A holidaymaker fell in France, and their state health card covered 80 percent of the treatment. They still owed 16,000 pounds, including the stretcher flight home. That case is one the Association of British Insurers set out in August, and it is the whole argument in a single line. UK insurers paid out 472 million pounds across more than half a million claims in 2024. Medical cases were about a third of the claims but more than half the money, 262 million pounds, and the largest single claim, treatment and a flight home from the United States, passed a million pounds.
I book trips for a living, and I read the cover the way I read a timetable: not the headline, the fine print underneath. The good news first, because it is real. Your card is genuinely competent at the small stuff. Trip cancellation, delay, lost bags: the benefits attached to a decent travel card handle these without drama, and for a short trip close to home that is mostly refundable anyway, that is all you need. The problem is not what the card does. It is the one thing it quietly does not.
That thing is medical treatment, and the flight home when the treatment is somewhere you cannot stay. Look at what your own card actually promises. On both sides of the Atlantic the standard benefit is called travel accident insurance, and the name flatters it. American Express in the UK spells it out: its Travel Accident cover pays a lump sum if you die or lose a limb or an eye, and it explicitly excludes sickness or disease. That is not a hospital bill. Medical treatment is a separate benefit, and on most cards it simply is not there.
The US market documents its card benefits in unusual detail, which makes it the clearest place to watch the trap close. Take the card Americans cite as the exception, the Chase Sapphire Reserve. Even it pays only 2,500 dollars of emergency medical per trip, with a 50-dollar deductible, secondary to any other cover you hold, and reimbursed only after you have covered it yourself. Its evacuation benefit caps at 100,000 dollars and takes you to the nearest adequate clinic, not to your own bed. That is the good card.
Now the real numbers. Avanti, a UK insurer, put the average medical evacuation from the United States back to Britain above 192,000 pounds in 2024, roughly a quarter of a million dollars. Chase's 100,000-dollar cap, one of the better ones, is a fraction of that, and the difference is the part you pay.
Europeans have their own version of this false comfort, and it is the EHIC or its British successor the GHIC. Useful, free, worth carrying. But the NHS says it in one line: it does not cover repatriation, private treatment, or mountain rescue. It is a state-healthcare card, not insurance. The traveler in France learned the difference at 16,000 pounds.
So, the rule I use. The card is fine when the trip is short, close to home, and refundable. Buy a standalone policy the moment you leave the country, put real money into nonrefundable bookings, or plan to ski or dive, because adventure sports are excluded almost everywhere unless you pay for the add-on. In the US market, NerdWallet (an aggregator, not an insurer) prices a standalone at 4 to 8 percent of the nonrefundable trip cost, where a mid-tier plan carries 50,000 dollars of medical and 500,000 of evacuation; European policies tend to run higher on the medical line. Either way you are buying the two things the card withholds: five-figure-plus medical cover and six-figure evacuation that flies you home, not just off the mountain.
Before you go, read your own card once, properly. Does it pay medical treatment, or only death and dismemberment? Does it pay first, or only after any other cover you hold? What is the evacuation cap, and does it repatriate you or merely deposit you at the nearest hospital? Pre-existing conditions, the sports you actually do: in or out? It takes twenty minutes and a coffee, and it is the cheapest twenty minutes on the whole trip. You only doubt that until the one time you needed it.
