USA vs Worldwide Travel Insurance: Why Canadians Pay More for U.S. Coverage (2026)

Two Ontario travellers, same age, same two-week trip, same $5-million coverage. One is flying to Portugal, the other to Florida. The person going to Florida pays noticeably more — sometimes a third to a half more — and it has nothing to do with them. It's the destination. Whether the United States is included is the single biggest lever on the price of a Canadian's travel medical insurance.

People assume "travel insurance is travel insurance." It isn't. The coverage is the same idea — emergency medical care while you're away — but insurers price it by what a claim would cost them there. And nowhere on earth is a claim more expensive than in the U.S. If you're buying travel insurance to the USA from Canada, here's exactly why it costs more, with the real numbers, and how to decide between a U.S.-inclusive plan and the cheaper "worldwide excluding USA" option.

First, a hard truth for Ontarians

Before we compare plans, know where you actually stand. On January 1, 2020, Ontario ended its Out-of-Country Travellers Program. OHIP now pays nothing toward emergency hospital or doctor care you receive outside Canada (there's a narrow exception for dialysis). Ontario was the first province in the country to drop out-of-country coverage entirely.

And even before that, the old program was almost meaningless abroad: it reimbursed up to $50 a day for outpatient care and up to $200–$400 a day for a hospital bed — roughly 5% of what care actually costs out of country. So whether you're in Lisbon or Fort Lauderdale, the math is the same: without private travel insurance, the entire bill is yours.

"Worldwide excluding USA" vs "worldwide including USA"

When you buy Canadian travel insurance you'll usually pick one of two geographic options:

• Worldwide, including the USA — covers you everywhere, the U.S. included. The most expensive option, because it exposes the insurer to American medical costs.
• Worldwide, excluding the USA — covers you everywhere except the United States. Meaningfully cheaper. The catch: a claim on U.S. soil — even during a layover — isn't covered.

Same emergency-medical coverage, same policy wording, same limits. The only variable is geography — and geography is where the money is.

Why is travel insurance to the USA so expensive?

The United States has excellent hospitals and the highest medical prices on the planet. The average U.S. hospital stay runs over $2,500 per day; the same day in a German hospital is closer to $1,000. A single overnight stay in the U.S. commonly lands between $5,000 and $10,000+, and a serious emergency climbs into six figures fast.

Then there's getting home. If you need a medical air ambulance back to Canada, that alone is a five-figure event: roughly $25,000–$32,000 from the U.S., and $45,000–$100,000 from Mexico depending on aircraft and routing. Here's what those numbers look like side by side:

An insurer covering your Florida trip has to price in the possibility of any of these. An insurer covering only your trip to Portugal — where a hospital day is a fraction of the U.S. figure and public systems cap what you'd be billed — carries far less risk. That difference in risk is the difference in your premium. It isn't a markup on you; it's the arithmetic of American healthcare.

So how much more is U.S. coverage?

There's no single multiplier — every insurer prices it differently — but as a rule, including the U.S. adds a meaningful chunk to the premium, often on the order of a quarter to a half more than the same plan excluding the U.S. The cleanest way to see it for your own age and trip is to toggle it yourself: our travel insurance cost calculator has a "Worldwide excl. USA / Including USA" switch on the Canadians-Abroad tab, so you can watch the estimate move.

The takeaway: if you're genuinely never setting foot in the U.S. on a trip, "worldwide excluding USA" is real money saved. If there's any U.S. exposure, paying for it is the entire point of having insurance.

The traps that catch Ontario travellers

Where "excluding USA" quietly goes wrong:

• The U.S. layover. Toronto to the Caribbean or Latin America often connects through Miami, Newark or Charlotte. If you're hospitalized during that connection, you're in the U.S. — and an excluding-USA plan won't respond. If your routing touches American soil, buy the U.S.-inclusive plan.
• The cross-border day trip. Driving to Buffalo for outlet shopping, a Bills game, or to fill up on cheaper gas is still travel to the United States. A same-day emergency there is a U.S. claim.
• Cruises. Plenty of "Caribbean" cruises depart from Florida or call at U.S. ports, and care given while in U.S. waters or on U.S. soil is treated as a U.S. claim.
• Snowbirds on the wrong plan. If your winter is in Florida, Arizona or Texas, a cheap Europe-style plan is not what you need. You need a U.S.-inclusive plan built for a long stay, with your stable pre-existing conditions properly covered.

Which one should you buy?

Simple rule of thumb: if your trip touches the U.S. in any way — destination, layover or border hop — buy the U.S.-inclusive plan. The savings on an excluding-USA policy vanish the instant you need care you're not covered for.

Frequently asked questions

Does travel insurance cover the USA?

Only if your plan includes the U.S. A "worldwide excluding USA" plan covers everywhere except the United States, so a claim on U.S. soil — including a layover or a border day trip — isn't covered. For U.S. coverage, buy a U.S.-inclusive or U.S.-specific plan.

Why is travel insurance to the USA more expensive?

Because U.S. healthcare is the world's most expensive — an average hospital day runs over $2,500 and serious emergencies reach six figures — so insurers charge more to cover any plan that includes the United States.

What does "worldwide excluding USA" mean?

Emergency medical coverage that applies everywhere except the U.S. It's cheaper, but a claim in the U.S. — including a layover — isn't covered.

Does OHIP cover me abroad?

No. Ontario ended out-of-country coverage on January 1, 2020, so OHIP pays nothing toward emergency care outside Canada (dialysis aside). Private travel insurance is now essential.

Do I need U.S. coverage for a layover?

Usually yes — if your trip routes through a U.S. airport, an emergency there is a U.S. claim that an excluding-USA plan won't cover.

The bottom line

U.S.-inclusive coverage costs more because U.S. care costs more — full stop. That's not a reason to skip it; it's a reason to buy the right version for your trip. If you're staying out of the States, "worldwide excluding USA" is a legitimate saving. If there's any American exposure at all, the higher premium is buying you the one thing that matters when a $36,000 bill lands. When in doubt, have an independent advisor price both for you and check the fine print on layovers and pre-existing conditions.

Related reading: Travel Insurance for Canadians Going Abroad · How to Make a Travel Insurance Claim · Does OHIP Cover Visitors to Canada?