I flew back to Chicago for Christmas to surprise my mom, slipped on icy pavement, and snapped my tibia. When I handed the ER clerk my “Global Nomad Insurance” card, she frowned and said, “This policy excludes the United States.” I am now facing a $35,000 orthopedic bill because I didn’t read the “Home Country Coverage” fine print.
Key Takeaways
- The US Exclusion: Most budget nomad insurance (SafetyWing, World Nomads) completely excludes the USA or limits coverage to 15 days, and only for accidents (not illness).
- The ACA Penalty: If you are a US citizen, you don’t pay a tax penalty anymore, but you lose your “Special Enrollment Period” rights if you don’t maintain credible coverage.
- Incidental vs. Endorsed: “Incidental” coverage covers you for a quick trip. “Endorsed” coverage means you pay extra to have the US fully covered.
- Medical Evacuation is ONE WAY: Travel insurance evacuates you to your home country. Once you land in the US, the policy ends. You need a bridge plan.
The “Why” (The Trap)
The trap is “Incidental Home Country Coverage.”
Insurers assume that if you go home, you have national healthcare (like the NHS in the UK). But Americans don’t.
Most policies say: “Coverage applies to your home country for 30 days per 90 days.”
The Catch: This is usually for accidents only or new emergencies. If you get the flu or need a prescription refill while visiting home, it pays $0.
The Investigation: I Called Them
- SafetyWing (Nomad Insurance): I checked my policy. It covers 15 days in the US for every 90 days abroad. BUT, you must have been abroad for 90 days first. If you travel in month 2, you are uninsured in the US.
- Verdict: Risky for frequent visits.
- IMG Global (Patriot Plan): I called them. They allow you to add “US Coverage” for an extra premium (about 50% more).
- Verdict: Good bridge plan. It covers you while in the US like a standard PPO.
- GeoBlue (Xplorer): This is the heavyweight. It is a Blue Cross Blue Shield plan that works globally AND in the US.
- Verdict: It’s expensive ($400+/mo), but it acts like real US health insurance. You can stay in the US for 6 months and still be covered.
Comparison Table: US Coverage for Nomads
| Feature | SafetyWing | IMG Patriot America | GeoBlue Xplorer |
| US Coverage | Limited (15 days/90) | Optional Add-on | Full Coverage |
| Network | None (Reimbursement) | UnitedHealthcare | Blue Cross Blue Shield |
| Pre-existing in US | NO | NO (Lookback period) | YES (Premier plan) |
| Cost | $ | | |
[IMAGE: Map graphic showing ‘World’ in Green and ‘USA’ in Red, with a ‘Coverage Void’ warning label]
Step-by-Step Action Plan
- Check Your Days: Count exactly how many days you will be in the US. If it’s more than 15, your standard nomad plan will likely fail.
- Buy a “Short Term Medical” Plan: If you are visiting the US for 1 month, buy a specific US short-term plan (like Pivot Health) just for that trip. Don’t rely on your travel insurance.
- Upgrade to Global Health: If you spend 3-4 months a year in the US, switch from “Travel Insurance” to “Global Medical Insurance” (GeoBlue/Cigna).
- Keep US Address: To get US specific short-term plans, you often need a US mailing address. Use a parent’s or friend’s.
FAQ
Does my travel insurance cover me if I get sick on the plane to the US?
Yes, usually until you clear customs. Once you are “in country,” the home country exclusion kicks in.
Can I use travel insurance if I am a US citizen but “live” abroad?
Yes, but you must prove you reside abroad. If you move back to the US, the policy voids immediately.
What is “Medical Evacuation to Home”?
If you get hurt in Bali, they fly you to the US. Once the plane lands, your travel insurance stops paying. You need US insurance the second the stretcher hits the tarmac.