Fixed vs Comprehensive Visitor Insurance: Bill Example

In the fixed vs comprehensive visitor insurance decision, the difference is how the plan pays. A fixed plan pays a set dollar amount for each service, such as a daily amount for a hospital room, and you owe the rest. A comprehensive plan pays a percentage of eligible expenses, often 100 percent in network after your deductible, up to the policy maximum. Fixed plans cost less. Comprehensive plans leave far less of a hospital bill with you.

Key facts at a glance

• Fixed plans are also called limited or scheduled benefit plans. Each service has its own cap, listed in a schedule of benefits.
• WorldTrips' VisitorSecure schedule pays $1,725 per day for hospital room and board on Plan B, for up to 30 days, according to the Description of Coverage we reviewed.
• KFF's hospital data puts average US hospital expenses at roughly $3,300 per inpatient day, well above typical fixed plan daily limits.
• Atlas America, a comprehensive plan, pays 100 percent of eligible expenses after the deductible up to the overall maximum, according to WorldTrips.
• VisitorSecure does not cover emergency room charges for an illness unless the visit results in an inpatient admission, under its listed exclusions.
• Age narrows both types. On VisitorSecure, travelers aged 80 and above must select Plan A with a $10,000 maximum, and Atlas America offers $10,000 at that age.

How does a fixed benefit plan pay?

A fixed plan works from a table. For each kind of service, the schedule shows the most the plan will pay. Using VisitorSecure Plan B as an example, the Description of Coverage lists $1,725 per day for hospital room and board, $2,600 per day for intensive care for up to 8 days, $4,800 per session for inpatient surgery, $75 per inpatient physician visit, and $85 per office or urgent care visit for up to 10 visits.

The hospital's actual charge does not change these amounts. If the charge is lower than the cap, the plan pays the charge. If it is higher, the plan pays the cap and the difference is yours. The overall policy maximum matters less than it appears, because the per service caps are reached long before it. Our VisitorSecure review goes through the full schedule.

How does a comprehensive plan pay?

A comprehensive plan starts from the bill rather than a table. You pay the deductible you chose. After that the plan pays its share of eligible expenses, which on plans such as Atlas America, Patriot America Plus and Safe Travels USA Comprehensive is 100 percent inside the provider network, up to the policy maximum. Some lower priced comprehensive plans share costs instead: Safe Travels USA Cost Saver pays 80 percent of the first $5,000 and 100 percent after that.

Most comprehensive plans for the United States use a PPO network, where providers have agreed rates and can bill the plan directly. Copays can apply. WorldTrips lists a $200 copay for emergency room use for an illness and a $15 urgent care copay on Atlas America. Eligible expenses are still subject to exclusions, usual and customary limits, and precertification rules, so comprehensive does not mean everything is paid.

What does each plan pay on the same hospital bill?

Here is an illustration. The bill is hypothetical and the amounts are rounded for clarity. A visitor aged 72 goes to an emergency room with a new illness and is admitted for three nights.

• Emergency room charge: $2,500
• Hospital room and board, including tests during the stay, 3 days at $3,300: $9,900
• Imaging and laboratory work billed separately: $3,000
• Inpatient physician visits, 3 at $250: $750
• Total billed: $16,150

Fixed plan, using the VisitorSecure Plan B schedule. The emergency room benefit is $485, payable because the visit led to admission. Room and board pays $1,725 per day, so $5,175 for three days. Under this Description of Coverage, diagnostic testing during an inpatient stay falls within the daily room and board limit, so the separate imaging and laboratory charge adds nothing. Physician visits pay $75 each, so $225. The plan's benefits total about $5,885 before the deductible, which is $100 or $200 at this age. The visitor owes roughly $10,300 to $10,500.

Comprehensive plan, using Atlas America with a $250 deductible. If the hospital is in network and the illness is eligible, the plan pays 100 percent after the deductible. The visitor owes about $250, plus any copay the certificate applies, and the plan's payment is counted against the $50,000 or $100,000 maximum available at age 72.

That is a difference of about $10,000 on a short, uncomplicated stay. This example is not a quote or a prediction of how any claim will be decided. Real bills vary widely, network discounts change the numbers, and every claim is assessed against the certificate. Use the medical cost estimator to try other scenarios.

Who does a fixed benefit plan suit?

A fixed plan can be a reasonable choice in a narrow set of cases. It suits a healthy younger visitor on a short trip who wants some help with a clinic visit or a minor injury, and who could absorb a larger bill if something serious happened. It suits a family whose budget will not stretch to a comprehensive plan for every traveler, where the realistic alternative is no cover at all. It can also be the only practical choice at ages where comprehensive maximums have fallen to $10,000 anyway.

The plan catalog itself carries the warning that coverage and benefits on fixed plans may not be adequate. Take that at face value.

Who should choose a comprehensive plan?

Anyone for whom a hospital admission is a realistic possibility. That includes most parents and grandparents, anyone staying for several months, and anyone with a health history, even though pre-existing conditions themselves are excluded. Comprehensive plans also tend to carry stronger acute onset of pre-existing condition benefits. On VisitorSecure the acute onset benefit applies only under age 70, while Atlas America extends it to travelers under 80.

If the premium is the obstacle, raise the deductible on a comprehensive plan before switching to a fixed one. A $1,000 or $2,500 deductible lowers the price and still limits your exposure on a large bill. Our guide to choosing a deductible and policy maximum explains the tradeoff.

How big is the price gap by age?

Premiums depend on age, trip length, policy maximum and deductible, so the gap is not one number. As a pattern, a fixed plan is the lower priced option for the same traveler and dates, and the gap in dollars tends to widen with age as premiums for every plan type rise.

Two things soften that picture for older travelers. Comprehensive maximums are capped at about $100,000 for ages 70 to 79 on most plans, which holds the premium down. And from age 80, both plan types offer low maximums, so the structural advantage of comprehensive cover shrinks. The only reliable comparison is a live one: run the same ages and dates through the visitor insurance quote page and put the premium difference next to the bill difference above.

Download our free Fixed vs Comprehensive Bill Calculator below. It is a worksheet that walks you through the sample bill line by line with your own quotes, so you can see what the premium saving buys and what it gives up.

How to get covered

Enter the traveler's age and dates on the visitor insurance quote page and select one fixed and one comprehensive plan to compare. Open each plan document, find the schedule of benefits, and check the limits for the traveler's exact age.

Frequently Asked Questions

Is fixed visitor insurance worth it?

It can be for a short, low budget trip by a healthy traveler who mainly wants help with clinic visits. It is a weak fit for hospital care, because per day and per service limits sit well below typical US charges. If you can afford a comprehensive plan with a higher deductible, that generally leaves you with less exposure on a hospital bill.

Can I switch from a fixed plan to a comprehensive plan during the trip?

You cannot convert one into the other. You would cancel or let the fixed plan end and buy a new comprehensive policy. The new policy treats anything that began before its start date as pre-existing, including illnesses that arose under the first plan. Switching is only sensible while the traveler is well.

Do fixed plans have a provider network?

Some do and some do not. VisitorSecure and Safe Travels Elite have no PPO network, so you can visit any provider and the plan pays its scheduled amount. Visitors Care uses the First Health network. A network can reduce the billed charge, but the plan still pays only the fixed amount for each service.

Does a comprehensive plan cover pre-existing conditions?

No. Both plan types exclude pre-existing conditions. Many comprehensive plans include a limited benefit for the acute onset of a pre-existing condition, with age limits and a requirement to seek treatment within 24 hours. Routine care, medication and monitoring for a known condition are not covered under either type of plan.

Choose the structure first and the price second. Compare plans on Ombrela with a visitor insurance quote, and keep the worksheet beside you while you read the schedules.