A friend has Medicare, which doesn't provide health insurance coverage overseas.
He thinks if he became ill abroad, he wouldn't be charged for medical services in countries where they provide universal health coverage for their own citizens. I think he would be charged.

What's the scoop? Are there some European countries in which he would receive free treatment?

Maybe in some cases, but he sure couldn't count on it! I seem to remember that many years ago there was a crackdown on tourists who came to the UK whose primary purpose was free medical/dental treatment.

Suppose someone suffers something that requires medical evacuation home, such as a stroke, severe broken bones, paraplegia, or whatever. What would he do then, even if he were lucky enough to get free treatment originally?

As someone who works in the UK National Health Service - if a visitor to the UK came into the A&E department with chest pains, RTA, broken bones or any other emergency, they would be treated without thought of charge at that time. If they were hospitalised then the treatment would not be on the NHS. Most EU countries provide reciprocal arrangements for each other's citizens (called E111) but not for persons falling outside that agreement. I have no medical health insurance because I use our "free" NHS (even though my national insurance deductions last month were £223 - but that's no longer to fund only the NHS so we won't go there!) and when travelling I rely on my holiday insurance.
Were your friend to seek the advice of a General Practitioner then that certainly would not be free.

Does you friend have a Medicare supplement? The one we have pays for travel abroad, but it does not cover medical evacuation.

If he became ill in France or Italy, where I've had some significant experience with medical emergencies, he'd be charged a nominal fee (like 20-40 euros). That is, if it were an accident or something that could be treated within a few hours' time at an emergency ward. I don't know about a longer illness, but I believe he'd be charged whatever the equivalent amount a citizen of that country would be responsible for (whether paying out of pocket or covered by the state), along with a form to pass on to his American insurance company for possible reimbursement. At least, that's been my experience.

Health care in all Western European countries I know of (and I think they all have some variation of public universal health coverage) is much more reasonable in price than in the US, but even for those covered, it is not always completely "free". There are various copayments involved in many services and the copayments are often set to help influence behavior, just as insurers do in the US. I don't know why your friend thinks he would get free care if he isn't covered in that system through various sick funds or other coverages. I think AR's comment about hospital emergency rooms are similar to the US, you will be treated for a real emergency, but that doesn't mean there won't be a bill.

I've been treated in London at St Mary's hospital as a tourist and it was not free, as I recall, but the bill was modest so was nothing to think about. This was an outpatient visit, however.

There are private hospitals in some countries, also, (perhaps all of them, it wouldn't surprise me, but I know of some in France) and if you go or are sent to a private hospital because of nationality, preference or language, charges can be higher.

I do consulting for a US insurance plan and we most certainly get bills from every country in the world when our beneficiaries are seen by their doctors or in their hospitals. The bills from all Western European countries are very reasonable, however, for the services. Some of the highest bills are not from where you would expect, but from cheaper countries where they like to charge high fees to foreigners or where there may be questionable business practices (such as the Philippines which has a lot of corruption in the hospital industry).

Your friend is mistaken if he believes he will receive endless free care in Europe. The national health care systems are funded by the citizens through taxes, and are intended for the citizens. Should there be some sort of catastrophic event he would receive emergency care through the national system (not through a provider of his choice), but ongoing, chronic care would not be provided without charge, nor would there be any provision for flights back to the states if required for medical reasons.
Some - but definitely not all - Medicare Plus Choice HMO's provide coverage abroad.
If your friend has any chronic conditions or is at risk for something, he would do well to obtain travel insurance. There are policies that can be taken out by the year rather than per trip if that is of interest. A good place to look and compare plans is www.insuremytrip.com

Your "friend" should be conducting his own research. And, he should consider trip insurance with medical coverage.

We have only had one visit to a European emergency room, and when we were checking out, I pulled out my bank card, but they wouldn't accept it. (I offered in vain to leave one of my children in lieu of cash.) Thankfully, the bill was much less than it would have been in the States, and I had enough cash. I've often wondered what the cashier would have done if I hadn't been able to pay. Maybe she would have changed her mind about keeping a kid...

BTW, it was an orthodontic emergency, believe it or not...

Suzy, your friend is seriously mistaken. It *could* happen that he would get free service for something minor (see below), but healthcare systems in Europe are under serious financial strain and they're not about to go around dishing out free care. Your friend may be treated without requiring to pay up front or show proof of insurance, but there will be a reckoning at some point.
*In one exception, I went to see a family doctor in a small town in central Germany for a painful, stiff neck. The doctor was the family doctor for our German relatives. The doctor refused to take payment for the examination and injection because she said the paperwork for a non-German was just too complicated to bother with. Instead she asked me to contribute voluntarily to the "coffee fund" for the young women working in reception. So we left 20 euros.
OTOH, when my husband needed a CT scan at a hospital, he was most definitely billed for the service! (but at a cheaper rate--173 euros for a fairly comprehensive contrast CT scan and reading seemed like a bargain compared to what he would have been charged in the U.S.)

I often see travel insurance questions on this board, and am rather surprised that people don't take it out as a matter of course. Is it very expensive in the US? Travel insurance is extremely cheap in the UK, and my annual worldwide policy covers me for medical emergencies, cancellations, theft, delays, you name it. For a small supplement I can also add in dangerous sports. I can't see the debate about whether to take it or not.

There's been a lot of press in the UK about "healthcare tourists", ie people coming here to get free health care, and they're trying to crack down on it, so while a medical emergency may be free, you certainly can't guarantee it. What's more, I don't see why I should pay for tourists to get free treatment!

Like all other posters, I'm going to tell that though they probably won't ask for proof of insurance upfront, he will eventually be billed for medical treatment received in France. The healthcare coverage apply to french citizens or foreign permanent residents (and to EU citizens) not to tourists.

Now, I wouldn't know what they could do if he then declined to pay the bills. I assume the amount would have to be pretty high for the hospital to start some legal procedure on another continent. Not that I would advise not to pay the bills, of course.

And, kate, you can be assured that anyone without health insurance would not get free treatment here, even residents!
The policies vary in price depending on the coverage desired. I just bought one for $77 for 2 of us for a 3 week trip. But since we are using miles and have made no deposits on rooms or cars, I didn't bother insuring those. We'll be covered for baggage loss or delay, medical care and evacuation at a set amount, which supplements our own Medicare supplement, and a few other things. I could have even added in collison insurance for the car at a lower rate than the rental companies charge. If we'd wanted the full megellah for a 3 week trip it could have run as high as $500.00!

Suzy, what kind of health is your friend in? i.e. is he/she healthy and just concerned if they gets ill. No one will ever refuse emergency treatment it is against any moral code of a doctor. I think Uncle Art mentioned on a post going to a Dr. or Hospital in the UK for some minor treatment and it was a minimal cost. If they have some serious conditions that travelling could make worse don't go. Your health is your wealth.

Hi suzy,

Your friend could take a chance on getting free or nominal cost emergency treatment, but not more than that.

Also, evacuation costs can be very high.

Your friend might want to check this site.

http://www.diversalertnetwork.org/me...p/benefits.asp
Basic membership gives you 100k worth of evacuation insurance (not medical coverage- but just to get you home) for diving or non-diving accidents or injuries from anywhere 50 miles from your home or farther. The family membership is $44.

Uhhhh..yes, suzy, you are very welcome for all the comments posted and not the decency of a reply from you....

What kind of Medigap insurance does your friend have? Medicare doesn;t cover outside the US but many of the Medigap plans do - or can have this added for a specific period of time. Would look into that - it may be cheaper than regular travel insurance.

For someone in the Medicare age group to travel without insurance would be foolhardy - we have been taking it routinely since my beau hit 45 - just in case.

Heading on a slight sideline... a question to Fodorites based in USA.

If an American citizen has no health insurance and they are involved in an accident in the USA and say break a leg or fracture their skull, are they entitled to medical treatment? If not, what happens? Are they just left?

No, of course they are not just left..they are billed for it at the going rate.. and the going rate is high! If they are indigent, they may have medicaid ( an ins. program for people under certain incomes with no tangible assets).

I had a friend who had no health ins and needed surgery..it was $24,000.00 here with the hospital stay..she went to the UK ( she has family there) and paid $7000.00 with a private room and all the extras!

Patients in an emergency situation are required to be treated by any hospital. But if they have no health insurance - and are not poor enough to qualify for Medicaid (essentailly indigent) - they will be billed for it - and if necessary sued for payment.

In a non-emergency situation people with no health insurance are not eligible for treatment - except via cash on the barrelhead - in many places. Or may have very limited access to publicly funded health services. These services are usually funded by states or localities - and are nonexistent in many places.

In New York, for instance, there is apublicy funded program that provides health care for children of lower income families for (I believe) very limited premiums. I think adults are just out of luck.