A surprise presidential proclamation on health insurance requirements for U.S. visitors issued late last year could have a significant effect on visitors to the United States in 2020.
In November, the Trump administration began requiring that a large group of travelers to America prove they will have U.S. health insurance within 30 days of their arrival or enough money to pay for healthcare emergencies.
"People are calling me and saying, 'I'm going to Disney World. Do I need health insurance?'," says Jason Finkelman, an immigration attorney with the Finkelman Immigration Law Firm. "Or, 'I'm coming here on a business trip. Do I need health insurance?' It's super-confusing."
Insurance companies are getting the same panicked calls.
"The proclamation issued by the Trump administration took a lot of travelers — and I'd venture to guess insurance providers too — by surprise," says Zubair Jeewanjee, CEO of G1G Travel & Visitors Insurance, an insuretech company. "We began getting calls almost immediately from travelers looking for details and clarification about what this means for them."
G1G posted a guide to the new health insurance requirements for visitors after the announcement.
"Much of the practical effect of this proclamation will have to await implementing instructions from the State Department to consular posts," William Stock, a founding member of Klasko Immigration Law Partners, told my FORBES colleague Stuart Anderson.
Among the questions: What are the requirements? Who needs insurance for visiting the United States? And what will happen if you don't have it?
New health insurance requirements for U.S. visitors may affect travel in 2020.
What are the new health insurance requirements for U.S. visitors?
The administration's move applies to immigrants who, in the government's words, "will financially burden" the United States healthcare system.
"An alien will financially burden the United States healthcare system unless the alien will be covered by approved health insurance … within 30 days of the alien's entry into the United States, or unless the alien possesses the financial resources to pay for reasonably foreseeable medical costs," according to the proclamation.
Visitors to the United States can meet that requirement by buying health insurance or a visitor health insurance plan that provides adequate coverage for medical care for a minimum of 364 days or until the beginning of planned, extended travel outside the United States, according to the government.
There are exceptions to the rules. Tourists, children, returning resident applicants with SB-1 visas, applicants for fiancé visas, and asylum-seekers are among those who are exempt.
While the administration's health insurance requirements for U.S. visitors affect mainly immigrants, they are also bringing a greater awareness of insurance to travelers who visit the United States for vacation. Other countries, notably Cuba, Russia and the United Arab Emirates, require U.S. visitors to carry health insurance before they enter the country. And, while health insurance isn't required for inbound tourists to the U.S. — at least not yet — it's worth considering, say experts.
Inbound tourism may be affected by new health insurance requirements for U.S. visitors.
Do you need visitor's insurance for your trip to the United States?
There's plenty of confusion about the proclamation and the resulting health insurance requirements for U.S. visitors. In November, a federal judge in Portland, Ore., issued a temporary restraining order that blocked the insurance requirements. The order has since been extended indefinitely.
"At the moment, it's not in effect," says Finkelman. "But if it does come into effect, it's going to have a significant impact."
Health insurance requirements or no, the question remains: If you're visiting the United States, do you need health insurance coverage? Probably. Your country's health insurance may have significant limits or may not be accepted at all in the U.S. Check with your health insurance provider before you leave. You may be able to purchase a travel insurance policy in your country before your departure that will cover you.
"Because of the fast pace changes regarding immigration and the general anti-immigrant climate we are seeing with this administration, visitors to the U.S. in 2020 should invest in travel insurance and should be checking the local U.S. news very often to make sure new policies won't affect their travel plans," advises immigration attorney Priscilla Deniz.
Deniz says she's seen an uptick in a lot of different types of people — visitors for pleasure, business, green card holders — getting put into secondary inspection at the airport when they arrive.
"It would seem like there is some sort of fishing expedition going on recently," she adds.
Jeewanjee, the G1G Travel & Visitors Insurance CEO, agrees that the best way to meet the immigrant health insurance requirements for U.S. visitors is to buy insurance, even if you don't have to yet. He recommends an immigrant medical insurance plan, which provides adequate coverage for medical care for a minimum of 364 days, or until the beginning of planned, extended travel within the United States.
"We've been advising our customers to purchase a plan with the maximum amount of coverage that fits within their budget, due to the simple fact that health care costs in the United States are among the highest in the world," he says.
That's true. The average American spends $10,348 per year on healthcare, according to the latest numbers from the U.S. Department of Health & Human Services. That's $3.3 trillion a year, or about 18% of the Gross Domestic Product. Only Switzerland and Norway come close to that kind of spending, as I noted in a recent FORBES story about visitor's insurance.
Understandably, visitors to the United States are surprised when they visit a doctor or hospital. A detour to the emergency room could push them into bankruptcy.
Could new health insurance requirements for U.S. visitors prevent you from visiting America?
What happens if you don't have health insurance for your trip?
In my consumer advocacy practice, I hear from a lot of people who get sick on vacation and end up in a foreign hospital. Their stories are cautionary tales. These visitors don't always have adequate insurance (in some cases, they have no insurance) and the hospitals won't release them until they pay their bill. It's not unusual for someone to pay tens of thousands of dollars and go into debt to settle an unexpected medical bill.
I remember Fred and Connie Claussen's honeymoon cruise, which I covered in a Washington Post column. During the voyage, Fred suffered a massive heart attack. The cruise line diverted the ship to St. Kitts and transferred him to a hospital. The hospital demanded $1,100 for its services before it would release him to an air ambulance that transported him to an American hospital — a payment that Connie called a "bribe."
OK, an American hospital probably won't ask you for a bribe. But it will present you with a bill, and probably for a lot more than $1,100. Until the new health insurance requirements for U.S. visitors are sorted out, buying insurance is a safe bet.
