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The scooter went down on a wet road outside Ubud, and the first thought through my friend’s head wasn’t the gravel in his forearm. It was the $6,000 the private clinic wanted before they would set the bone. He’d skipped travel insurance because the trip was nine days long and the policy quoted at $48. That arithmetic has stuck with me for a decade.
Choosing travel insurance is one of those jobs nobody enjoys. Comparison sites push the cheapest headline price, the wording is written by lawyers, and every policy looks roughly identical until the moment you need it. The gap between a good policy and a cheap one rarely shows up until you’re standing at a hospital admissions desk in a country where your home health system has no say.
Here’s how to actually work through the decision, in the order that matters.
Start With the Trip, Not the Quote
Before you open a single comparison tab, write down what the trip genuinely involves. Insurance is priced against risk, so the risk profile of a two-week city break in Portugal looks nothing like three weeks of trekking in Nepal.
Ask yourself some blunt questions. Will you be riding a moped, renting a car, or skiing? Is there a pre-existing condition in the mix, even a managed one like asthma or high blood pressure? Are you pregnant, over 65, or travelling with a young child? Is the trip expensive enough that losing the deposit would genuinely hurt, or is it a $400 flight you could absorb?
Cost of medical care at the destination matters more than most people realise. A broken ankle in the US can run into five figures. A medical evacuation from a remote Indonesian island to Singapore or Australia can hit $30,000 or more. In Vietnam or Thailand, private hospital treatment is cheaper but still nothing you want on a credit card. Meanwhile, an EHIC or GHIC card covers some state care in Europe, which nudges the calculation but doesn’t replace proper cover for repatriation or private treatment.
It also helps to know what you’re walking into. If you’re heading somewhere with limited infrastructure, read up on destinations that live up to the hype but demand proper planning, because remote places tend to be exactly where evacuation cover earns its keep.
The Four Elements That Actually Matter
Strip away the extras and a travel policy is built from a handful of components. Compare these four before you compare anything else.
Emergency medical treatment and evacuation
This is the core of the policy and the reason you’re buying it. Look for at least $100,000 in medical cover for Europe, and $250,000 to $1 million for the US, Canada, or the Caribbean. Evacuation and repatriation should be a separate, generous limit, not lumped into the medical total. A policy with $500,000 medical but only $20,000 evacuation is weaker than it looks.
Trip cancellation and interruption
Cancellation cover reimburses prepaid, non-refundable costs if you can’t travel for a covered reason: illness, a death in the family, jury duty, sometimes redundancy. Interruption cover handles the same problem mid-trip if you have to fly home early. Check whether the policy pays a percentage or a flat sum, and whether it covers the full value of your bookings or caps out well below them.
Baggage, delays, and personal liability
These are the sections people overvalue. Baggage cover usually has a per-item cap, often around $500, so a $2,000 camera might not be fully covered even under a $3,000 total limit. Delay benefits tend to be modest: $100 to $200 after a six-hour wait. Worth having, not worth paying a premium for. Personal liability cover, on the other hand, is cheap to include and protects you if you accidentally damage property or injure someone abroad.
Activity and destination exclusions
Standard policies quietly exclude anything resembling risk. That includes mopeds over a certain engine size, scuba diving below 18 metres, skiing off-piste, and often hiking above 3,000 metres. If your itinerary includes any of that, you need a policy that names the activity explicitly, or an adventure sports add-on.
Read the Exclusions Before You Read the Price
Exclusions are where claims die. The same five or six clauses appear again and again, and they’re worth scanning for by name.
- Pre-existing medical conditions. Most policies exclude them entirely unless declared and accepted. Declare everything, even the thing you’ve had under control for years, and get the confirmation in writing.
- Alcohol. A claim related to drinking is one of the most common grounds for refusal. Two glasses of wine with dinner and a fall down hotel stairs can become a fight.
- Unlicensed or unendorsed driving. Riding a moped in Thailand without the correct licence class voids most policies instantly, regardless of how the accident happened.
- Reckless behaviour. Vague by design. Cliff jumping, ignoring local warnings, or swimming outside flagged areas all sit in this bucket.
- Not reporting the incident promptly. Many policies require you to contact the emergency assistance line before treatment, not after.
This is the same category of boring preparation that saves trips in general. The small admin tasks people forget before travelling are rarely exciting, and policy paperwork is right at the top of that list.
Excess, Deductibles, and the Cheap Policy Trap
A $19 policy usually has a $250 excess and a medical limit that wouldn’t cover a night in a US hospital. Raising your excess lowers the premium, and for a healthy traveller on a short trip that’s a reasonable trade. Do it deliberately, though, not by accident.
Watch for policies that are cheap because they’re narrow. Something has to give to hit that price: a low medical limit, an evacuation cap, a long list of excluded activities, or a deductible applied per section rather than per claim. Compare the medical and evacuation figures side by side across three or four quotes and the shortcuts become obvious.
Paying more isn’t automatically better either. If you’ve already got trimmed your travel budget without gutting the trip, the sensible move is to spend on the sections that protect real money and skip the gadget cover, the airport lounge add-ons, and the premium tier that only raises baggage limits.
Single Trip, Annual Multi-Trip, or Credit Card Cover
If you take three or more trips a year, an annual multi-trip policy usually beats buying single policies each time, often for the price of two short trips. Check the per-trip duration limit, commonly 30 to 45 days, and whether the policy covers the whole world or excludes the US and Canada unless you pay extra.
Credit card insurance is real cover, but the conditions trip people up. You generally need to have paid for the trip on that card, the cover is often secondary to any other policy, and medical limits can be low. It’s a decent backstop for a weekend in Madrid. It’s not what you want holding the line during a $40,000 evacuation.
Families and couples should price a joint policy against two singles, since child cover is frequently free or heavily discounted on a family plan. Older travellers will pay more, and anyone over 70 should expect medical screening questions and possibly a specialist insurer.
Buy Early, and Know What to Do When Something Goes Wrong
Buy the policy the day you book the first non-refundable element. Cancellation cover then applies from that point, which is the whole reason to buy early rather than the night before you fly. Sorting it alongside the rest of your pre-flight checklist of things worth sorting in advance means it actually gets done.
Once you’re covered, save the emergency assistance number to your phone and write it on a card in your wallet. If something happens, call that line before you agree to treatment or pay a bill. Keep every receipt, photograph the damage or the injury, and get a written diagnosis from the treating doctor. Insurers reject claims far more often for missing paperwork than for genuine disputes about cover.
And if you’re weighing up a destination with notoriously steep medical costs, it’s worth knowing which countries sit in that bracket before you book. A quick look at a country guide matched to your travel style will tell you plenty about infrastructure, and that shapes what your policy needs to do.
One last practical note: read the cancellation clause for the specific event you’re worried about. If a parent is ill, if your job is unstable, if you’re travelling during hurricane season, find the sentence that covers that scenario and check it names it. If it doesn’t, ring the insurer and ask. Five minutes on the phone before you pay is cheaper than a rejected claim afterwards.
