crises, traveling without dedicated medical and evacuation insurance is a risk that US officials are now openly urging citizens not to take.