Quick answer: travel insurance for the USA 2026
- Avg US claim
- £7,594
- Highest in the world
- Medical cover minimum
- £10m
- £15m for ski / Hawaii
- ER walk-in, no admission
- £1,300+
- CDC median, 2025
- ESTA fee
- $21
- Apply on esta.cbp.dhs.gov
Why a US claim costs four times a European one
Three things drive US healthcare prices that do not exist in the European systems UK travellers are used to. First, there is no price cap. Hospitals negotiate prices privately with insurers; tourists without a US insurance plan are billed at the "chargemaster" rate, which is typically 2 to 5 times what a US-insured patient pays.
Second, the system is fragmented. An ER visit can generate four separate invoices: facility fee, physician fee, radiology fee and lab fee, each from a different billing entity. Travel insurers handle this, but the cumulative bill almost always exceeds an uninsured traveller’s estimate.
Third, US ER departments demand a deposit before treatment in many states, especially Florida, Nevada and Texas. Without proof of insurance or a credit card, you can be stabilised then transferred to a public hospital, doubling the bill and the wait. The travel insurer’s 24-hour line solves both problems with a single call.
Real US hospital bills (in pounds, 2025)
Ranges from Kaiser Family Foundation 2025 chargemaster data, converted at $1.27/£1. The high end of each band is the typical NYC/SF/LA private hospital figure.
| Treatment | Typical bill | Notes |
|---|---|---|
| A&E walk-in, no admission | £1,300to£2,600 | Median across all US hospitals (CDC 2025). |
| Stitches for a 3cm cut | £700to£2,400 | Depends on whether a plastic surgeon is consulted. |
| Broken arm, cast applied | £2,500to£8,500 | Higher in California and the Northeast. |
| Appendicitis, 2-night stay | £28,000to£52,000 | Most common UK claim from US trips. |
| Heart attack, 5-night ICU | £95,000to£240,000 | Easily six figures; £10m cover absorbs it. |
| Air ambulance back to the UK | £45,000to£95,000 | Pacific or central US is the upper end. |
Real billed amounts before insurance negotiation. UK travel insurers negotiate these down through US claims networks; your out-of-pocket on a £10m policy is normally the excess (£75 to £200).
USA cover-level calculator
Pick your US trip type. The calculator returns the medical, cancellation and baggage levels we would specify in 2026, plus the one risk most UK travellers under-price for that trip.
Your US trip type
2026 recommended cover
Medical cover
Non-negotiable floor for US travel
Cancellation
Baggage
State-by-state: the risks that change the policy
Six US states drive most of the destination-specific claims UK insurers see. Each one needs a particular policy tweak.
Florida
Hurricane Jun-Nov
Annual hurricane curtailment; theme-park hospitals (Orlando AdventHealth) bill on average £4,800 for an A&E visit.
California
Wildfire, earthquake
Wildfire smoke triggers respiratory claims even hundreds of miles from the fire. San Francisco hospitals routinely bill £6,000+ for ER.
New York
Highest hospital fees
NYC private hospitals top the ABI claim severity table. £39,000 average appendix bill in Manhattan, 2025.
Nevada
Heat, alcohol claims
Vegas insurers see disproportionate dehydration and alcohol-related ER admissions. Some policies exclude "intoxication-related" claims; check the wording.
Colorado
Ski rescue + altitude
Helicopter rescue at Vail/Aspen quoted at £8,000 to £25,000 in 2025. Add winter-sports cover before you board the chairlift.
Hawaii
Evacuation distance
Inter-island ambulance flights £10,000+, mainland evacuation £40,000+. Bump medical to £15m for Hawaii alone.
USA travel insurance: the five-point checklist
The cheapest US policy is rarely the right one. Use this checklist as a hard filter before you commit.
Medical cover at least £10 million, £15 million for ski or Hawaii.
£5 million policies look cheap but get exhausted by a single ICU stay. The premium gap between £5m and £10m is normally £8 to £20 on a single trip.
24-hour US claims line, ideally with a US-based assistance partner.
Hospitals call the insurer for pre-authorisation. UK office hours do not align with US ER hours; ask before you buy.
Repatriation cover that includes accompanying nurse or doctor if needed.
An air ambulance from the West Coast costs £75,000 to £95,000 and almost always needs a medical escort. Confirm both are bundled, not extras.
Pre-existing conditions: declared, not assumed.
US claims trigger the most aggressive screening. Declare blood pressure, diabetes, cholesterol medication, every test in the last 12 months. Specialist over-65 insurers (Saga, Staysure, Avanti) usually take it all.
Natural-disaster cancellation cover for Florida and California.
Hurricane and wildfire cancellations are now annual events. Confirm "natural disaster" is listed in the cancellation reasons, not just "medical".
Other destination guides
Canada
Travel insurance for Canada
Visitors not covered by medicare. £4,500 average claim.
Caribbean
Travel insurance for the Caribbean
Hurricane season, evacuation cover, island-by-island.
Worldwide
Worldwide travel insurance
Including vs excluding the USA, Canada and Caribbean.
Medical conditions
Pre-existing conditions
Why US trips need the longest screening form.
USA travel insurance FAQ
£10 million is the floor; £15 million for ski, Hawaii or cruise. US hospitals do not cap charges, so a routine appendix bill of £28,000 to £52,000 sits next to a five-night cardiac ICU stay at £95,000 to £240,000 on the same insurer's books. Cheaper policies that cap medical at £5m can be exhausted by a single serious admission.
No. Policies labelled "Europe" exclude North America entirely. Most "worldwide" policies sold in the UK also exclude the USA, Canada and the Caribbean by default; you need the "worldwide inclusive" or "USA/Canada included" tier. The premium roughly doubles, but so does the medical headroom. Check the certificate before you fly.
Yes. UK passport holders need an ESTA (visa waiver) for any visit up to 90 days; the fee rose to £16 (US$21) in May 2025 and is valid for two years or until your passport expires. Apply on esta.cbp.dhs.gov only; third-party sites charge £40 to £60 for the same approval. Travel insurance does not replace an ESTA, and an ESTA does not replace insurance.
Yes, but the premium roughly doubles compared with the under-65 rate, and the panel narrows. Specialist insurers (Saga, Staysure, Avanti, AllClear, Goodtogo) write the bulk of over-65 US business. Declare every condition and every medication: the most common claim refusal at this age is undeclared blood pressure or atrial fibrillation, even when the actual claim is unrelated.
Medical treatment after either incident is covered under the standard medical-emergency clause; cancellation and curtailment are the parts that vary. Premium policies (with "terrorism cover") will reimburse a trip if your destination is the site of a declared incident. Standard policies usually exclude it. Read the policy wording before you book Orlando, Las Vegas or New York.
Never automatically. US claims are the most expensive in the world, so insurers screen aggressively. The medical screening form is longer than for any other destination. Declare every condition diagnosed in the last 5 years, every medication, every test you are still awaiting results for, and any GP referral. Undeclared illness invalidates the policy and the insurer can refuse a claim that has nothing to do with the missed condition.
The insurer's 24-hour assistance line, before you go to hospital, unless the situation is life-threatening. US hospitals will treat you faster and bill the insurer direct if the insurer pre-authorises the admission. Walking in without notifying the insurer is the second most common reason claims are refused or reduced; the insurer can argue you over-treated or chose a more expensive facility.