Travel insurance for the USA from Australia
Travel insurance for the USA from Australia is about one thing above all: medical costs. Smartraveller says US medical costs are extremely high, that a doctor's visit for even a minor issue can cost thousands of dollars, and that you may be asked for proof of insurance or your ability to pay before treatment. There is no reciprocal health care agreement, so Medicare will not help. Buy a policy with the highest overseas medical limit you can get, ideally unlimited, and make sure the region includes the Americas.
The US is also where region settings trip people up. A policy priced for Asia or Europe does not cover a stopover in Los Angeles or a week in Hawaii, and those are exactly the places where an uninsured hospital stay is least survivable. Our guide to compare travel insurance explains the rest of the policy.
By Better Rate Mate Editorial Team ยท Last reviewed
General advice only. It doesn't consider your circumstances. Read the PDS and TMD before you decide.
Smartraveller's current advice for the USA
As at 2 October 2026, Smartraveller's advice for the United States (page updated 26 September 2026) is to exercise normal safety precautions, with no higher regional levels. Level 1 means the security situation is comparable to a large Australian city. It does not change the cost of medical care, which is the risk that matters most for insurance.
What US medical bills look like
Insurers' own claims show the scale. nib reported in March 2025 that its largest single claim in 2024, more than $3 million, was for an Australian who fell ill in the United States, spent several weeks in hospital including intensive care, and came home by air ambulance. It also said visitors to the US made 674 claims in 2024 with about $10 million in medical costs, the highest total of any destination.
Smaller cases add up quickly too. Southern Cross Travel Insurance's lists of its most expensive claims include $157,935 in 2024 for a 49-year-old who had a seizure in the US and needed surgery for a brain tumour, and $87,000 in 2023 for a 60-year-old who needed surgery on a broken wrist.
| What happened | Claim paid | Year | Published by |
|---|---|---|---|
| Illness, several weeks in hospital including intensive care, air ambulance home | More than $3 million | 2024 | nib (25 March 2025) |
| Seizure, then surgery for a brain tumour | $157,935 | 2024 | Southern Cross Travel Insurance |
| Serious wrist fracture needing surgery | $87,000 | 2023 | Southern Cross Travel Insurance (19 December 2023) |
Why the medical limit matters more in the US
There is no public system you can fall back on as a visitor, and Smartraveller's advice for the US is that your insurance should cover pre-existing conditions, all planned activities and medical evacuation. Many comprehensive policies offer unlimited overseas medical cover; others set a dollar cap or a time limit on ongoing treatment. For the US, choose unlimited where you can, and check any time limit and the sub-limits for dental and for evacuation.
| Risk | Why it matters in the US | What to check in the PDS |
|---|---|---|
| Hospital and emergency care | No reciprocal agreement and very high costs | Unlimited or high medical limit; any time cap on treatment |
| Medical evacuation | Getting you home on a stretcher or with a medical escort is expensive | Evacuation included in the medical benefit and approval rules |
| Pre-existing conditions | An undeclared condition can make a US hospital bill yours | Every condition declared and accepted in writing |
| Stopovers and side trips | Any time in the US needs an Americas region | Region covers every country, including transit |
| Driving and hire cars | Licence rules vary by state and rental company | Rental vehicle excess cover and licence conditions |
| Hurricanes and wildfires | Can cancel flights, cruises and accommodation | Known-event rule and cancellation reasons |
If you need a hospital in the US
Call your insurer's emergency assistance line before you are admitted where you can, and give the hospital your policy details. Smartraveller warns you may need to pay up front or show proof of insurance or ability to pay, and the assistance team is what turns your policy into a guarantee of payment the hospital will accept. Keep every itemised bill and medical report, because US bills often arrive separately from the hospital, the doctors and the ambulance, and each one is part of your claim.
The Americas region and stopovers
Insurers price the Americas separately because of US medical costs. Your policy's region has to include every country you visit, including stopovers and transits, so a flight to Europe or Mexico through a US airport, a US port on a cruise, or a detour to Hawaii all need the Americas included. On an annual multi-trip policy, set the region for the most expensive destination you might visit during the year.
ESTA and entry rules
Australians can usually visit the US for tourism or business for less than 90 days under the Visa Waiver Program with an approved ESTA (Electronic System for Travel Authorization). Smartraveller notes approval can take up to 72 hours, an ESTA is valid for 2 years for multiple entries on the same passport, and a Visa Waiver Program stay generally cannot be extended beyond 90 days. Apply only through the official US Government site.
Travel to Cuba since 12 January 2021, or to Iran and certain other listed countries since 1 March 2011, makes you ineligible for the Visa Waiver Program, so you would need a visa. Smartraveller also notes that officials may inspect your devices, and that foreign nationals aged 14 or over staying more than 30 days must register.
Driving, motorbikes and e-scooters
Some US states accept an Australian licence for a limited time, while others, and some rental companies, require an International Driving Permit. Smartraveller advises getting an IDP before you leave Australia, and warns that driving without a required IDP can void your travel and vehicle insurance. Carry your physical licence, as digital licences are not widely accepted. Our guide to rental car insurance covers car hire excess cover, including the US collision damage waiver some policies include.
Hurricanes, wildfires and natural disasters
Smartraveller lists hurricanes, tornadoes, wildfires, earthquakes and winter storms among US hazards, with hurricane risk running from May to November. Its US page, updated 26 September 2026, notes that after Hurricane Lowell the Hawaii Tourism Authority encouraged travellers to postpone trips to Kauai: exactly the kind of event that becomes a known event for any policy bought afterwards. Buy cover when you book so cancellation cover is in place before the weather turns.
Cruises from US ports
Many Australians join cruises in the US, to Alaska, the Caribbean or Mexico. Smartraveller's advice is to choose a policy that covers you for cruising and any activities you do on shore. That usually means adding a cruise option and checking the region covers every port of call; see cruise travel insurance.
General advice only. This information doesn't take into account your objectives, financial situation or needs. Consider whether the product is right for you and read the Product Disclosure Statement (PDS) and Target Market Determination (TMD) before you decide. We don't compare every product in the market, and we may earn a commission if you take up a product through our links.
What to watch for
- Choose an unlimited or very high overseas medical limit for any US travel.
- A US stopover or port of call needs the Americas in your policy's region.
- Declare every pre-existing condition; a US hospital bill for an excluded condition is yours.
- Get an IDP before you leave; driving without a required IDP can void your insurance.
- Hurricanes become known events quickly. Buy the policy when you book.
Common questions
Do I need travel insurance for the USA?
Travelling without it is a serious financial risk, even though it isn't an entry requirement. There is no reciprocal health care agreement, Medicare does not cover you, and Smartraveller says a doctor's visit for a minor issue can cost thousands of dollars.
How much medical cover do I need for the USA?
As much as you can get. Many comprehensive policies offer unlimited overseas medical cover, which is the safest choice for the US, where insurers have paid single claims of more than $3 million. If a policy caps medical cover, check the cap, any time limit on treatment and the evacuation terms.
Is credit card travel insurance enough for the USA?
Check before you rely on it. Smartraveller warned in October 2026 that several Australian banks are reducing or removing the travel insurance on their credit cards, and that you may have lost cover for medical expenses, cancellations, luggage or rental car excess. Read your card's current PDS for activation rules, trip length and medical limits, and compare it with a comprehensive policy for the USA.
Does a stopover in the US change my travel insurance?
Yes. The policy's region must cover every country you visit, including transits and stopovers, so time in the US usually means choosing a region that includes the Americas.
Do I need an ESTA to visit the USA?
Australians visiting for less than 90 days under the Visa Waiver Program need an approved ESTA before travel. It can take up to 72 hours to approve and is valid for 2 years on the same passport. Some past travel, such as to Cuba or Iran, makes you ineligible.
Do I need an International Driving Permit in the USA?
Some states and rental companies require one. Smartraveller advises getting an IDP before leaving Australia, and warns that driving without one where it is required can void your travel and vehicle insurance.