Travel policies covering the United States are priced differently from everything else, for one reason: American medical costs generate far larger claims than the same injury does elsewhere.
The geographical limits
The first thing to check, and it is stated near the front of the wording.
Policies commonly define regions as Europe only, worldwide excluding US, Canada and the Caribbean, or worldwide including.
The exclusion of North America and the Caribbean is why many cheap policies are cheap, and buying one for a US trip means having no cover at all.
Why the costs are what they are
Not a moral point, a practical one.
Emergency treatment, imaging, surgery and a hospital stay accumulate at rates that exhaust modest limits quickly. A straightforward fracture requiring surgery can generate a bill that would be a fraction of that in most of Europe.
Add repatriation on top — an air ambulance across the Atlantic runs into six figures.
Policies covering the US carry limits in the millions because those are the numbers involved.
The practical mechanics
Call the insurer's emergency line before treatment wherever possible. The assistance company can arrange direct billing, which avoids you paying up front.
US hospitals commonly ask for payment guarantees before non-emergency treatment, and will ask for insurance details on arrival.
Emergency rooms treat first in genuine emergencies and bill afterwards, and the bill will follow you.
Keep every document. US billing generates a great deal of paperwork from multiple providers — the hospital, the physician, the radiologist and the ambulance may all bill separately.
What to check specifically
| Item | Why it matters here |
|---|---|
| Geographical limits | Is the US covered at all |
| Medical expenses limit | Must reflect US costs |
| Repatriation limit | Transatlantic air ambulance |
| Excess | Per person, per section |
| Emergency line | Saved offline before departure |
| Pre-existing conditions | Declared and accepted |
The activities to declare
American trips frequently involve things that sit outside basic cover.
Hiking at altitude — Colorado, the Sierra Nevada and the Tetons all exceed common altitude caps.
Skiing, and off-piste within it.
Watersports, including jet skis.
Driving, where your travel policy covers you as a person and the vehicle comes from the rental agreement or separate excess cover.
Motorcycle hire, requiring the correct licence category.
The car rental question
Separate from travel insurance and frequently confused with it.
Liability cover in the US is the significant one, and minimum state requirements can be low relative to potential claims.
Check what your rental agreement includes, what your credit card provides, and whether either covers liability rather than only damage to the vehicle.
The standing caveat
Products, limits and prices change continuously and depend on your country of residence and age.
Check the geographical limits and the medical limit for the specific policy you are buying. Those two decide whether it is fit for a US trip.