does aetna cover foreign travel

Protect Your Trip »

Does your health insurance plan cover you while abroad.

A primer on figuring out if you're covered and advice on investing in supplemental insurance.

Does Health Insurance Cover You Abroad?

Passport, maps, money, boarding pass etc

Getty Images

First, determine if your plan covers emergency care abroad. Then decide if buying supplemental coverage is a smart decision based on factors like your itinerary and any pre-existing health conditions.

Picture this: You're traveling overseas and you come down with a fever. You don't speak the native language and you're uncertain if your health plan covers medical care, like a visit to a doctor or hospital, abroad.

While this is probably the last scenario you want to consider while planning your trip, medical emergencies happen. But here's the silver lining: You can easily find out what your insurance will cover while traveling abroad by asking your provider a few key questions. To determine what coverage you have, and what you'll need when traveling overseas, begin by asking these five questions.

1. What does my health plan cover overseas?

The level of medical coverage available for international travel can vary widely, depending on your domestic health care provider and plan. The State Department advises contacting your insurance company prior to your trip and inquiring about the specific medical services overseas that are included in your coverage.

The Centers for Disease Control and Prevention also encourages travelers to ask what's excluded from their policy, such as risky activities. And depending on what is available to you, the CDC advises considering a supplemental policy. The State Department also recommends inquiring about specifics such as whether the plan includes coverage for emergency evacuations to the U.S. and pre-existing medical conditions. You should also familiarize yourself with any out-of-pocket costs that you may encounter for medical procedures or services overseas.

[ Compare travel insurance plans and get a quote .]

2. What if I have Medicare?

Keep in mind that Medicare does not cover emergency medical service for travelers out of the country. There are some Medigap plans that can offer supplemental coverage but remember that there is a lifetime cap of $50,000 for foreign travel emergency coverage.

3. What about emergency medical evacuations?

Few domestic health insurance providers will pay to transport ill patients back to the United States. And emergency evacuations can be expensive, costing more than $100,000, depending on your health condition and where you're located at the time the emergency takes place. If you're visiting a place that's isolated or where the quality of health care is subpar, do a cost-benefit analysis of investing in a supplemental evacuation insurance plan.

4. Should I buy travel medical insurance for my next vacation?

It's a smart idea to consider investing in travel insurance . But before you make a final decision, you'll want to evaluate a variety of factors, including the type of trip you're planning and if you'll be taking part in risky activities, such as scuba diving or mountain climbing during your trip. According to the CDC, there are three types of insurance travelers should consider while traveling: trip cancellation insurance, travel health insurance and medical evacuation insurance.

And according to a report released by InsureMyTrip, a travel insurance comparison and booking site, 75 percent of the site's consumers pick comprehensive travel insurance plans, which typically include emergency medical coverage, emergency medical evacuation coverage, trip cancellation coverage, trip interruption coverage and baggage coverage.

Another important reason to consider purchasing travel health insurance is that travel health insurance can help fill any gaps in domestic health insurance coverage. Plus, travel health insurance can provide 24/7 emergency assistance to help aid you in the event of a medical emergency. A licensed travel insurance agent can provide advice on appropriate coverage limits and how to qualify for coverage for pre-existing medical conditions.

5. What if I have to file a claim?

A claim is typically required in order to request reimbursement for medical bills. Most providers will require all hospital records (usually translated if in a non-English language) and receipts in order to evaluate the validity of the claim.

Travelers are encouraged to enroll in the Smart Traveler Enrollment Program (STEP) prior to international travel. Doing so will notify the nearest U.S. Embassy or Consulate of your travel plans. The local embassy can also help connect American travelers with a local medical facility.

Tags: Travel , health insurance , Travel Tips

About En Route

Practical advice on the art of traveling smarter with tips, tricks and intel from En Route's panel of experts.

Contributors have experience in areas ranging from family travel, adventure travel, experiential travel and budget travel to hotels, cruises and travel rewards and include Amy Whitley , Claire Volkman , Holly Johnson , Marsha Dubrow , Lyn Mettler , Sery Kim , Kyle McCarthy , Erica Lamberg , Jess Moss , Sheryl Nance-Nash , Sherry Laskin , Katie Jackson , Erin Gifford , Roger Sands , Steve Larese , Gwen Pratesi , Erin Block , Dave Parfitt , Kacey Mya , Kimberly Wilson , Susan Portnoy , Donna Tabbert Long and Kitty Bean Yancey .

Edited by Liz Weiss .

If you make a purchase from our site, we may earn a commission. This does not affect the quality or independence of our editorial content.

12 Cheap Fourth of July Getaways

April 29, 2024

The Best Tours of Buckingham Palace

Laura French April 29, 2024

Flight Canceled or Delayed? What to Do

Amanda Norcross April 26, 2024

The Best Beach Hats

Megan Johnson and Sharael Kolberg April 26, 2024

The Best Florence Tours

John Rodwan April 25, 2024

The 9 Best Louisiana Swamp Tours of 2024

John Rodwan April 24, 2024

How Much Does a Cruise Cost?

Gwen Pratesi April 24, 2024

The Best Whale Watching in Cape Cod

Lyn Mettler April 24, 2024

Best Whale Watching Tours in Maine

Marisa Méndez April 23, 2024

Credit cards
View all credit cards
Banking guide
Loans guide
Insurance guide
Personal finance
View all personal finance
Small business
Small business guide
View all taxes

Does My Health Insurance Cover International Travel?

Many or all of the products featured here are from our partners who compensate us. This influences which products we write about and where and how the product appears on a page. However, this does not influence our evaluations. Our opinions are our own. Here is a list of our partners and here's how we make money .

Table of Contents

Does health insurance cover you abroad?

How to get medical coverage for international travel, if you need health insurance that covers international travel.

When making travel reservations, we often fantasize about the historical landmarks we’re going to see at our destination or the flavorful cuisine we plan to devour at local restaurants. But few fantasize about spending a night at the hospital in another country or calling for a medical evacuation — even though it can happen.

You might already have health insurance that covers you in your country of residence, but does it cover you internationally? If you’ve wondered about what would happen if you broke a leg or suffered a stroke on a trip overseas, it’s a good idea to find out if your current insurance will provide assistance.

We’ll help you figure out if your health insurance provides coverage abroad, as well as what your options are to obtain coverage if it doesn’t.

» Learn more: The best travel insurance companies so you can worry less, adventure more

If you rely on Medicare or Medicaid for your medical coverage, then the answer is no, you’re not covered outside of the United States. In fact, Medicaid coverage doesn’t extend beyond your state of residence except in rare emergency situations, so keep that in mind when crossing state lines.

If you’re enrolled in an insurance plan through your place of employment or through the Health Insurance Marketplace, then the answer isn’t so concrete. It largely depends on your plan.

Subsidized insurance plans, such as those you find through the marketplace, are exclusive to each state. You might be able to get some emergency coverage abroad to an extent, but you won’t be able to visit a doctor for a routine procedure or buy prescription medication and expect a reimbursement. Private insurance might or might not offer coverage overseas, but again, it depends on the plan you have.

So, the best way to find out whether your health insurance covers international travel is to contact your insurance provider.

Ask the agent whether your emergency medical coverage extends outside of the United States, whether it covers pre-existing conditions and how to proceed with a claim if your policy does include coverage abroad and you need medical services.

If you require emergency treatment at a foreign hospital, make sure to bring your passport and your health insurance information with you. Otherwise, you might not be admitted.

Make sure you read the fine print and understand what kind of an emergency would be included or excluded from your plan.

» Learn more: What to know before buying travel insurance

If your health insurance doesn’t provide coverage abroad, consider the following options to get medical coverage for an international trip.

Purchase travel insurance

The first tried-and-true method of getting medical coverage on a trip overseas is to purchase travel insurance . Not every traveler needs it, and you might not buy it for every trip, but it’s one of those things that can save the day when you’re in a pickle.

The price varies and is based on the destination, length of trip, traveler’s age, amount you’ve prepaid and how much coverage you want. In addition to emergency medical insurance , you can choose to be covered for trip cancellation and interruption, weather, terrorism, travel and baggage delay, as well as a missed connection and even rental car damage .

In most cases, you’ll also have some type of medical evacuation and repatriation coverage included in the comprehensive plan. If you’re hospitalized abroad and you want to be transferred to a medical facility of your choice — or even return home — for more effective treatment, then your international coverage plan will take care of it.

Examples of why you might need medical evacuation coverage:

While paragliding in Chile, you land incorrectly and break your ankle.

You get in a serious car accident while driving a rental car across Ireland.

You’re helping build a school in Guatemala and suffer a stroke.

Some plans offer up to $1 million in medical evacuation and repatriation coverage, which includes return of remains back to your loved ones.

If you have a pre-existing condition, be on the lookout for plans that offer a pre-existing condition waiver.

Also note that you must purchase a policy for each person traveling to make sure everyone is covered in case of an emergency medical situation.

» Learn more: Can I get travel insurance for pre-existing medical conditions?

Use a travel credit card to pay for your trip

Although emergency evacuation coverage that comes with travel rewards credit cards includes a smaller maximum amount, it’s good to have in case you didn’t purchase a comprehensive travel insurance plan.

To be covered, you must pay for all or a portion of the trip with your travel card (see each cards’ terms). For example, the Chase Sapphire Reserve® and The Platinum Card® from American Express both cover up to $100,000 in emergency medical evacuation. However, compared to up to a million in reimbursed expenses offered by a travel insurance provider, the covered amount is much lower. Terms apply.

The limits are also lower for medical coverage. For example, the travel insurance plan can offer up to $250,000 in emergency medical and dental expenses, while the insurance that comes with The Platinum Card® from American Express offers a reimbursement of up to $20,000 for emergency medical services and up to $1,000 for emergency dental treatment. Terms apply.

The Chase Sapphire Reserve® caps out at $2,500 (with a $50 deductible). With most credit cards, no coverage is offered at all.

» Learn more: Credit cards with travel insurance

First and foremost, make sure to contact your health insurance provider to find out if the plan you’re on would cover an emergency during a trip overseas. If not, familiarize yourself with your credit card benefits guide and determine whether any included coverage is enough for you.

Alternatively, consider purchasing a comprehensive plan from one of the many travel insurance providers that also includes coverage against other potential travel mishaps.

How to maximize your rewards

You want a travel credit card that prioritizes what’s important to you. Here are our picks for the best travel credit cards of 2024 , including those best for:

Flexibility, point transfers and a large bonus: Chase Sapphire Preferred® Card

No annual fee: Bank of America® Travel Rewards credit card

Flat-rate travel rewards: Capital One Venture Rewards Credit Card

Bonus travel rewards and high-end perks: Chase Sapphire Reserve®

Luxury perks: The Platinum Card® from American Express

Business travelers: Ink Business Preferred® Credit Card

on Chase's website

1x-10x Earn 5x total points on flights and 10x total points on hotels and car rentals when you purchase travel through Chase Travel℠ immediately after the first $300 is spent on travel purchases annually. Earn 3x points on other travel and dining & 1 point per $1 spent on all other purchases.

60,000 Earn 60,000 bonus points after you spend $4,000 on purchases in the first 3 months from account opening. That's $900 toward travel when you redeem through Chase Travel℠.

1x-5x 5x on travel purchased through Chase Travel℠, 3x on dining, select streaming services and online groceries, 2x on all other travel purchases, 1x on all other purchases.

60,000 Earn 60,000 bonus points after you spend $4,000 on purchases in the first 3 months from account opening. That's $750 when you redeem through Chase Travel℠.

Chase Southwest Rapid Rewards® Plus Credit Card

1x-2x Earn 2X points on Southwest® purchases. Earn 2X points on local transit and commuting, including rideshare. Earn 2X points on internet, cable, and phone services, and select streaming. Earn 1X points on all other purchases.

50,000 Earn 50,000 bonus points after spending $1,000 on purchases in the first 3 months from account opening.

Ad-free. Influence-free. Powered by consumers.

The payment for your account couldn't be processed or you've canceled your account with us.

We don’t recognize that sign in. Your username maybe be your email address. Passwords are 6-20 characters with at least one number and letter.

We still don’t recognize that sign in. Retrieve your username. Reset your password.

Forgot your username or password ?

Don’t have an account?

Account Settings
My Benefits
My Products
Donate Donate

Save products you love, products you own and much more!

Other Membership Benefits:

Will Your Health Insurance Cover You Overseas?

How to get and pay for the treatment you need if you get sick or injured abroad, sharing is nice.

We respect your privacy . All email addresses you provide will be used just for sending this story.

If you're traveling abroad this summer, the last thing you probably want to think about is what you'll do if you get sick or injured. But experts say 15 percent of travelers encounter some kind of medical problem on their journey—and depending on your destination, your U.S. health insurance may not be much use.

The good news is that if you have to look beyond your own health plan, there are ways to cover medical emergencies that can be surprisingly inexpensive. Here's what you need to think about.

Key Considerations

Check your existing health plan. Coverage varies by health insurer and plan, so you must contact your carrier to get the details of your specific policy, says Cathryn Donaldson, a spokesperson for America's Health Insurance Plans, a trade association. In most cases, Medicare does not cover you outside the U.S., though some Medicare Advantage and Medigap plans offer worldwide emergency care.

"Most domestic health plans provide limited coverage overseas and won't cover prescriptions abroad," says Margaret Wilson, M.D., chief medical officer of UnitedHealthcare Global, which is part of UnitedHealthcare, the largest health insurer in the U.S.

If your insurer does provide coverage for medical treatment you get in another country, the care is typically reimbursed at an out-of-network rate, which means higher out-of-pocket costs.

The Centers for Disease Control and Prevention (CDC) recommends that you ask your insurer about exclusions for injuries related to terrorist attacks , acts of war, natural disasters, adventure activities such as scuba diving and mountain climbing, and exacerbations of pre-existing conditions . Also ask whether preauthorization is needed for treatment, hospital admission, or other services, and find out about the deductibles, copays, limits, and other policies for out-of-network services.

Consider international travel health insurance. If you find gaps in your existing healthcare policy, the CDC and major carriers such as Aetna, Kaiser Permanente, and UnitedHealthcare say you should consider filling the holes with a supplemental international travel health insurance plan. These plans provide secondary coverage that picks up the costs where your primary health insurance stops; some provide primary coverage.

Beware exclusions for pre-existing conditions. Travel health insurance policies typically don't cover pre-existing conditions. But you can buy a waiver of that exclusion, and you should consider doing so if you've had a change in your health or medicines in the 180 days before you buy the coverage.

Shop wisely for travel health insurance. Compare policies and premiums on sites that specialize in travel insurance, such as InsureMyTrip (800-487-4722), QuoteWright (800-821-4940) and Squaremouth (800-240-0369). Use these websites' toll-free phone numbers to get precise guidance from a human agent.

Policies tend to cost less the younger the traveler and the less comprehensive the plan. A $1 million medical insurance plan with zero deductible could cost a 35-year-old less than $15 per week, according to a review of plans on travel insurance broker sites. The same medical coverage for a 65-year-old—but with a pre-existing medical condition waiver, medical evacuation, and $5,000 trip cancellation/interruption coverage—could cost $220 to more than $600 per week.

Be prepared to pay up front. Even if you're covered by your regular U.S. health policy and supplemental travel health insurance, you should be ready to pay up front for medical care you receive abroad. That's because most foreign healthcare providers require payment in cash or by credit card when you receive treatment, and only some U.S. insurers have direct billing and payment relationships with healthcare providers all over the world, says Margaret Wilson at UnitedHealthcare Global.

Some international travel health plans also require that you pay up front and get reimbursed later, and others pay providers a certain amount on the spot to get you treated and admitted. The GeoBlue international travel health plans, however, have a global network of 7,100 physicians and 2,000 facilities in 190 countries, which the insurer pays directly if you get treated there.

Of course, you can't choose where you'll fall ill or be injured. So you must have ready money. "Even with international coverage, consider carrying an extra credit card with a large limit to use for unanticipated medical expenses," Wilson says. To ensure proper and prompt reimbursement by your insurers, Wilson advises that you get clear and complete copies of all bills, medical records, and discharge notes after you receive treatment.

Add medical evacuation protection. Not every travel destination in the world has doctors and hospitals that are up to U.S. standards, and many locations have none. If you're traveling in a developing country or a remote destination that's far off the grid, the CDC advises that you consider purchasing yet another type of protection called medical evacuation insurance. It covers the cost of medical transportation that can fly you hundreds or thousands of miles to a major city with quality medical care.

International air ambulances aren't cheap. They can cost $20,000 to $250,000, depending on departure point and destination as well as medical complexity, says William Siegart, D.O., chief medical officer of On Call International, one of the major services providing medical evacuations.

Although the need for medevac is relatively uncommon, On Call International handled more than 20,000 medical cases in 2017. Its 24/7 year-round service connects to a network of 4,000 medical centers and numerous air ambulance and commercial medical transport providers worldwide.

Medical evacuation insurance also covers the high cost of repatriating a recovering traveler to the U.S. on a commercial flight with a rescue nurse and necessary medical equipment, which can can cost $10,000 to $50,000.

In the U.S., medical-emergency helicopters are often out of network and not fully covered by insurance, so you definitely want to ask your health insurer whether medevac is covered overseas.

Kaiser Permanente, for example, covers local emergency medical transportation to the nearest hospital or other facility if it determines that doing so is necessary. But it doesn't generally cover or arrange other transportation, unless it deems it necessary to manage the member's care.

If repatriation is approved by Kaiser, it will pay for that service directly. But a Kaiser spokeswoman says members should consider supplemental medevac insurance "to lessen potential financial liability for noncovered travel‐related expenses."

Know who to call if you need help. If the worst happens and you need medical attention, the CDC recommends several resources to find care. First, contact the U.S. Embassy in the country you're staying to locate local medical services and they can also notify your family if needed. The International Society of Travel Medicine and the International Association for Medical Assistance to Travellers (IAMAT) can also help you find local doctors, clinics, and medical services. Membership for IAMAT is required but free and includes a guide on what to look for in travel health insurance plans.

Be the first to comment

Wellness & You

Main navigation.

Aetna education
Healthy all year
Live well guide
Benefit spotlight

Senior couple relaxing on the couch together

Find local support for healthy living

5 reasons to use your secure member website

Have questions we can help..

Call us at 1-833-570-6670 (TTY: 711) between 8 AM and 8 PM, seven days a week. Or visit AetnaMedicare.com

Vaccines for Travel

Clinical Policy Bulletins
Medical Clinical Policy Bulletins

Number: 0473

Footnotes † Persons who are immunocompromised because of immune deficiency diseases, leukemia, lymphoma, generalized cancer, or the acquired immunodeficiency syndrome, or who are receiving immunosuppressive therapy with corticosteroids, alkylating agents, anti-metabolites, or radiation.

Footnotes †† LYMErix was withdrawn from the U.S. market in February 2002.

Footnotes * Most Aetna benefit plans exclude coverage of vaccines for work. Please check benefit plan descriptions.

Note : The Advisory Committee on Immunization Practices (1996) states that plague vaccination is not indicated for most travelers to countries in which cases of plague have been reported.

Experimental and Investigational

The following vaccines for travel are considered experimental and investigational (not an all-inclusive list):

Malaria vaccine for travel because an effective malaria vaccine has yet to be developed.
Oral or skin-patch cholera vaccine for prevention of entero-toxigenic Escherichia coli diarrhea because their clinical value has not been established.

Policy Limitations and Exclusions

Note: Most Aetna HMO plans exclude coverage of vaccines for travel. Most Aetna traditional plans cover medically necessary travel vaccines for members of plans with preventive services benefits. Please check benefit plan descriptions.

Note : Many of these vaccines may also be considered medically necessary for reasons other than travel, and may be covered when medically necessary in members with preventive benefits, regardless of whether the plan excludes coverage of travel vaccines.

The Centers for Disease Control and Prevention (CDC)'s recommended vaccinations for travelers can be found at the following website: Destinations and Travelers Health .

In a Cochrane review on vaccines for preventing malaria, Graves and Gelband (2006a) concluded that there is no evidence for protection by SPf66 vaccines against P. falciparum in Africa. There is a modest reduction in attacks of P. falciparum malaria following vaccination with SPf66 in South America. There is no justification for further trials of SPf66 in its current formulation. Further research with SPf66 vaccines in South America or with new formulations of SPf66 may be justified.

In another Cochrane review, Graves and Gelband (2006b) concluded that the MSP/RESA (Combination B) vaccine shows promise as a way to reduce the severity of malaria episodes, but the effect of the vaccine is MSP2 variant-specific. Pre-treatment for malaria during a vaccine trial makes the results difficult to interpret, particularly with the relatively small sample sizes of early trials. The results show that blood-stage vaccines may play a role and merit further development.

Vaughan et al (2009) presented a comprehensive meta-analysis of more than 500 references, describing nearly 5,000 unique B cell and T cell epitopes derived from the Plasmodium genus, and detailing thousands of immunological assays. This was the first inventory of epitope data related to malaria-specific immunology, plasmodial pathogenesis, and vaccine performance. The survey included host and pathogen species distribution of epitopes, the number of antibody versus CD4(+) and CD8(+) T cell epitopes, the genomic distribution of recognized epitopes, variance among epitopes from different parasite strains, and the characterization of protective epitopes and of epitopes associated with parasite evasion of the host immune response. The results identified knowledge gaps and areas for further investigation. This information has relevance to issues, such as the identification of epitopes and antigens associated with protective immunity, the design and development of candidate malaria vaccines, and characterization of immune response to strain polymorphisms.

Currently, there is an ongoing phase III clinical trial of a candidate vaccine for malaria, but the study has not been completed (Birkett, 2010).

The Advisory Committee on Immunization Practices (ACIP) of the CDC provided the following recommendations regarding the prevention of plague (1996):

Routine plague vaccination is not necessary for individuals living in areas in which plague is enzootic.
Plague vaccination is not indicated for hospital staff or other medical personnel in such areas.
Plague vaccination is not indicated for most travelers to countries in which cases of plague have been reported.

In a Cochrane review, Ahmed et al (2013) evaluated the safety, effectiveness, and immunogenicity of vaccines for preventing entero-toxigenic Escherichia coli (ETEC) diarrhea. These investigators searched the Cochrane Infectious Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, and ClinicalTrials up to December 2012. Randomized controlled trials (RCTs) and quasi-RCTs comparing use of vaccines to prevent ETEC with use of no intervention, a control vaccine (either an inert vaccine or a vaccine normally given to prevent an unrelated infection), an alternative ETEC vaccine, or a different dose or schedule of the same ETEC vaccine in healthy adults and children living in endemic regions, intending to travel to endemic regions, or volunteering to receive an artificial challenge of ETEC bacteria were included for analysis. Two authors independently assessed each trial for eligibility and risk of bias. Two independent reviewers extracted data from the included studies and analyzed the data using Review Manager (RevMan) software. They reported outcomes as risk ratios (RR) with 95 % confidence intervals (CI) and assessed the quality of the evidence using the GRADE approach. A total of 24 RCTs, including 53,247 participants, met the inclusion criteria – 4 studies assessed the protective efficacy of oral cholera vaccines when used to prevent diarrhea due to ETEC and 7 studies assessed the protective efficacy of ETEC-specific vaccines. Of these 11 studies, 7 studies presented efficacy data from field trials and 4 studies presented efficacy data from artificial challenge studies. An additional 13 trials contributed safety and immunological data only. The currently available, oral cholera killed whole cell vaccine (Dukoral®) was evaluated for protection of people against "travelers' diarrhea" in a single RCT in people arriving in Mexico from the USA. These researchers did not identify any statistically significant effects on ETEC diarrhea or all-cause diarrhea (1 trial, 502 participants; low-quality evidence). Two earlier trials, one undertaken in an endemic population in Bangladesh and one undertaken in people travelling from Finland to Morocco, evaluated a precursor of this vaccine containing purified cholera toxin B subunit rather than the recombinant subunit in Dukoral®. Short-term protective efficacy against ETEC diarrhea was demonstrated, lasting for around 3 months (RR 0.43, 95 % CI: 0.26 to 0.71; 2 trials, 50,227 participants). This vaccine is no longer available. An ETEC-specific, killed whole cell vaccine, which also contains the recombinant cholera toxin B-subunit, was evaluated in people traveling from the USA to Mexico or Guatemala, and from Austria to Latin America, Africa, or Asia. These investigators did not identify any statistically significant differences in ETEC-specific diarrhea or all-cause diarrhea (2 trials, 799 participants), and the vaccine was associated with increased vomiting (RR 2.0, 95 % CI: 1.16 to 3.45; 9 trials, 1,528 participants). The other ETEC-specific vaccines in development have not yet demonstrated clinically important benefits. The authors concluded that there is currently insufficient evidence from RCTs to support the use of the oral cholera vaccine Dukoral® for protecting travelers against ETEC diarrhea. Moreover, they stated that further research is needed to develop safe and effective vaccines to provide both short- and long-term protection against ETEC diarrhea.

Also, an UpToDate review on "Travelers' diarrhea" (Wanke, 2014) states that "Use of vaccines to protect against travelers’ diarrhea is hindered by the varied pathogens that can cause it. Although enterotoxigenic E. coli (ETEC) predominates as an etiology of travelers’ diarrhea, vaccination strategies that have focused on this pathogen as a target have been suboptimal. Although vaccination to protect against cholera is not routinely recommended for travelers, a number of trials suggest that the oral, killed whole-cell vaccine given with the nontoxic B subunit of cholera toxin (Dukoral) provides protection for travelers against ETEC infection. The rationale for such protection is that the B subunit of cholera is antigenically similar to the heat-labile enterotoxin of ETEC. In two randomized trials, the killed whole-cell vaccine combined with the B subunit of cholera toxin reduced the incidence of diarrhea caused by ETEC by 67 percent in a trial in Bangladesh and 52 percent among travelers to Morocco. The Dukoral vaccine was approved in the United States in late 2006 for use as a travelers' diarrhea vaccine. However, a conservative estimate that took into account the incidence of ETEC infection throughout the world and the efficacy of the vaccine suggested that it may prevent ≤7 percent of travelers' diarrhea cases. The 2006 guidelines on travel medicine from the Infectious Diseases Society of America concluded that the decision to use the vaccine to prevent travelers' diarrhea must balance its cost, adverse effects, and limited utility against the known effectiveness and costs of self-treatment as described above. A separate vaccination strategy for ETEC also appears to have limited utility. Despite initial promising data on vaccination with heat-labile enterotoxin from ETEC via a skin patch, it was not effective in decreasing the incidence of moderate to severe diarrhea due to either ETEC or any cause in a randomized, placebo controlled trial that included 1,644 individuals who traveled to Mexico or Guatemala. In a subgroup analysis, the vaccine provided modest protection against ETEC that produced only heat-labile enterotoxin (vaccine efficacy 61 percent [95 % CI, 7 to 84 percent]), but not ETEC that produced heat-stable toxin or both. This highlights the limitations of a single-antigen vaccine for travelers’ diarrhea".

An UpToDate review on "Immunizations for travel" (Freedman and Leder, 2015) states that "In general, severely immunocompromised patients should not receive live vaccines. Live vaccines include yellow fever vaccine, oral typhoid vaccine, nasal influenza vaccine, oral polio vaccine (OPV), MMR, and varicella vaccine. Inactivated vaccines include meningococcal vaccine, parenteral typhoid vaccine, hepatitis A and B vaccines, rabies vaccine, Japanese encephalitis vaccine, inactivated influenza vaccine, inactivated polio vaccine (IPV), Tdap, and Td".

Chikungunya Vaccine

Chikungunya is primarily a mosquito-borne alphavirus caused by the chikungunya virus (CHIKV) that is often associated with fever and debilitating joint pain. Rarely, the virus can be transmitted via blood products, laboratory and maternal-fetal transmission. Outbreaks typically occur in tropical and subtropical regions of Africa, Asia, Oceania, and parts of the Americas and Europe where chikungunya virus-carrying mosquitos are endemic (Bettis et al, 2022; Wilson and Lenschow, 2022). Between 2014 and 2016, 3,941 cases were reported in the United States among travelers; 92% were associated with travel in the Americas (most commonly the Dominican Republic, Puerto Rico, and Haiti). The remaining 8% had traveled to Asia, Africa, or the Western Pacific (Lindsey et al, 2018; Wilson and Lenschow, 2022).

Management of the chikungunya virus is supportive (i.e., rest, fluids, antiinflammatory and analgesic agents). Systemic glucocorticoids or treatment with a disease-modifying antirheumatic drug (DMARD) has been used in refractory or chronic arthritis cases. The cornerstone of prevention has been minimizing mosquito exposure (Lenschow and Wilson, 2023). In November 2023, the FDA approved the first chikungunya vaccine (Ixchiq, Valneva Scotland Ltd) for the prevention of disease caused by chikungunya virus (CHIKV) in individuals 18 years of age and older who are at increased risk of exposure to CHIKV. "This indication is approved under accelerated approval based on anti-CHIKV neutralizing antibody titers. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory studies" (Valneva, 2023).

FDA approval was based on two clinical trials conducted in North America that evaluated the safety of Ixchiq in adults 18 years or older. In clinical studies, the most common solicited injection site reaction (greater than 10%) was tenderness (10.6%). The most common solicited systemic adverse reactions (greater than 10%) were headache (31.6%), fatigue (28.5%), myalgia (23.9%), arthralgia (17.2%), fever (13.5%) and nausea (11.2%). The effectiveness was based on immune response data from a clinical study conducted in the US in adults. "In this study, the immune response of 266 participants who received the vaccine was compared to the immune response of 96 participants who received placebo. The level of antibody evaluated in study participants was based on a level shown to be protective in non-human primates that had received blood from people who had been vaccinated. Almost all vaccine study participants achieved this antibody level" (FDA, 2023).

Ixchiq is administered as a single intramuscular injection. Ixchiq contains a live, weakened version of the chikungunya virus and may cause symptoms in the vaccine recipient similar to those experienced by people who have chikungunya disease. It is contraindicated in immunocompromised individuals or those with a history of a severe allergic reaction to any component of Ixchiq. Vertical transmission of wild-type CHIKV from pregnant individuals with viremia at delivery is common and can cause potentially fatal CHIKV disease in neonates. Vaccine viremia occurs in the first week following administration of Ixchiq, with resolution of viremia by 14 days after vaccination. It is not known if the vaccine virus can be vertically transmitted and cause fetal or neonatal adverse reactions. A decision to administer during pregnancy should take into consideration the individual’s risk of wild-type CHIKV infection, gestational age, and risks to the fetus or neonate from vertical transmission of wild-type CHIKV. Labeled warnings and precautions also include risk of syncope associated with administration of injectable vaccines (Valneva, 2023).

The Centers for Disease Control's (CDC) Advisory Committee on Immunization Practices (ACIP) met in October 2023 to discuss recommendations for the chikungunya vaccine. Draft recommendations include chikungunya vaccine recommendation for persons 18 years of age and older traveling to a country or territory where there is a chikungunya outbreak. In addition, the vaccine may be considered for persons traveling to a country or territory without an outbreak but with evidence of chikungunya virus transmission among humans within the last 5 years:

Older persons (e.g., >65 years), particularly those with underlying medical conditions, who are likely to have at least moderate exposure (moderate exposure could include travelers who might have at least 2 weeks (cumulative) of exposure to mosquitoes in indoor and/or outdoor settings) to mosquitoes
Persons staying for a cumulative period of 6 months or more during a 2-year period

Japanese Encephalitis Vaccine for Pediatric Travelers

Taucher and colleagues (2020) stated that in an initial study among children from non-Japanese encephalitis (JE)-endemic countries, sero-protection rates (SPRs) remained high 6 months following completion of the primary series with IXIARO. In an open-label, follow-up study, a subset of 23 children who received a 2-dose primary series of IXIARO in the parent study, were examined for safety and neutralizing antibody persistence for 36 months. SPRs remained high but declined from 100 % 1 month after primary immunization to 91.3 % at month 7 and 89.5 % at month 36. Geometric mean titers (GMTs) declined considerably from 384.1 by day 56-60.8 at month 36. No long-term safety concerns were identified. The authors concluded that the substantial decline in GMT observed in this study, together with previously published data on children vaccinated with IXIARO supported the recommendation for a booster dose in children who remain at risk of JE from 1 year after the primary series of IXIARO, consistent with the recommendation for adults.

Jost and colleagues (2015) evaluated the relevance of travel-related measles, a highly transmissible and vaccine-preventable disease. Between 2001 and 2013, surveillance and travel-related measles data were systematically reviewed according to the PRISMA guidelines with extraction of relevant articles from Medline, Embase, GoogleScholar and from public health authorities in the Region of the Americas, Europe and Australia. From a total of 960 records, 44 articles were included and they comprised 2,128 imported measles cases between 2001 and 2011. The proportion of imported cases in Europe was low at 1 to 2 %, which reflected the situation in a measles-endemic region. In contrast, imported and import-related measles accounted for up to 100 % of all cases in regions with interrupted endemic measles transmission; 11 air-travel related reports described 132 measles index cases leading to 47 secondary cases. Secondary transmission was significantly more likely to occur if the index case was younger or when there were multiple infectious cases on board. Further spread to health care settings was found. Measles cases associated with cruise ship travel or mass gatherings were sporadically observed. The authors concluded that within both, endemic and non-endemic home countries, pre-travel health advice should assess MMR immunity routinely to avoid measles spread by non-immune travelers. They stated that to identify measles spread as well as to increase and sustain high vaccination coverages, joint efforts of public health specialists, health care practitioners and travel medicine providers are needed.

An UpToDate review on "Immunizations for travel" (Freedman and Leder, 2016) states that "Children traveling outside the United States should receive MMR vaccination sooner than the standard immunization schedule. Prior to departure, children 12 months of age or older should have received 2 doses of MMR vaccine separated by at least 28 days, with the first dose administered on or after the first birthday. Children aged 6 to 11 months should receive 1 dose of MMR before departure. MMR vaccination for adults is indicated for individuals born in 1957 or later in the United States (before 1970 in Canada; before 1966 in Australia) without evidence of immunity or without evidence of 2 doses of an adequate live vaccine at any time after age 12 months. Although individuals born before 1957 in the United States are presumed to be immune (exceptions include United States healthcare workers and women of childbearing age), 2 doses of MMR vaccine spaced by 1 month should be strongly considered for unvaccinated individuals without other evidence of immunity who were born before 1957 (in the United States) and are traveling for purposes of healthcare or humanitarian work potentially entailing close contact with ill individuals. MMR vaccination is contraindicated in pregnant and immunocompromised patients".

The CDC (2015) states that anyone who is not protected against measles is at risk of getting infected when they travel internationally. It recommends the following: Centers for Disease Control and Prevention .

Infants 6 months through 11 months of age should receive 1 dose of MMR vaccine Footnotes for MMR vaccines for infants †
Children 12 months of age and older should receive 2 doses of MMR vaccine separated by at least 28 days.
Teenagers and adults who do not have evidence of immunity Footnotes for Acceptable presumptive evidence of immunity against measles * against measles should get 2 doses of MMR vaccine separated by at least 28 days.

Footnotes † Infants who get 1 dose of MMR vaccine before their first birthday should get 2 more doses (1 dose at 12 through 15 months of age and another dose at least 28 days later).

Footnotes * Acceptable presumptive evidence of immunity against measles includes at least one of the following: written documentation of adequate vaccination, laboratory evidence of immunity, laboratory confirmation of measles, or birth in the United States before 1957.

Contraindications and Precautions: Vaccine Recommendations and Guidelines of the ACIP .

Contraindications

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy Footnotes for deferred vaccine † or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised) Footnotes for HIV infected children *

Footnotes † Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered.

Footnotes * HIV-infected children may receive varicella and measles vaccine if CD4+ T-lymphocyte count is greater than 15 %.

Precautions

Moderate or severe acute illness with or without fever
Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product) Footnotes for immune globulin products †
History of thrombocytopenia or thrombocytopenic purpura
Need for tuberculin skin testing Footnotes for Measles vaccination *

Footnotes † Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered

Footnotes * Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine can be administered on the same day as tuberculin skin testing. If testing cannot be performed until after the day of MMR vaccination, the test should be postponed for at least 4 weeks after the vaccination. If an urgent need exists to skin test, do so with the understanding that reactivity might be reduced by the vaccine.

Tick-Borne Encephalitis Vaccine

Rampa et al (2020) state that tick-borne encephalitis (TBE) is increasing in Europe and has become one of the most important causes of viral encephalitis, as well as the most frequent cause of viral meningitis, in Europe. The authors note that there is no antiviral treatment against TBE and that active vaccination is a practical preventive measure to reduce the number of cases. There are two inactivated virus vaccines licensed in Europe: FSME-Immun® (Pfizer), in some countries distributed as Ticovac®, and Encepur® (Bavarian Nordic). FSME-Immun is based on the TBE virus strain Neudoerfl (Nd), whereas Encepur is based on the TBE virus strain Karlsruhe-23 (K23). Both vaccines have a pediatric TBE vaccine variant. Thus, the authors conducted a systematic review (registered at PROSPERO (#CRD42020155737) and conducted in accordance with PRISMA guidelines) of the immunogenicity and safety of the tick-borne encephalitis vaccine (2009-2019). Of a total of 2464 records, 49 original research publications included evaluation for immunogenicity and safety. The authors found that TBE-vaccines showed adequate immunogenicity, good safety and interchangeability in adults and children with some differences in long-term protection (seropositivity in 90.6–100% after primary vaccination; 84.9%–99.4% at 5 year follow up). Primary conventional vaccination schedule (days 0, 28, and 300) demonstrated the best immunogenic results (99–100% of seropositivity). Mixed brand primary vaccination presented adequate safety and immunogenicity with some exceptions. After booster follow-ups, accelerated conventional and rapid vaccination schedules were shown to be comparable in terms of immunogenicity and safety. First booster vaccinations five years after primary vaccination were protective in adults aged less than 50 years, leading to protective antibody levels from at least 5 years up to 10 years after booster vaccination. In older vaccinees, 50 years and older, lower protective antibody titers were found. Allergic individuals showed an adequate response and immunosuppressed individuals a diminished response to TBE-vaccination. The authors concluded that the TBE-vaccination with Encepur or FSME-Immun to be highly immunogenic, well tolerated and in all studies except one to be interchangeable. Schedules should, if possible, use the same vaccine brand (non-mixed). TBE-vaccines are immunogenic in terms of antibody response but less so when vaccination is started after the age of 50 years. Age at priming is a key factor in the duration of protection. In terms of safety, the European, licensed vaccines were found to be well tolerated in both children (aged 1–17 years) and in adults, with local injection site reactions in 24.8% (4.3–54%) and systematic reactions in 30% (0.6–45.9%) of vaccinees. Vaccine related serious adverse events (SAE) were rare.

In February 2021, the U.S. FDA accepted for Priority Review Pfizer’s Biologics License Application (BLA) for TicoVac, its tick-borne encephalitis (TBE) vaccine for active immunization to prevent TBE in individuals 1 year of age and older. If approved, TicoVac would be the first vaccine in the U.S. to help protect adults and children who are visiting or living in TBE endemic areas. In line with Priority Review designation, the FDA will target an action within six months of the application submission date, with the anticipated Prescription Drug User Fee Act (PDUFA) action date expected for August 2021.

The BLA is based on results from "more than 40 years of experience and evidence outside the U.S. In clinical trials, the safety and immunogenicity of TicoVac was assessed across two age groups (1-15 years of age and 16-65 years of age). In these studies, pooled seropositivity rates were 99-100% in 1-15 year olds and 94-99% in adults >15 years following three doses. Clinical studies demonstrated that TicoVac was well-tolerated with no unexpected adverse events or vaccine-related serious adverse events observed. Subsequent real-world studies have shown that the vaccine is 96-99% effective in people who have received at least two doses of the vaccine, and two to three doses of the vaccine were shown to be sufficient to provide a long-lasting immune memory” (Pfizer, 2021b).

On August 13, 2021, the U.S. FDA approved Ticovac (Pfizer Inc.), tick-borne encephalitis (TBE) vaccine, for active immunization to prevent TBE in individuals 1 year of age and older. FDA approval was based on the safety and immunogenicity of Ticovac that were assessed cross two age groups (Study 209: 1 to15 years of age and Studies 213 and 690601: persons 16 years of age and older). In these studies, seropositivity rates were 99.5% in the group of 1 to 15 year olds and 98.7-100% in persons older than 15 years following three primary doses. Clinical studies demonstrated that Ticovac was generally well-tolerated with no unexpected adverse events or vaccine-related serious adverse events observed. The most common adverse reactions across both age groups were local tenderness, headache, local pain, fever, restlessness, fatigue, and muscle pain. Real-world studies from Austria have shown that the vaccine is 96-98.7% effective in people who have received at least three doses of the vaccine (Pfizer, 2021a, 2021c).

Two open-label, multi-center, follow-up studies which enrolled subjects who were seropositive 1 month after the third vaccination from Studies 213 (N=252, ages 16 through 65 at the time of first TICOVAC dose) and 209 (N=358, ages 1 through 15 at the time of first Ticovac dose) were conducted to assess the seropersistence of TBE antibodies after completion of the primary vaccination series and the antibody response to a booster administration. Three years after the primary series of Ticovac , neutralization test (NT) seropositivity in follow-up studies 223 and 700401 ranged from 82.9% to 100% depending on age. Following a booster dose the NT seropositivity rates were 100% (Pfizer, 2021a).

Vaccines for Pregnant Travelers

Nasser and colleagues (2020) noted that pregnant travelers and their offspring are vulnerable to severe outcomes following a wide range of infections. Vaccine-preventable diseases can have a particularly severe course in pregnant women, but little is known about the safety of travel vaccines in pregnant women. These investigators carried out a systematic review of all published literature concerning the safety of vaccines frequently given to travelers such as yellow fever, MMR (mumps, measles and rubella), influenza, Tdap (tetanus, diphtheria and pertussis), meningococcus, hepatitis A and B, rabies, polio, typhoid fever, tick-borne encephalitis and Japanese encephalitis vaccines. They included case series, cohort studies and RCTs. For the meta-analysis, these researchers included only RCTs that compared the administration of a vaccine to placebo or to no vaccine. Outcome measures included severe systemic adverse events (AEs), maternal outcomes related to the course of pregnancy, neonatal outcomes and local AEs. They calculated the RR and its 95 % CI as the summary measure. The safety of influenza vaccine is supported by high-quality evidence. For Tdap vaccine, no evidence of any harm was found in the meta-analysis of RCTs. A slight increase in chorioamnionitis rate was reported in 3 out of 12 observational studies. However, this small possible risk is far out-weighed by a much larger benefit in terms of infant morbidity and mortality. Meningococcal vaccines are probably safe during pregnancy, as supported by RCTs comparing meningococcal vaccines to other vaccines. Data from observational studies support the safety of hepatitis A, hepatitis B and rabies vaccines, as well as that of the live attenuated yellow fever vaccine. The authors found little or no data about the safety of polio, typhoid, Japanese encephalitis, tick-borne encephalitis and MMR vaccines during pregnancy.

Yellow Fever Vaccine Safety in Immunocompromised Individuals

de Araujo Lagos et al (2023) stated that yellow fever (YF) is an arbovirus with variable severity, including severe forms with high mortality; and vaccination is the most effective measure to protect against the disease . Non-serious and serious AEs have been described in immunocompromised individuals; however, previous studies have failed to show this association. In a systematic review, these investigators examined the risk of AEs following YF vaccination in immunocompromised individuals compared with its use in non-immunocompromised individuals. They carried out a literature search in the Medline, LILACS, Embase, SCOPUS, DARE, Toxiline, Web of Science and grey literature databases for publications until February 2021. Randomized and quasi-randomized clinical trials and observational studies that included immunocompromised subjects (individuals with HIV infection, organ transplantation, cancer, who used immunosuppressive drugs for rheumatologic diseases and those on immunosuppressive therapy for other diseases) were selected. The methodological quality of observational or non-randomized studies was assessed by the ROBINS-I tool. These researchers carried out 2 meta-analyses, proportion and risk factor analyses, to identify the summary measure of RR in the studies that had variables suitable for combination. A total of 25 studies were included, most with risk of bias classified as critical; 13 studies had enough data to perform the proposed meta-analyses; 7 studies without a comparator group had their results aggregated in the proportion meta-analysis, identifying an 8.5 % (95 % CI: 0.07 to 21.8] risk of immunocompromised individuals presenting AEs following vaccination; 6 cohort studies were combined, with an RR of 1.00 (95 % CI: 0.78 to 1.29). Subgroup analysis was conducted according to the etiology of immunosuppression and was also unable to identify an increased risk of AEs following vaccination. The authors concluded that it was not possible to affirm that immunocompromised individuals, regardless of etiology, had a higher risk AEs, following receiving the YF vaccine.

Zaire Ebolavirus Vaccine

The Ebola virus [Zaire ebolavirus (EBOV)] vaccine is a replication-competent, live, attenuated recombinant vesicular stomatitis virus (rVSV) vaccine. It contains a gene from the Ebola virus, not the whole virus, which means persons cannot become infected with EBOV from the vaccine. The vaccine is known as rVSVΔG-ZEBOV-GP Ebola vaccine, brand name Ervebo (manufactured by Merck). The vaccine was approved by the U.S. FDA on December 19, 2019, for the prevention of Ebola virus disease (EVD) caused by EBOV in people 18 years of age and older, based on the data from 12 clinical trials that included a total of 15,399 adults (CDC, 2021).

Study 3 (Ring vaccination study) was an open-label, randomized cluster (ring) vaccination study conducted in the Republic of Guinea during the 2014 outbreak. Each cluster was composed of contacts and contacts of contacts of individuals with laboratory-confirmed Ebola virus disease (EVD). Clusters were randomized to receive either an “immediate” vaccination or a 21-day “delayed” vaccination. In the primary efficacy analysis, 3,537 subjects 18 years of age and older were considered contacts and contacts of contacts of an index case with laboratory-confirmed EVD. Of these, 2,108 were included in 51 immediate vaccination clusters, and 1,429 were included in 46 delayed vaccination clusters. In the primary efficacy analysis, the number of cases of laboratory-confirmed EVD in subjects vaccinated in immediate vaccination clusters was compared to the number of cases in subjects in delayed vaccination clusters. Cases of EVD that occurred between Day 10 and Day 31 post-randomization of the cluster were included in the analysis. Vaccine efficacy was 100%; no cases of confirmed EVD were observed in the immediate vaccination clusters, and 10 confirmed cases of EVD were observed in a total of 4 delayed vaccination clusters between Day 10 and Day 31 post-randomization (Merck, 2019).

On February 26, 2020, the Advisory Committee on Immunization Practices (ACIP) recommended pre-exposure vaccination with Ervebo® for adults aged 18 years or older in the U.S. population who are at potential risk of exposure to EBOV. This recommendation includes adults who are responding or may respond to an outbreak of EVD; laboratorians or other staff working at biosafety-level 4 facilities in the United States; or healthcare personnel (HCP) working at federally designated Ebola Treatment Centers in the United States. HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. These HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, clinical laboratory personnel, autopsy personnel, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel) (CDC, 2021).

Ervebo (Merck Sharp & Dohme Corporation) is a vaccine indicated for the prevention of disease caused by Zaire ebolavirus in individuals 18 years of age and older. Immunization with Ervebo results in an immune response and protection from disease caused by Zaire ebolavirus. The relative contributions of innate, humoral and cell-mediated immunity to protection from Zaire ebolavirus are unknown.

Limitations of use include:

The duration of protection conferred by Ervebo is unknown;
Ervebo does not protect against other species of Ebolavirus or Marburgvirus;
Effectiveness of the vaccine when administered concurrently with antiviral medication, immune globulin (IG), and/or blood or plasma transfusions is unknown.

Ervebo is available as 1 mL suspension for injection supplied as a single-dose vial and is to be administered intramuscularly.

Ervebo label carries warnings and precautions for anaphylaxis. Vaccinated individuals should continue to adhere to infection control practices to prevent Zaire ebolavirus infection and transmission. Vaccine virus RNA has been detected in blood, saliva, urine, and fluid from skin vesicles of vaccinated adults; transmission of vaccine virus is a theoretical possibility. The most common injection-site adverse events were injection-site pain (70%), swelling (17%), and redness (12%). The most common systemic adverse events reported were headache (37%), feverishness (34%), muscle pain (33%), fatigue (19%), joint pain (18%), nausea (8%), arthritis (5%), rash (4%) and abnormal sweating (3%) (Merck, 2019).

The above policy is based on the following references:

Ahmed T, Bhuiyan TR, Zaman K, et al. Vaccines for preventing enterotoxigenic Escherichia coli (ETEC) diarrhoea. Cochrane Database Syst Rev. 2013;7:CD009029.
American Academy of Pediatrics Committee on Infectious Diseases. Poliovirus. Pediatrics. 2011;128(4):805-808.
Arguin PM, Kozarsky PE, Reed C, eds. CDC Health Information for International Travel, 2008. St. Louis, MO: Mosby; 2007.
Bettis AA, L'Azou Jackson M, et al. The global epidemiology of chikungunya from 1999 to 2020: A systematic literature review to inform the development and introduction of vaccines. PLoS Negl Trop Dis. 2022;16(1):e0010069.
Birkett A. MVI discusses what's on the horizon for malaria vaccine development. Bethesda, MD: The PATH Malaria Vaccine Initiative; 2010.
Carroll ID, Williams DC. Pre-travel vaccination and medical prophylaxis in the pregnant traveler. Travel Med Infect Dis. 2008;6(5):259-275.
Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP), Viral Special Pathogens Branch (VSPB). Ebola vaccine: Information about Ervebo. Atlanga, GA: CDC; February 25, 2021. Available at: https://www.cdc.gov/vhf/ebola/clinicians/vaccine/index.html. Accessed June 6, 2021.
Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Evidence to recommendations for chikungunya vaccine use among adult travelers. ACIP meeting; October 26, 2023. Available at: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-10-25-26/02-Chikungunya-Hills-508.pdf. Accessed November 20, 2023.
Centers for Disease Control (CDC). Rabies prevention -- United States, 1984. MMWR Morbid Mortal Wkly Rep. 1984;33(28):393-402, 407-408.
Centers for Disease Control and Prevention (CDC). Inactivated Japanese encephalitis virus vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1993;42(RR-1):1-15.
Centers for Disease Control and Prevention (CDC). Prevention and control of meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep. 2000;49(RR-7):1-10.
Centers for Disease Control and Prevention (CDC). Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep. 1999;48(RR-12):1-37.
Centers for Disease Control and Prevention (CDC). Recommendations for the use of Lyme disease vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1999;48(RR-7):1-17, 21-25.
Centers for Disease Control and Prevention (CDC). Recommendations of the Advisory Committee on Immunization Practices: Revised recommendations for routine poliomyelitis vaccination. MMWR Morbid Mortal Wkly Rep. 1999;48(27):590.
Centers for Disease Control and Prevention (CDC). The Yellow Book. CDC Health Information for International Travel 2012. New York, NY: Oxford University Press; 2011.
Centers for Disease Control and Prevention (CDC). The Yellow Book. CDC Health Information for International Travel 2018. New York, NY: Oxford University Press; 2017.
Centers for Disease Control and Prevention (CDC). Travelers' health: Chapter 4: Travel-related infectious diseases: Hepatitis B. The Yellow Book. Atlanta, GA: CDC; reviewed July 1, 2019. Available at: https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/hepatitis-b. Accessed April 12, 2022.
Centers for Disease Control and Prevention (CDC). Typhoid immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep. 1990;39(RR-10):1-5.
Centers for Disease Control and Prevention (CDC). Update: Recommendations to prevent hepatitis B virus transmission -- United States. MMWR Morbid Mortal Wkly Rep. 1995:44(30):574-575.
Centers for Disease Control and Prevention (CDC). Update: Recommendations to prevent hepatitis B virus transmission -- United States. MMWR Morbid Mortal Wkly Rep. 1999;48(2):33-34.
Centers for Disease Control and Prevention. Prevention of plague: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 1996;45(No. RR-14).
Cetron MS, Marfin AA, Julian KG, et al. Yellow fever vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2002. MMWR Morbid Mortal Wkly Rep. 2002;51(RR-17):1-11.
de Araujo Lagos LW, de Jesus Lopes de Abreu A, Caetano R, Braga JU. Yellow fever vaccine safety in immunocompromised individuals: A systematic review and meta-analysis. J Travel Med. 2023;30(2):taac095.
Fischer M, Lindsey N, Staples JE, Hills S; Centers for Disease Control and Prevention (CDC). Japanese encephalitis vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59(RR-1):1-27.
Fraser A, Goldberg E, Acosta CJ, et al. Vaccines for preventing typhoid fever. Cochrane Database Syst Rev. 2007;(3):CD001261.
Freedman D, Leder K. Immunizations for travel. UpToDate [online serial]. Waltham, MA: UpToDate; reviewed March 2015; March 2016.
Garcia Garrido HM, Wieten RW, Grobusch MP, Goorhuis A. Response to hepatitis A vaccination in immunocompromised travelers. J Infect Dis. 2015;212(3):378-385.
Gautret P, Wilder-Smith A. Vaccination against tetanus, diphtheria, pertussis and poliomyelitis in adult travellers. Travel Med Infect Dis. 2010;8(3):155-160.
Graves P, Gelband H. Vaccines for preventing malaria (blood-state). Cochrane Database Syst Rev. 2006b;(4):CD006199.
Graves P, Gelband H. Vaccines for preventing malaria (SPf66). Cochrane Database Syst Rev. 2006a;(2):CD005966.
Graves PM, Deeks JJ, Demicheli V, Jefferson T. Vaccines for preventing cholera: Killed whole cell or other subunit vaccines (injected). Cochrane Database Syst Rev. 2001;(1):CD000974.
Houle SKD, Eurich DT. Completion of multiple-dose travel vaccine series and the availability of pharmacist immunizers: A retrospective analysis of administrative data in Alberta, Canada. PLoS One. 2019;14(1):e0211006.
Hyle EP, Rao SR, Bangs AC, et al. Clinical practices for measles-mumps-rubella vaccination among US pediatric international travelers. JAMA Pediatr. 2020;174(2):e194515.
Jelinek T. Ixiaro: A new vaccine against Japanese encephalitis. Expert Rev Vaccines. 2009;8(11):1501-1511.
Jost M, Luzi D, Metzler S, et al. Measles associated with international travel in the region of the Americas, Australia and Europe, 2001-2013: A systematic review. Travel Med Infect Dis. 2015;13(1):10-18.
Lamarche L, Taucher C. Travel vaccines: Update. Can Pharm J (Ott). 2020;153(2):72-73.
Lenchow DJ, Wilson ME. Chikungunya fever: Treatment and prevention. UpToDate [online serial]. Waltham, MA: UpToDate; reviewd October 2023.
Lindsey NP, Staples JE, Fischer M. Chikungunya Virus Disease among Travelers-United States, 2014-2016. Am J Trop Med Hyg. 2018;98(1):192-197.
Marfin AA, Eidex RS, Kozarsky PE, Cetron MS. Yellow fever and Japanese encephalitis vaccines: Indications and complications. Infect Dis Clin North Am. 2005;19(1):151-168, ix.
Merck Sharp & Dohme Corporation. Ervebo (Ebola Zaire vaccine, live) suspension for intramuscular injection. Prescribing Information. Whitehouse Station, NJ: Merck; 2019.
Nasser R, Rakedzon S, Dickstein Y, et al. Are all vaccines safe for the pregnant traveller? A systematic review and meta-analysis. J Travel Med. 2020;27(2).
Nelson NP, Link-Gelles R, Hofmeister MG, et al. Update: recommendations of the Advisory Committee on Immunization Practices for use of hepatitis A vaccine for postexposure prophylaxis and for preexposure prophylaxis for international travel. MMWR Morb Mortal Wkly Rep. 2018;67(43):1216-1220.
No authors listed. Cholera vaccine. MMWR Morbid Mortal Wkly Rep. 1988;37(40):617-618, 623-624.
Pfizer Inc. Ticovac (tick-borne encephalitis vaccine), suspension for intramuscular injection. Prescribing Information. New York, NY: Pfizer; revised August 2021a.
Pfizer Inc. U.S. FDA accepts for priority review Pfizer’s application for TicoVac (tick-borne encephalitis vaccine). Press Release. New York, NY: Pfizer; February 23, 2021. Available at: https://www.pfizer.com/news/press-release/press-release-detail/us-fda-accepts-priority-review-pfizers-application. Accessed June 7, 2021b.
Pfizer Inc. U.S. FDA approves Ticovac, Pfizer's tick-borne encephalitis (TBE) vaccine. Press Release. New York, NY: Pfizer; August 13, 2021c.
Rampa JE, Askling HH, Lang P, et al. Immunogenicity and safety of the tick-borne encephalitis vaccination (2009–2019): A systematic review. Travel Medicine and Infectious Disease. 2020;37:101876.
Ritz N, Connell TG, Curtis N. To BCG or not to BCG? Preventing travel-associated tuberculosis in children. Vaccine. 2008;26(47):5905-5910.
Schioler KL, Samuel M, Wai KL Vaccines for preventing Japanese encephalitis. Cochrane Database Syst Rev. 2007;(3):CD004263.
Staples JE, Gershman M, Fischer M; Centers for Disease Control and Prevention (CDC). Yellow fever vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59(RR-7):1-27.
Taucher C, Barnett ED, Cramer JP, et al. Neutralizing antibody persistence in pediatric travelers from non-JE-endemic countries following vaccination with IXIARO® Japanese encephalitis vaccine: An uncontrolled, open-label phase 3 follow-up study. Travel Med Infect Dis. 2020;34:101616.
U.S. Food and Drug Administration (FDA). FDA approves first vaccine to prevent disease caused by chikungunya virus. FDA News Release. Silver Spring, MD: FDA; November 13, 2023.
Valneva Scotland Ltd. Ixchiq (chikungunya vaccine, live) solution for intramuscular injection. Prescribing Information. Livingston, United Kingdom; revised November 2023.
Vaughan K, Blythe M, Greenbaum J, et al. Meta-analysis of immune epitope data for all Plasmodia: Overview and applications for malarial immunobiology and vaccine-related issues. Parasite Immunol. 2009;31(2):78-97.
Wanke CA. Travelers' diarrhea. UpToDate [online serial]. Waltham, MA: UpToDate; reviewed March 2014.
Wilder-Smith A. Meningococcal disease in international travel: Vaccine strategies. J Travel Med. 2005;12 Suppl 1:S22-S29.
Wilson ME, Lenschow DJ. Chikungunya fever: Epidemiology, clinical manifestations, and diagnosis. UpToDate [online serial]. Waltham, MA: UpToDate; reviewed January 2022.
Wong KK, Burdette E, Mahon BE, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine. MMWR. 2017;66(18):482-485.

Policy History

Effective: 04/13/2001

Next Review: 05/09/2024

Review History

Definitions

Additional Information

Clinical Policy Bulletin Notes

You are now leaving the Aetna website .

Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.

The Enlightened Mindset

Exploring the World of Knowledge and Understanding

Welcome to the world's first fully AI generated website!

Does Aetna Cover International Travel? An Overview of What You Need to Know

By Happy Sharer

Introduction

Traveling abroad can be an incredibly exciting experience. However, it’s important to make sure you’re adequately prepared and covered in case of any unexpected events. That’s where Aetna comes in. Aetna is one of the leading providers of international travel coverage, offering a range of options for travelers heading abroad.

But what does Aetna cover for international travel? In this article, we’ll explore the details of Aetna’s international travel coverage, what it covers and doesn’t cover, and how to use Aetna for international travel.

Exploring Aetna’s International Travel Coverage

What does aetna cover for international travel.

Aetna offers several different types of international travel insurance, including trip protection, medical coverage, and evacuation coverage.

Trip protection covers the cost of trip cancellation or interruption due to a number of circumstances, such as sickness, injury, or death of a family member. It also covers expenses related to lost baggage, flight delays, and other inconveniences.

Medical coverage includes reimbursement for medical care received while abroad, such as doctor visits or hospital stays. It also covers medical evacuation if necessary.

Evacuation coverage covers the cost of being evacuated from your destination in case of a medical emergency or a natural disaster.

How to Use Aetna for International Travel

Using Aetna for international travel is easy. All you need to do is purchase the appropriate coverage for your trip. Aetna offers a variety of plans that can be tailored to meet your specific needs and budget.

Once you’ve purchased the plan, you’ll need to provide proof of coverage when traveling. This could include a card, letter, or electronic confirmation. Make sure to keep this with you at all times while traveling, as it may be needed in order to access medical services or file a claim.

Are There Any Limitations on Aetna’s International Travel Coverage?

What is not covered by aetna’s international travel coverage.

It’s important to note that Aetna’s international travel coverage does not cover certain activities or situations. These include pre-existing medical conditions, acts of terrorism, and hazardous activities such as scuba diving or skydiving.

It’s also important to remember that Aetna’s international travel coverage is only valid in certain countries. Before purchasing a plan, make sure to check if the country you’re visiting is included in Aetna’s coverage.

A Guide to Aetna’s International Travel Coverage

Understanding the details of aetna’s international travel insurance.

When selecting a plan, it’s important to understand the details of each option. Aetna offers a variety of plans with varying levels of coverage. For example, some plans may offer more comprehensive medical coverage than others. It’s important to read the fine print and select a plan that best meets your needs.

You should also consider the length of your trip when selecting a plan. Some plans are designed for shorter trips, while others are designed for longer trips. Make sure to select a plan that covers the duration of your trip.

Comparing Aetna’s International Travel Options to Other Providers

When selecting a plan, it’s also important to compare Aetna’s international travel options to those offered by other providers. Different providers may offer different levels of coverage or different pricing structures. Comparing various providers can help you find the best plan for your needs.

It’s also important to research the reputation of the provider. Read customer reviews and ask questions to make sure the provider is reliable and trustworthy. You want to make sure your plan will provide the coverage you need in case of an emergency.

Aetna’s international travel coverage is a great option for travelers looking for peace of mind while abroad. The company offers a range of plans that can be tailored to meet your specific needs and budget. It’s important to understand the details of each plan and compare Aetna’s options to other providers before making a decision.

When using Aetna for international travel, make sure to carry proof of coverage with you at all times. This could include a card, letter, or electronic confirmation. Finally, be aware of what Aetna’s international travel coverage does not cover, such as pre-existing medical conditions, acts of terrorism, and hazardous activities.

Overall, Aetna provides a great option for travelers looking for coverage while abroad. With the right plan, you can have peace of mind knowing that you’re protected in case of an emergency.

(Note: Is this article not meeting your expectations? Do you have knowledge or insights to share? Unlock new opportunities and expand your reach by joining our authors team. Click Registration to join us and share your expertise with our readers.)

Hi, I'm Happy Sharer and I love sharing interesting and useful knowledge with others. I have a passion for learning and enjoy explaining complex concepts in a simple way.

Exploring japan: a comprehensive guide for your memorable journey, your ultimate guide to packing for a perfect trip to hawaii, the ultimate packing checklist: essentials for a week-long work trip, leave a reply cancel reply.

Your email address will not be published. Required fields are marked *

Expert Guide: Removing Gel Nail Polish at Home Safely

Trading crypto in bull and bear markets: a comprehensive examination of the differences, making croatia travel arrangements, make their day extra special: celebrate with a customized cake.

Stick to your fitness goals and you could earn AARP Rewards points. Learn how.

AARP daily Crossword Puzzle

Hotels with AARP discounts

Life Insurance

AARP Dental Insurance Plans

AARP MEMBERSHIP — $12 FOR YOUR FIRST YEAR WHEN YOU SIGN UP FOR AUTOMATIC RENEWAL

Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP the Magazine.

right_container

Work & Jobs

Social Security

AARP en Español

Membership & Benefits

AARP Rewards

AARP Rewards %{points}%

Conditions & Treatments

Drugs & Supplements

Health Care & Coverage

Health Benefits

Staying Fit

Your Personalized Guide to Fitness

AARP Hearing Center

Ways To Improve Your Hearing

An illustration of a constellation in the shape of a brain in the night sky

Brain Health Resources

Tools and Explainers on Brain Health

A Retreat For Those Struggling

Scams & Fraud

Personal Finance

Money Benefits

zoomed in map of the united states with map locator pins scattered around

View and Report Scams in Your Area

AARP Foundation Tax-Aide

Free Tax Preparation Assistance

a man and woman at home looking at a laptop together

AARP Money Map

Get Your Finances Back on Track

thomas ruggie with framed boxing trunks that were worn by muhammad ali

How to Protect What You Collect

Small Business

Age Discrimination

illustration of a woman working at her desk

Flexible Work

Freelance Jobs You Can Do From Home

AARP Skills Builder

Online Courses to Boost Your Career

illustration of person in a star surrounded by designs and other people holding briefcases

31 Great Ways to Boost Your Career

a red and white illustration showing a woman in a monitor flanked by a word bubble and a calendar

ON-DEMAND WEBINARS

Tips to Enhance Your Job Search

green arrows pointing up overlaid on a Social Security check and card with two hundred dollar bills

Get More out of Your Benefits

A balanced scale with a clock on one side and a ball of money on the other, is framed by the outline of a Social Security card.

When to Start Taking Social Security

Mature couple smiling and looking at a laptop together

10 Top Social Security FAQs

Social Security Benefits Calculator

arrow shaped signs that say original and advantage pointing in opposite directions

Medicare Made Easy

Original vs. Medicare Advantage

illustration of people building a structure from square blocks with the letters a b c and d

Enrollment Guide

Step-by-Step Tool for First-Timers

the words inflation reduction act of 2022 printed on a piece of paper and a calculator and pen nearby

Prescription Drugs

9 Biggest Changes Under New Rx Law

A doctor helps his patient understand Medicare and explains all his questions and addresses his concerns.

Medicare FAQs

Quick Answers to Your Top Questions

Care at Home

Financial & Legal

Life Balance

LONG-TERM CARE

Understanding Basics of LTC Insurance

illustration of a map with an icon of a person helping another person with a cane navigate towards caregiving

State Guides

Assistance and Services in Your Area

a man holding his fathers arm as they walk together outside

Prepare to Care Guides

How to Develop a Caregiving Plan

Close up of a hospice nurse holding the hands of one of her patients

End of Life

How to Cope With Grief, Loss

Recently Played

Word & Trivia

Atari® & Retro

Members Only

Staying Sharp

Mobile Apps

More About Games

Right Again! Trivia

Right Again! Trivia – Sports

Atari, Centipede, Pong, Breakout, Missile Command Asteroids

Atari® Video Games

Throwback Thursday Crossword

Travel Tips

Vacation Ideas

Destinations

Travel Benefits

a graphic of two surf boards in the sand on a beach in Hawaii.

Beach vacation ideas

Vacations for Sun and Fun

Plan Ahead for Tourist Taxes

Two images of Seattle - Space Needle and a seafood display in the Pike Place Market - each one is framed in Polaroid style

AARP City Guide

Discover Seattle

illustration of an airplane in the sky sounded by clouds in the shape of dollar signs

25 Ways to Save on Your Vacation

Entertainment & Style

Family & Relationships

Personal Tech

Home & Living

Celebrities

Beauty & Style

A collage of stars from reality TV shows such as "The Voice," "The Great British Baking Show," "Survivor" and "American Idol."

TV for Grownups

Best Reality TV Shows for Grownups

actor robert de niro photographed by a a r p in new york city november twenty twenty three

Robert De Niro Reflects on His Life

A collage of people and things that changed the world in 1974, including a Miami Dolphins Football player, Meow Mix, Jaws Cover, People Magazine cover, record, Braves baseball player and old yellow car

Looking Back

50 World Changers Turning 50

Sex & Dating

Spice Up Your Love Life

a woman holding onto a family tree when her branch has been cut off

Navigate All Kinds of Connections

Illustration of a white home surrounded by trees

Life & Home

Couple Creates Their Forever Home

a woman looks at her phone while taking her medication

Store Medical Records on Your Phone?

Close-up of Woman's hands plugging a mobile phone into a power bank in a bar

Maximize the Life of Your Phone Battery

Virtual Community Center

Join Free Tech Help Events

Create a Hygge Haven

from left to right cozy winter soups such as white bean and sausage soup then onion soup then lemon coriander soup

Soups to Comfort Your Soul

Your Ultimate Guide to Mulching

Driver Safety

Maintenance & Safety

Trends & Technology

bottom of car, showing one wheel on road near middle yellow lines

AARP Smart Guide

How to Keep Your Car Running

We Need To Talk

Assess Your Loved One's Driving Skills

AARP Smart Driver Course

A woman using a tablet inside by a window

Building Resilience in Difficult Times

Tips for Finding Your Calm

Weight Loss After 50 Challenge

Cautionary Tales of Today's Biggest Scams

Travel stuff on desktop: map, sun glasses, camera, tickets, passport etc.

7 Top Podcasts for Armchair Travelers

jean chatzky smiling in front of city skyline

Jean Chatzky: ‘Closing the Savings Gap’

a woman at home siting at a desk writing

Quick Digest of Today's Top News

A man and woman looking at a guitar in a store

AARP Top Tips for Navigating Life

two women exercising in their living room with their arms raised

Get Moving With Our Workout Series

You are now leaving AARP.org and going to a website that is not operated by AARP. A different privacy policy and terms of service will apply.

Go to Series Main Page

Will Medicare cover me if I travel outside the United States?

Kimberly Lankford,

Medicare doesn’t pay for medical services outside the United States or its territories, except in very limited circumstances, including if:

You experience a medical emergency while traveling between Alaska and another state and a Canadian hospital is closest to your location.
You face a medical emergency while you’re in the United States or one of its territories, but the nearest hospital is across the border, for example in Canada or Mexico.
You live in the United States or one of its territories and need hospital care, regardless of whether it’s an emergency, but the nearest hospital is in a foreign country.
You need medical attention and you’re on a ship within six hours of a U.S. port.

Medicare covers all 50 states and the District of Columbia as well as U.S. territories American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

AARP Membership — $12 for your first year when you sign up for Automatic Renewal

What kind of care outside the U.S. will Medicare cover?

In rare situations, Medicare Part A will cover inpatient hospitalization and Medicare Part B will cover emergency ambulance and doctor services immediately before and during your hospital stay.

The same deductibles, copayments and coinsurance apply as for services in the U.S. But coverage is limited: Medicare won’t pay for ambulance or doctor services in the foreign country after your covered hospital stay ends.

If you qualify, the foreign hospital may file a claim with Medicare, but it’s not required to do so. In that case, you may need to submit an itemized bill to Medicare. If you receive care on a cruise ship within six hours of a U.S. port, the attending doctor usually submits the Medicare claim.

Do Medicare supplement policies cover foreign travel?

If you buy a private Medicare supplement policy , better known as Medigap, you may be insured for foreign travel emergencies. Medigap plans C, D, F, G, M and N cover emergency health care while traveling outside of the country. But plans C and F are no longer available to new Medicare beneficiaries; only those eligible for Medicare before 2020 can enroll in plans C and F.

Medigap plans cover foreign travel emergency care that begins in the first 60 days of your trip. They pay 80 percent of the billed charges for specific medically necessary emergency care you receive outside the U.S., but you must first pay a $250 deductible for the year. Medigap’s foreign travel emergency coverage has a lifetime limit of $50,000.

AARP NEWSLETTERS

%{ newsLetterPromoText }%

%{ description }%

ARTICLE CONTINUES AFTER ADVERTISEMENT

What other foreign travel emergency coverage is available?

Medicare Advantage. Some private Medicare Advantage plans cover foreign travel emergency care, but here, too, coverage is limited and details vary. Find out more about the Medicare Advantage plans available in your area by using the Medicare Plan Finder .

Travel insurance. While some travel insurance policies cover trip cancellations, others also cover emergency medical care in a foreign country and medical evacuation either to a nearby medical facility or back to the U.S. However, some travel insurance policies exclude preexisting conditions, so find out about exclusions, coverage limits and other details before choosing a policy.

Tricare for Life. If you’re a military retiree, you may have foreign-country health care coverage through Tricare for Life after you enroll in Medicare. Tricare for Life typically covers Medicare’s deductibles, copayments and coinsurance, but it also provides additional benefits, such as health care outside of the U.S. It’s the same foreign travel insurance military retirees and dependents have before enrolling in Medicare. You pay any deductibles and copayments for that coverage.

AARP® Vision Plans from VSP™

Exclusive vision insurance plans designed for members and their families

Keep in mind

If you plan to live abroad or travel back and forth regularly, rather than just vacation out of the country, you can enroll in Medicare. But you’ll forgo coverage while you’re away and still have to pay the monthly Part B premiums , typically $174.70 a month in 2024. You’ll also have to pay Part A premiums if you or your spouse haven’t paid Medicare taxes for at least 10 years.

If you decide to wait to enroll in Medicare until after you return to the United States, you may have to pay a late enrollment penalty . If you work abroad and receive health insurance from your employer, live in a country with a national health system or volunteer and have health coverage through a sponsor organization, you may have some exemptions.

This includes eligibility for an eight-month special enrollment period after you stop working or lose your insurance; six months if you’re volunteering. It’s a good idea to research your options before making any decisions about health care insurance while traveling.

Return to Medicare Q&A main page

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe . She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

Discover AARP Members Only Access

Already a Member? Login

Does Medicare Supplement Plan G Cover Foreign Travel?

Eligibility for Original Medicare is an important milestone for seniors, but it may be disappointing to learn that it does not cover everything. Part A helps with inpatient care in a hospital, skilled nursing unit and religious nonmedical health care facility. Part B provides for outpatient care, medical office visits, home health services, durable medical equipment and mental health services. But both Parts A and B have a deductible, coinsurance, copayments and no ceiling on the amount of out-of-pocket expenses that may be incurred.

Some Medicare recipients choose to enroll in a Medicare Advantage plan instead, which provides Parts A and B, and often includes drug coverage and other additional benefits as well. Others prefer to stay on Original Medicare and simply want to supplement it to fill some of the gaps in coverage. The solution is often a Medicare Supplement, or Medigap, which is supplemental insurance for a series of plans labeled with letters A through N.

Asking the Right Questions When researching supplement plans, there are a few key questions that may expedite the selection process:

How much is the monthly premium?
What is the premium based on; for example, health status, gender, smoking history or marital status?
Does everyone pay the same premium regardless of age, or will premium increases be imposed as I age?
Will pre-existing conditions impact the timing of my eligibility to join certain plans?

Medicare Supplement Plan G Plan G is known for its robust coverage compared to other supplement policies. It covers all the components available in a Medigap program except the Medicare Part B deductible, and there is no limit on out-of-pocket expenses. The Part B deductible is not worth any consideration at this point because that benefit will become obsolete in 2020. The only supplement plans that currently cover it are Plans C and F, which are being phased out in 2020. Of course, the price tag reflects this suite of provisions.

Plan G is also one of the Medigap plans that include foreign travel. With so many people on the move these days, this benefit is a priority for those who travel for work or leisure. Foreign travel emergency care is covered if it begins during the first 60 days of the excursion. After meeting a deductible, the benefit amounts to 80% of the charges invoiced for specific medically necessary emergency care outside the United States. In 2019, the deductible is $250 and the lifetime limit is $50,000.

Does Medicare Supplement Cover Deductibles? (Opens in a new browser tab)

How Do I Choose the Medicare Advantage Plan That’s Best for Me? (Opens in a new browser tab)

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, Simply, UnitedHealthcare®, Wellcare, WellPoint

Need A Medicare Advantage Quote?

Request A Free Consultation For Medicare Advantage Plans

Best International Travel Insurance for May 2024

Find a Qualified Financial Advisor

Finding a financial advisor doesn't have to be hard. SmartAsset's free tool matches you with up to three fiduciary financial advisors that serve your area in minutes. Each advisor has been vetted by SmartAsset and is held to a fiduciary standard to act in your best interests. Start your search now.

The offers and details on this page may have updated or changed since the time of publication. See our article on Business Insider for current information.

Affiliate links for the products on this page are from partners that compensate us (see our advertiser disclosure with our list of partners for more details). However, our opinions are our own. See how we rate insurance products to write unbiased product reviews.

If you're planning your next vacation or trip out of the country, be sure to factor in travel insurance. Unexpected medical emergencies when traveling can drain your bank account, especially when you're traveling internationally. The best travel insurance companies for international travel can step in to provide you with peace of mind and financial protection while you're abroad.

Our top picks for the best international travel insurance

Best overall: Allianz Travel Insurance
Best for exotic travel: World Nomads Travel Insurance
Best for trip interruption coverage: C&F Travel Insured
Best for families: Travelex Travel Insurance
Best for long-term travel: Seven Corners Travel Insurance

How we rate the best international travel insurance »

Compare the top international travel insurance

As a general rule, the most important coverage to have in a foreign country is travel medical insurance , as most US health insurance policies don't cover you while you're abroad. Without travel medical coverage, a medical emergency in a foreign country can cost you. You'll want trip cancellation and interruption coverage if your trip is particularly expensive. And if you're traveling for an extended period of time, you'll want to ensure that your policy is extendable.

Here are our picks for the best travel insurance companies for international travel.

Best overall: Allianz

Allianz Travel Insurance offers the ultimate customizable coverage for international trips, whether you're a frequent jetsetter or an occasional traveler. You can choose from an a la carte of single or multi-trip plans, as well as add-ons, including rental car damage, cancel for any reason (CFAR) , adventure sport, and business travel coverage. And with affordable pricing compared to competitors, Allianz is a budget-friendly choice for your international travel insurance needs.

The icing on the cake is Allyz TravelSmart, Allainz's highly-rated mobile app, which has an average rating of 4.4 out of five stars on the Google Play store across over 2,600 reviews and 4.8 out of five stars from over 22,000 reviews on the Apple app store. So, you can rest easy knowing that you can access your policy and file claims anywhere in the world without a hassle.

Read our Allianz Travel Insurance review here.

Best for exotic trips: World Nomads

World Nomads Travel Insurance offers coverage for over 150 specific activities, so you can focus on the adventure without worrying about gaps in your coverage.

You can select its budget-friendly standard plan, starting at $79. Or if you're an adrenaline junkie seeking more thrills, you can opt for the World Nomads' Explorer plan for $120, which includes extra sports like skydiving, scuba diving, and heli-skiing. And World Nomads offers 24/7 assistance, so you can confidently travel abroad, knowing that help is just a phone call away.

Read our World Nomads Travel Insurance review here.

Best for trip interruption: C&F Travel Insured

C&F Travel Insured offers 100% coverage for trip cancellation, up to 150% for trip interruption, and reimbursement for up to 75% of your non-refundable travel costs with select plans. This means you don't have to worry about losing your hard-earned money on non-refundable travel costs if your trip ends prematurely.

Travel Insured also stands out for its extensive "reasons for cancellation" coverage. Unlike many insurers, the company covers hurricane warnings from the National Oceanic and Atmospheric Administration (NOAA).

Read our C&F Travel Insured review here.

Best for family coverage: Travelex

Travelex Travel Insurance offers coverage for your whole crew, perfect for when you're planning a family trip. Its family plan insures all your children 17 and under at no additional cost. The travel insurance provider also offers add-ons like adventure sports and car rental collision coverage to protect your family under any circumstance. Got pets? With Travelex's Travel Select plan, you can also get coverage for your furry friend's emergency medical and transportation expenses.

Read our Travelex Travel Insurance review here.

Best for long trips: Seven Corners

Seven Corners Travel Insurance offers specialized coverage that the standard short-term travel insurance policy won't provide, which is helpful if you're embarking on a long-term trip. You can choose from several plans, including the Annual Multi-Trip plan, which provides medical coverage for multiple international trips for up to 364 days. This policy also offers COVID-19 medical and evacuation coverage up to $1 million.

You also get the added benefit of incidental expense coverage. This policy will cover remote health-related services and information, treatment of injury or illness, and live consultations via telecommunication.

Read our Seven Corners Travel Insurance review here.

How to find the right international travel insurance company

Different travelers and trips require different types of insurance coverage. So, consider these tips if you're in the market to insure your trip.

Determine your needs

Consider the nature of your travel (leisure, business, or adventure) and the associated risks (medical emergencies, trip cancellations, etc.).
Determine your budget and the amount of coverage you require.
Consider the duration of your trip and the countries you'll be visiting, as some policies won't cover specific destinations.

Research the reputation of the company

Look for the company's reviews and ratings from reputable sources like consumer advocacy groups and independent website reviews.
Check the provider's financial stability and credit ratings to ensure it can pay out claims reliably.
Investigate the company's claims process to ensure it can provide timely support if you need to file a claim.

Compare prices

Get quotes from multiple providers to compare rates and coverage options.
See if the company provides discounts or special offers to lower your cost.
Look at the deductible or any out-of-pocket expenses you may have to pay if you file a claim to determine if you can afford it.

Understanding international travel insurance coverage options

Travel insurance can be confusing, but we're here to simplify it for you. We'll break down the industry's jargon to help you understand what travel insurance covers to help you decide what your policy needs. Bear in mind that exclusions and limitations for your age and destination may apply.

Finding the best price for international travel insurance

Your policy cost will depend on several factors, such as the length of your trip, destination, coverage limits, and age. Typically, a comprehensive policy includes travel cancellation coverage costs between 5% and 10% of your total trip cost.

If you're planning an international trip that costs $4,500, you can expect to pay anywhere from $225 to $450 for your policy. Comparing quotes from multiple providers can help you find a budget-friendly travel insurance policy that meets your needs.

How we reviewed international travel insurance companies

We ranked and assigned superlatives to the best travel insurance companies based on our insurance rating methodology . It focuses on several key factors, including:

Policy types: We analyzed company offerings such as coverage levels, exclusions, and policy upgrades, taking note of providers that offer a range of travel-related issues beyond the standard coverages.
Affordability: We recognize that cheap premiums don't necessarily equate to sufficient coverage. So, we seek providers that offer competitive rates with comprehensive policies and quality customer service. We also call out any discounts or special offers available.
Flexibility: Travel insurance isn't one-size-fits-all. We highlight providers that offer a wide array of coverage options, including single-trip, multi-trip, and long-term policies.
Claims handling: The claims process should be pain-free for policyholders. We seek providers that offer a streamlined process via online claims filing and a track record of handling claims fairly and efficiently.
Quality customer service: Good customer service is as important as affordability and flexibility. We highlight companies that offer 24/7 assistance and have a strong record of customer service responsiveness.

We consult user feedback and reviews to determine how each company fares in each category. We also check the provider's financial rating and volume of complaints via third-party rating agencies.

International travel insurance FAQs

Which company has the best international travel insurance.

The best insurance policy depends on your individual situation, including your destination and budget. However, popular options include Allianz Travel Insurance, World Nomads, and Travel Guard.

Are there any limitations or exclusions international travelers should be aware of?

You should pay attention to any limitations regarding covered cancellations, pre-existing conditions, and adventure activities. For example, if you're worried you may have to cancel a trip for work reasons, ensure that you've worked at your company long enough to qualify for cancellation coverage, as that is a condition with some insurers. You should also see if your destination has any travel advisories, as that can affect your policy.

What insurance do you need for international travel?

Typically, your regular health insurance won't cover you out of the country, so you'll want to make sure your travel insurance has adequate medical emergency coverage. Depending on your travel plans, you may want to purchase add-ons, such as adventure sports coverage, if you're planning on doing anything adventurous like bungee jumping.

Should you get travel insurance for international travel?

Travel insurance is worth the price for international travel because they're generally more expensive, so you have more to lose. Additionally, your regular health insurance won't cover you in other countries, so without travel insurance, you'll end up paying out of pocket for any emergency medical care you receive out of the US.

How far in advance should international travelers purchase travel insurance?

You should purchase travel insurance as soon as possible after making payment on your trip. This makes you eligible for add-ons like coverage for pre-existing conditions and CFAR. It also mitigates the chance of any losses in the days leading up to your trip.

If you enjoyed this story, be sure to follow Business Insider on Microsoft Start.

This article may contain affiliate links that Microsoft and/or the publisher may receive a commission from if you buy a product or service through those links.

Best International Travel Insurance for May 2024

IMAGES

Does Aetna Medicare Cover Foreign Travel? Exploring Your Options
Does Aetna Medicare Advantage Cover Dental
Does My Aetna Plan Cover International Travel? A Guide to Understanding
Does Aetna Insurance Cover Hearing Aids?
Does my aetna health insurance cover international travel?
Does Aetna Insurance Cover You for Hearing Care and Hearing Aids

COMMENTS

International Health Insurance
International health insurance for individuals. Enjoy peace of mind wherever you travel with global medical coverage. Aetna International Health Insurance. We have over 30 years experience in international health insurance. And more than 500,000 members trust us with their care worldwide.
International Health Insurance
International Health Insurance. Choose the plan that best protects you and your family as you live and travel abroad. We offer award-winning international health insurance plans for you and your family while you're away from your home country. Make sure you have the coverage you need to maintain your health and take care of any medical ...
The right Medicare coverage for travelers
An MA plan can be the right choice for coverage, giving you extra benefits and access to travel-related perks. However, you need to do your homework to pick the plan that best fits your needs. After all, the right plan is one of the most important items you can take with you on your adventures. Aetna Medicare is a HMO, PPO plan with a Medicare ...
Does Your Health Insurance Plan Cover You While Abroad?
Keep in mind that Medicare does not cover emergency medical service for travelers out of the country. There are some Medigap plans that can offer supplemental coverage but remember that there is a ...
International Health Insurance
International Health Insurance. Choose the plan that best protects you and your family as you live and travel abroad. Get an instant quote Request a callback. Customer satisfaction over 96%. 365/24/7 support for you and your family. Global medical network of 1.4 million medical providers.
Does My Health Insurance Cover International Travel?
So, the best way to find out whether your health insurance covers international travel is to contact your insurance provider. Ask the agent whether your emergency medical coverage extends outside ...
Global Health Insurance
View all of our global health insurance plans. 24 hour assistance. Annual and short term cover available. Inpatient and day-care treatment. Outpatient treatment up to 90 days. Emergency medical evacuation. Rehabilitation up to 120 days. Emergency maternity care. Emergency dental treatment.
Will Your Health Insurance Cover You Overseas?
12 Travel Tips for a Healthy Vacation. "Most domestic health plans provide limited coverage overseas and won't cover prescriptions abroad," says Margaret Wilson, M.D., chief medical officer of ...
Plan for Your Trip
At Aetna International, we offer more than just health insurance benefits. You can also turn to us for resources that help make navigating your time away easier on you and your family. Get started by contacting member services and ask to speak with our International Care Management team about pre-trip planning.
Plan for Your Trip
Feel confident about your health care decisions. Each country has its unique culture, customs and environment. Our country guides help prepare you for differences in health care services and conditions. See the Destination Guides. Use our planning resources to help move yourself or your family overseas.
Travel
If you're getting ready to work abroad or relocate to another country, Aetna International's resource centre offers important news and useful information to help make your journey easier. Find out about everything from health coverage in a crisis to international family relocation and pre-trip planning.
PDF Aetna Travel 2019 USD Benefits Schedule
Aetna Travel Page 2 of 7 At a glance Eligibility You're covered for worldwide trips up to 180 days at a time when you take out an Aetna Travel plan with an Aetna Pioneer plan or Aetna Summit plan. You're not covered for any medical conditions you had within the 24 month period before you booked a trip or joined the plan. Yearly premiums
Health care that travels with you
In order for your family member to call on your behalf, you will have to fill out some forms before your trip. Call Aetna Member Services for more information. Have questions? We can help. Call us at 1-833-570-6670 (TTY: 711), between 8 AM and 8 PM, 7 days a week. Or visit AetnaMedicare.com.
Emergency health care: What you need to know
If you need health care advice or if there's a medical emergency, you can call our care management team, 24/7, all year round. Our call handlers will take down your details and send it through to the care management team who will help you to manage your condition, prevent the onset of future conditions, respond to a medical emergency, or work ...
Expat Health Insurance
Get a quote Request a Call Back. Customer satisfaction over 96%. 365/24/7 support for you and your family. Global medical network of 1.4 million medical providers. Trusted by 55 million member worldwide. Our expatriate health insurance plans provide you and your family with world-class insurance coverage for medical expenses when living and ...
Does Health Insurance Cover You Outside The U.S.?
Aetna health insurance plans only cover emergency ... Medigap plans that cover international care have a $50,000 lifetime limit and only cover travel emergencies in other countries if they happen ...
Vaccines for Travel
4 doses administered before school entry, at 2, 4 and 6 to 18 months and 4 to 6 years. Adult primary dose: 2 doses (0.5 ml) subcutaneously, 4 to 8 weeks apart; third dose 6 to 12. Preferred for primary immunization; one-time booster dose for travelers.
Does Aetna Cover International Travel? An Overview of What You ...
Finally, be aware of what Aetna's international travel coverage does not cover, such as pre-existing medical conditions, acts of terrorism, and hazardous activities. Overall, Aetna provides a great option for travelers looking for coverage while abroad. With the right plan, you can have peace of mind knowing that you're protected in case of ...
Do I Need Additional Health Coverage if I Travel Internationally?
Many American health insurance plans don't cover out-of-network care and don't include foreign hospitals in their networks, so you may need separate travel health insurance to receive coverage ...
Medicare Advantage for Travelers: Which Medicare Advantage Plans Cover
Some Medicare Part C plans include a benefit covering 80% of medically necessary urgent care received abroad. The care must begin during the first 60 days of each trip, after paying a $250 annual deductible. These plans carry a lifetime maximum benefit of $50,000. Cigna and Aetna are two companies that do have plans that cover international travel.
Do I Have Medicare Coverage When Travelling Abroad?
Travel insurance. While some travel insurance policies cover trip cancellations, others also cover emergency medical care in a foreign country and medical evacuation either to a nearby medical facility or back to the U.S. However, some travel insurance policies exclude preexisting conditions, so find out about exclusions, coverage limits and ...
Does Medicare Supplement Plan G Cover Foreign Travel?
The Part B deductible is not worth any consideration at this point because that benefit will become obsolete in 2020. The only supplement plans that currently cover it are Plans C and F, which are being phased out in 2020. Of course, the price tag reflects this suite of provisions. Plan G is also one of the Medigap plans that include foreign ...
Does Medicare Cover International Travel?
Overview of Medicare Supplement foreign travel emergency coverage: Carries a $250 deductible. Coverage only lasts the first 60 days of your trip. Your plan pays 80% of your medical bills while out of the country. The lifetime coverage limit is $50,000. Your Medicare Supplement plan will provide foreign travel coverage if your health services ...
Best International Travel Insurance for May 2024
Compare the top international travel insurance. As a general rule, the most important coverage to have in a foreign country is travel medical insurance, as most US health insurance policies don't ...
Family travel insurance: What is it and do you need it?
What does family travel insurance cover? Families choose their level of coverage when they purchase a travel insurance policy. A comprehensive policy is the safest option for all kinds of family ...