- The Association of British Insurers reported that one member paid out more than 1 million pounds for a customer admitted to hospital for emergency treatment in the USA who then needed repatriation to the UK (2024 data, published 21 August 2025).
- Across 2024, ABI members paid 472 million pounds on more than 500,000 travel claims, with medical claims accounting for 262 million pounds and 34 percent of all claims, up from 29 percent in 2023.
- The UK Global Health Insurance Card does not apply in the USA; it covers state healthcare in the EEA and a short list of other countries, and never covers repatriation or private treatment.
- Some UK providers publish emergency medical limits of 10 million pounds (for example Covered2Go) or unlimited cover (for example Staysure) on their higher tiers.
How USA cover differs from European cover
The single variable that separates a USA travel insurance policy from a European one is the emergency medical limit. The USA has no reciprocal healthcare arrangement with the UK, and treatment is billed at private rates that bear no relationship to NHS or EEA pricing. An air ambulance transfer, an intensive care stay, and a medically supervised flight home can run into six figures and, in the case the Association of British Insurers highlighted, beyond 1 million pounds for a single traveller.
That figure is not an outlier used for shock value. The ABI recorded that one of its members paid more than 1 million pounds in 2024 for a customer who was admitted to hospital for emergency treatment in the USA and required repatriation. Across the same year, ABI members paid 472 million pounds across more than 500,000 travel claims. Medical claims alone reached 262 million pounds and made up 34 percent of all claims, up from 29 percent the year before. Medical expenses were the most common reason to claim.
For European trips, a limit of a few million pounds is conventional and rarely tested to its ceiling because the UK Global Health Insurance Card sits behind it for state treatment. For the USA, neither of those things is true: there is no GHIC backstop, and the underlying bills are far larger. That is why limits marketed at 10 million pounds or described as unlimited exist, and why the medical section deserves more scrutiny than the headline price.
Why the GHIC does not help in the USA
The NHS is explicit that the UK GHIC covers medically necessary state healthcare in EEA countries plus a small group of others such as Montenegro, Australia, Jersey, Guernsey, the Isle of Man, St Helena, Tristan and Ascension. The USA is not on that list. The card also never covers being flown back to the UK (medical repatriation), treatment in a private medical facility, or ski and mountain rescue, and the NHS states plainly that it is not a replacement for travel insurance.
The practical consequence for a US trip is that the insurance policy carries the entire medical risk on its own. There is no parallel scheme reducing the bill, and the repatriation element, which the GHIC excludes everywhere, is precisely the part that pushed the ABI case over 1 million pounds. For the USA, the policy is the whole safety net rather than a top-up.
What to look for in a USA policy
The Foreign, Commonwealth and Development Office advises that a policy should cover the full length of the trip, treatment in state or private hospitals, and emergency transport such as an ambulance, which it notes is often charged separately to other medical expenses. For the USA, those three points translate into specific checks.
- Emergency medical and repatriation limit. This is the figure that absorbs the kind of claim the ABI described. Limits of 10 million pounds or unlimited exist; a limit in the low millions is far more common on cheaper European-focused policies and is worth confirming before purchase.
- Repatriation as a named benefit. The FCDO flags emergency transport as a separate cost, and repatriation is the most expensive element of a serious US claim. Confirm it is included rather than assumed.
- Pre-existing condition declaration. The FCDO warns that failing to declare existing conditions or pending treatment can invalidate cover. In the USA, where bills are highest, an invalidated policy is the most costly outcome of all.
- Excess on the medical section. The FCDO notes some insurers waive the medical excess where an EHIC or GHIC is used, but that waiver is an EEA mechanism and does not apply in the USA. Read the flat excess that will apply to a US medical claim.
- Trip length and activities. The FCDO notes many policies cap maximum trip length and that some activities need specialist cover or an add-on. A long US road trip or an adventure activity can fall outside a standard policy.
Cover limits and exclusions
Two exclusion patterns matter most on US trips. The first is the pre-existing condition exclusion: anything not declared and accepted by the insurer is typically not covered, and the FCDO is direct that non-declaration can void the whole policy. The second is the activity exclusion, where injuries from an undeclared sport or adventure pursuit fall outside the medical section even though the medical limit itself looks generous.
Alcohol-related incidents, undeclared trip extensions beyond the policy maximum, and treatment that is elective rather than emergency are also common carve-outs. Because the USA produces the largest bills, the gap between what a traveller assumes is covered and what the wording actually says carries the highest financial stakes of any destination.
Providers offering USA cover
The following providers publish USA-relevant cover on their own sites. The figures are taken from each brand's product pages and should be reconfirmed directly, as tiers and limits change.
Staysure is a trading name of TICORP Limited (FCA FRN 663617). Its Comprehensive and Signature tiers are described as carrying unlimited emergency medical cover and emergency expenses, with cancellation up to 15,000 pounds on Signature, no upper age limit, and cover stated for more than 1,300 medical conditions. The absence of an upper age limit and the medical-condition focus make the medical section the centre of its proposition. Details: staysure.co.uk.
Covered2Go is a trading name of Rush Insurance Services Limited (FCA FRN 714385), with cover underwritten by Millstream Underwriting Limited on behalf of AWP P&C SA. Its USA pages describe emergency medical cover of up to 10 million pounds across Silver, Gold and Platinum tiers, with the Platinum tier offering cancellation and curtailment up to 10,000 pounds per person and a 0 pounds excess option. Details: covered2go.co.uk.
Other UK insurers advertise comparable 10 million pound medical limits for the USA, but a limit is only meaningful alongside the excess, the activity list, and the pre-existing condition terms. Read the medical section and the repatriation benefit on any quote before comparing prices.
Common pitfalls
The most expensive mistake on a US trip is treating travel insurance as a European purchase. A policy bought for its price, with a medical limit in the low millions and a GHIC assumed to sit behind it, leaves a traveller exposed precisely where US bills are largest, because the GHIC does not operate in the USA at all.
A second pitfall is non-declaration of medical history. The FCDO is unambiguous that failing to declare existing conditions or pending treatment can invalidate the policy, and the financial consequence of an invalidated US policy is the difference between a covered claim and a personal bill that the ABI has seen exceed 1 million pounds. A third is ignoring the repatriation benefit, which the FCDO singles out as a separately charged cost and which is the element the GHIC never covers anywhere.
