The United States doesn't require travel insurance to enter on a visa or an ESTA, and it's the one major tourist destination where traveling without it can ruin you financially. An emergency room visit for a stomach bug costs between $1,500 and $3,500 without insurance; a night in the hospital, about $3,100; an appendectomy, more than $30,000. This guide explains what travel insurance for the US covers, how much coverage makes sense, what it costs in 2026, what it doesn't cover, how to use it when something happens and the mistakes that leave people paying out of pocket. Last checked September 7, 2026.
What matters most
- It isn't mandatory for the visa, for the ESTA or to enter the country. No one will ask for it at the airport.
- It's the most important money decision of the trip after your flight, because healthcare in the US is private and the bill arrives even if you're a tourist.
- Sensible minimum coverage: $100,000 in medical expenses, including evacuation and repatriation, with no or a low deductible, and 24-hour assistance in your language.
- What it costs: about $3 to $8 per day per person for good coverage; between $58 and $353 a month depending on age and coverage in 2026 comparisons.
Why it matters in the US more than almost anywhere
In Europe, insurance is mandatory for the Schengen visa (a minimum of 30,000 euros) and public healthcare is inexpensive; in the US there is no public healthcare for visitors, and list prices are the highest in the world. The federal EMTALA law requires emergency rooms to treat and stabilize you even if you have no insurance or papers, but it doesn't require them to do it for free: they treat you and bill you afterward, and the hospital can send the debt to a collection agency in your home country. Your national health system or private plan at home usually covers nothing abroad, and some premium credit cards include limited travel assistance that's worth reading carefully before relying on it.
What good US travel insurance should cover
- Medical expenses for illness and accidents: at least $100,000; for long trips, travelers over 60 or sports, $250,000 or more. $30,000 won't cover a three-day hospital stay.
- Medical evacuation and repatriation: air ambulance transfer to the right hospital or to your home country. An evacuation from the US to South America costs $50,000 to $150,000, and longer distances cost more.
- Prescription drugs during the trip and emergency dental care (a tooth can cost $300 to $1,000).
- 24-hour assistance in your language, with a network of hospitals that bill the insurer directly ("direct billing"). Without it, you pay and claim reimbursement later.
- Trip cancellation and interruption for covered reasons (illness, hurricanes, denied entry in some policies): recovers non-refundable flights and hotels.
- Lost or delayed baggage, and personal liability if you damage something or injure someone. Note that travel insurance rarely covers liability while driving a rental car; see renting a car in the US.
- Sports if you'll ski, surf or do serious hiking: usually a separate add-on.
What it usually doesn't cover (and where people lose money)
Undeclared pre-existing conditions: if you have high blood pressure, diabetes or recent surgery, say so when you buy and choose a policy that covers it, even if it costs more; insurers review your history when the bill is large. Pregnancy past a certain week, and childbirth. Injuries under the influence of alcohol or drugs, the exclusion most often applied in Las Vegas and Miami. Risky sports without an add-on. Treatment that could wait until you're home, checkups and scheduled appointments. Pandemics, in some older policies; almost all 2026 policies cover COVID like any other illness. And anything you didn't get authorized by the assistance center: many policies require you to call before seeing a doctor, except in a life-threatening emergency.
What it costs in 2026
For a 35-year-old adult spending 10 days in the US, coverage of $100,000 to $150,000 costs between $35 and $80 from travel assistance companies and international comparison sites. For a family of four over two weeks, between $150 and $300. From age 65 the price rises sharply, and many policies reduce coverage or require a health declaration; at 75 there are fewer options. An annual multi-trip policy pays off if you travel more than twice a year. The rule of thumb: insurance should cost between 4% and 8% of the trip; if it costs less than 2%, read the exclusions.
How to use it when something happens
- If it's a life-threatening emergency (chest pain, trouble breathing, a serious accident), call 911 first and the insurer afterward. EMTALA guarantees you'll be treated.
- If it isn't, call the assistance center before going anywhere: they'll point you to the nearest facility in their network (often an urgent care clinic, not a hospital), open a case and arrange direct billing.
- Carry your policy on your phone, your passport and a credit card. At in-network facilities you don't pay; outside the network, you pay and keep everything.
- Keep every document: the itemized bill, the medical report, prescriptions and pharmacy receipts. You claim reimbursement from home within 15 to 30 days with those documents.
- If a bill arrives later for covered care, don't pay it without telling the insurer: hospitals bill the doctor, the lab and the facility separately, and the insurer negotiates them.
Common mistakes
Relying on your credit card's insurance without reading the cap (many cover $10,000 or $20,000, which in the US is an afternoon in the hospital). Choosing the cheapest policy without looking at the medical coverage. Not declaring a pre-existing condition to pay less. Going straight to the hospital with a cold instead of calling the assistance line, and paying $2,000 for something an urgent care clinic handles for $200. Not carrying your policy. And buying insurance after you've left home: most policies can only be bought before you travel, and the few sold at the destination exclude anything that has already started.
Recent changes
- 2025-2026: some insurers added cancellation coverage for denied entry or ESTA revocation; you have to ask for it specifically.
- 2026: US medical costs keep rising faster than inflation; an average emergency room visit now tops $2,500 and a hospital night $3,000.
- Still in force: tourists can't buy US health insurance (the ACA marketplace is for residents only); the only coverage available is what you buy before you travel.
Insurance isn't one of the entry requirements, and the officer won't ask about it. What they do ask is covered in what US immigration asks when you arrive.
Frequently asked questions
Is travel insurance required to enter the United States?
No. Neither the B1/B2 visa nor the ESTA requires it, and no one asks for it at the airport. It's recommended because healthcare is private and an uninsured ER visit costs between $1,500 and $3,500.
How much does travel insurance for the US cost?
About $3 to $8 per day per adult for $100,000 to $150,000 of medical coverage; $35 to $80 for ten days, more for travelers over 65.
How much medical coverage should I get?
$100,000 with evacuation and repatriation. $30,000, the European minimum, won't cover three days in a US hospital.
Is my credit card's insurance enough?
Almost never: most cover $10,000 to $20,000, and only if you paid for your flight with that card. Read the cap before relying on it.
Can I buy insurance after arriving in the US?
Almost no policy allows it, and those that do exclude anything that has already started. Buy it before you leave home.
Does it cover pre-existing conditions?
Only if you declare them when you buy and choose a policy that includes them. Hiding them to pay less is the most common reason claims are denied.