As tourism has grown, so has the hospitalization and medical cost many countries have had to cover for vacationers who required healthcare services while visiting.

As a result, an increasing number of countries are making travel insurance compulsory, a requirement for a tourist to even enter their borders.

In a recent report, Allianz Partners, the same company that owns Allianz Global Assistance USA, noted how 15 of the 26 Schengen nations (a combination of European Union countries and independent nations like Iceland, Norway and Switzerland) currently require some type of insurance for visitors, students and expats.

Additionally, Cuba, Ecuador, Qatar, Russia, Turkey, the United Arab Emirates and the U.S. are requiring the same. On Aug. 28, 2018, Egypt announced its plans to introduce mandatory compulsory insurance; and Thailand is currently undergoing a debate on mandatory travel insurance for visiting tourists.

According to the report, in many countries, “travelers are asked to show proof of medical or hospitalization coverage before they can enter.” Visitors who can’t provide proof of travel insurance may be required to either purchase a policy on-site or be denied entry into the country.

Determining factors and requirements vary by country, from all visitors demonstrating health and/or hospitalization coverage to limited requirements for students and expats, the report noted.

“This trend is set to continue, as countries seek ways to relieve themselves of the financial burden of medical bills left unpaid by tourists, whether that is travelers taking advantage of free healthcare or simply making a swift exit without paying their bills,” Allianz said in the report.

Visitors to Cuba must have proof of travel health insurance upon entry. Those who can’t provide immigration control with proof of coverage are forced to buy insurance from the local Cuban insurance provider, which has an office in the airport.

Beginning Sept. 12, 2018, all tourists to Ecuador have been required to have a valid health insurance policy. Egypt’s new policy will require personal accident insurance, coverage for total disability and death, along with treatment for medical expenses.

And certain applicants for a Russian visa are required to have travel health insurance that is valid for the duration of their visa.

Not only are countries looking to insulate themselves from incurring the medical costs of tourists, so do companies, such as “most Antartica tour operators,” Allianz said.

For visitors who are insured or covered by a statutory social security scheme in an EEA country and Switzerland, the EU offers a free European Health Insurance Card (EHIC), so that they can receive medical treatment in another member state free or at a reduced cost, if that treatment becomes necessary during their visit.

One out of five unaware of health insurance limitations

Many Americans are mistaken about their health insurance coverage when traveling abroad. A 2018 survey by InsureMyTrip shows that more than one out of five Americans believed their U.S. health insurance would cover medical expenses (e.g. emergency doctor or hospital visits) abroad, while 56 percent of Americans polled were not sure. Some 22 percent understood that their domestic health insurance would offer no coverage.

InsureMyTrip’s survey reached 498 Americans, 35 years or older, between Aug. 7-10, 2018.

In a press release accompanying the report, InsureMyTrip also stated that Americans should be aware that “original Medicare does not cover emergency medical care for travelers outside the U.S.,” though there are “supplemental plans such as Medicare Advantage and Medigap,” that can provide limited additional coverage, the company said.

Additionally, very few domestic health insurance companies will pay for a medical evacuation back to the U.S., which can cost upwards of $100,000, depending on the condition and location of the patient.