Travel Health Insurance for the USA: Costs, Criteria and Emergencies

For any trip to the USA you need private international travel health insurance, because German statutory health insurance does not pay there: Germany and the United States have no agreement covering health care, and the German-U.S. social security agreement only deals with pensions. Medical care in the USA is expensive; back in 2019 an emergency room visit already cost about USD 2,450 on average. Good travel health insurance for the USA pays without a coverage cap, covers repatriation as soon as it is medically reasonable, and covers the full length of your trip.

This guide goes deeper than the short insurance section in our overview First trip to the USA: tips. You will learn which costs are realistic, which policy clauses matter, where credit card insurance falls short and what to do in an emergency. The article explains criteria but does not recommend any provider and is not insurance or medical advice. Discuss health questions with your doctor, and questions about your policy with your insurer or a German consumer advice centre (Verbraucherzentrale).

Does German statutory health insurance pay in the USA?

No. Under Section 16 of the German Social Code Book V (SGB V), benefit entitlements are suspended while insured persons are abroad, expressly including illness during a temporary stay. Exceptions apply within Europe and in countries with an agreement that also covers health insurance. The USA is not one of them.

The Germany-U.S. Agreement on Social Security has been in force since 1 December 1979. According to the German Liaison Agency Health Insurance – International (DVKA) at the GKV-Spitzenverband, on the German side it covers only pension insurance, the miners' pension scheme, the steelworkers' supplementary scheme and old-age security for farmers. On the U.S. side it concerns Social Security and contributions to Medicare Part A hospital insurance. It does not regulate benefits in case of illness. The European Health Insurance Card on the back of your German health card does not help in the USA either.

There is one narrow exception. Under Section 18(3) SGB V, if treatment becomes urgently necessary during a trip outside the EU and EEA, the statutory insurer only pays if you demonstrably cannot obtain private insurance because of a pre-existing condition or your age and the insurer confirmed this before departure. Even then it reimburses no more than the treatment would have cost in Germany, for a maximum of six weeks per calendar year. At U.S. prices that often covers only part of the bill. If you have private German health insurance, check your policy terms to see whether and for how long it applies worldwide.

In its travel and safety advice for the USA, the German Federal Foreign Office strongly recommends travel health insurance with repatriation cover and also advises medical evacuation insurance. It points out that treatment is expensive and requires prepayment or direct payment (as of 4 November 2026).

How much does a doctor's visit cost in the USA?

There is no fixed fee schedule in the USA as there is in Germany. Hospitals and practices set their own prices, and amounts vary widely by region, facility and treatment. Reliable figures exist mainly for emergency rooms and hospitals:

Two notes on reading the table. The emergency room figures are amounts that large U.S. health plans negotiated with hospitals; foreign self-paying patients do not automatically get such discounts. The KFF figures show what a hospital spends on a day of care; the bill sent to patients is a separate matter. Both show the order of magnitude: even a short hospital stay with surgery quickly reaches five figures.

An appointment at a doctor's office or an urgent care clinic is usually cheaper. The U.S. health library MedlinePlus notes that emergency room care can cost much more than the same care at a provider's office. A reliable average figure for a simple doctor's visit still cannot be given. Before any planned treatment, ask for the self-pay price and have your insurer confirm that it will cover the costs.

What should travel health insurance for the USA cover?

Most policies look similar at first glance. The differences are in the terms and conditions, and with U.S. prices they decide between full reimbursement and an unpaid bill. The criteria below follow the checkpoints used by Stiftung Warentest, Germany's consumer testing foundation, and the advice of the German consumer advice centres:

Also look for a 24/7 emergency hotline, ideally with German-speaking staff, and for cover for search, rescue and recovery. Stiftung Warentest checks whether insurers reimburse at least EUR 10,000 for this.

Pre-existing conditions deserve a second look. According to the consumer advice centres, some insurers do not pay for chronic conditions if you were treated for an acute worsening in the six months before departure or if treatment was already planned. People with chronic illnesses should therefore choose a policy without such clauses. A doctor's certificate confirming fitness to travel can be useful. Whether you can travel and what precautions you need is something to decide with your doctor.

For pregnancy, keep in mind that a planned delivery is not emergency treatment while travelling. Before booking, check with your gynaecologist, your insurer and your airline what applies up to which week of pregnancy.

How much does cover cost?

Good cover is inexpensive. In its comparison (as of 23 October 2026), Stiftung Warentest evaluates 87 travel health insurance policies for holiday trips. Good annual policies start at about EUR 8 per year for individuals and about EUR 30 for families; for a 70-year-old woman the test lists just under EUR 21 per year. An annual policy covers any number of trips in the insurance year, each up to the agreed maximum length per trip.

Note: Take out the insurance before you leave, and save your insurer's emergency number on your phone and on paper in your hand luggage. In an emergency, this call is the most important step.

Is credit card travel insurance enough?

Many credit cards advertise built-in travel insurance. Stiftung Warentest advises against relying on it for health cover abroad. The cover often applies only if the trip was paid with the card, and it is not certain that all family members are insured, that the sum insured is sufficient and that repatriation is included.

Typical pitfalls of credit card insurance:

• Activation only by payment: Cover often applies only if the flight or trip was paid in full or in part with that specific card. A trip paid with miles or by your employer may not be covered.
• Limited amounts: Instead of uncapped cover there are often maximum amounts that a U.S. hospital stay can quickly exhaust.
• Who is covered? Partners and children are not always included, or only when travelling with the cardholder.
• Limited trip length: Card insurance also limits the insured length of each trip.
• Repatriation missing or narrowly defined: Check whether it is included and under what condition.
• Cover ends with the card: If you switch or cancel the card, the insurance usually ends too.

If you have such a card, read the insurance terms, not just the brochure. Card cover can be a useful supplement. For your main protection in the USA, rely on a separate travel health insurance policy that applies regardless of how you paid for the trip.

What to do in a medical emergency in the USA?

In an emergency, a fixed sequence helps:

1. Call 911 if life is at risk. 911 reaches ambulance, fire and police services nationwide. MedlinePlus lists examples for an emergency call such as trouble breathing, severe chest pain or pressure, a seizure lasting more than one minute, sudden paralysis or inability to speak, and heavy bleeding. For a mental health crisis you can call or text 988 around the clock.
2. Choose the right place. Life-threatening and serious cases belong in the emergency room. Milder complaints can be treated at an urgent care clinic or via telemedicine; see the next section.
3. Call your insurer's emergency hotline. Get in touch as early as possible, at the latest before an expensive measure such as hospital admission or surgery. The hotline can name suitable hospitals, talk to the hospital and organise repatriation.
4. Clarify prepayment or a guarantee of payment. Expect the hospital or practice to ask for payment or a credit card. For larger amounts your insurer can issue a guarantee of payment to the hospital. Ask for this confirmation in writing, as the consumer advice centres also recommend. A credit card with a sufficient limit helps.
5. Keep every document. Ask for an itemized bill showing your name, dates, diagnosis and individual services. Keep payment receipts, prescriptions, pharmacy receipts and medical reports. You will need them to claim the costs from your insurer after you return.
6. Get medication locally if needed. U.S. pharmacies generally do not fill German prescriptions. What to do instead, and what applies when entering with medication, is explained in our guide Bringing medication to the USA.

Emergency room, urgent care or telemedicine?

Where you go affects waiting time and cost. When in doubt: if you feel you are in danger, call 911.

Important: This overview does not replace a medical assessment. If you are unsure, ask your insurer's hotline, or call 911 immediately if there is danger.

Business travel: who pays if you fall ill on a business trip?

A special rule applies to employees. If you work temporarily in the USA for your German employer and remain in German statutory health insurance, you receive the health insurance benefits from your employer if you fall ill (Section 17 SGB V). According to the DVKA, this also applies to insured family members who accompany or visit you. The statutory insurer reimburses the employer only up to German contract rates, so the difference to U.S. prices stays with the company.

Many employers therefore take out group travel health insurance for business trips. Before you leave, check with HR or your travel department:

• whether a group policy exists and what its emergency number is,
• whether private days before or after the business part are covered,
• whether accompanying family members are included,
• who advances the money if a hospital demands prepayment.

The social security agreement between Germany and the USA plays no role when you are ill. In a secondment it determines in which country pension contributions (on the U.S. side also Medicare Part A contributions) are due, not who pays for treatment. After a work accident, the DVKA advises contacting the responsible German statutory accident insurer, for example the Berufsgenossenschaft. Self-employed people and freelancers are not covered by Section 17 SGB V and need their own insurance in any case. Everything else that matters on business trips, from entry to permitted activities, is summarised in our guide to business travel to the USA.

Longer stays: what applies beyond six to eight weeks?

Annual policies limit the length of each individual trip. According to Stiftung Warentest, all policies in its comparison cover trips of six to ten weeks each; the consumer advice centres mention six or eight weeks depending on the contract. If you travel for more than 70 days in a row, Stiftung Warentest says you need a different policy. Long-term travel insurance for several months exists but costs considerably more.

This affects many U.S. travellers, because the permitted stay is often longer than the insurance cover:

• With ESTA you may stay up to 90 days per entry. An annual policy with an eight-week maximum therefore ends in the middle of a long holiday.
• With a B-2 visitor visa, U.S. Customs and Border Protection (CBP) sets the length of stay at entry, usually up to six months. The date on your electronic I-94 record is what counts. Parents and grandparents visiting family in the USA for several weeks easily exceed the limit of their annual policy.
• If you extend your stay, your insurance must be extended as well. How an extension generally works is explained in our article Extending your stay in the USA.

For such trips, take out long-term travel health insurance before departure that covers the entire period, and allow a buffer for a later return. For studies and exchange programmes (such as F-1 or J-1), universities and program sponsors usually set their own insurance requirements. Our visa check tells you in a few minutes whether ESTA is enough or whether you need a visa; the basics of the visitor visa are in B-1/B-2 visa basics.

Where can you find independent comparisons?

Two sources offer a neutral overview. Stiftung Warentest publishes a regularly updated comparison of travel health insurance that rates the policy terms, separately for individuals and families. The German consumer advice centres explain which clauses to avoid and offer personal advice, including on whether an existing policy still fits. Comparison portals list many policies but do not always sort them by the criteria that matter for the USA.

How to compare:

1. Determine how long your longest trip of the year will be and who is travelling with you.
2. Check the eight criteria from the table above in the policy terms, not just in the marketing text.
3. Clarify pre-existing conditions with the insurer in writing beforehand, and your fitness to travel with your doctor.
4. Save your policy number and emergency number on your phone and write both down on paper.

Remember your travel first-aid kit as well: which medicines to take is best discussed with your doctor or pharmacist. Medication belongs in your hand luggage on flights; the rules of the U.S. security screening agency TSA for liquids and medication are explained in our guide Connecting and domestic flights in the USA.

Next steps

With suitable travel health insurance, an important part of your preparation is done. What usually remains is entry and travel authorisation: what happens at the border is explained in our article U.S. entry: CBP and customs. Our visa check shows whether ESTA is enough or a visa is needed. We are happy to help with visa applications, appointment booking or Global Entry; you will find an overview under Services.

This article is non-binding guidance, not insurance, legal or medical advice. Only your policy terms are decisive. Decisions on entry and stay rest solely with the U.S. authorities.