While only a handful do it today, more countries are considering requiring proof of medical coverage from travelers before allowing them entry. 

For most leisure travelers, that means purchasing travel insurance. Insurers view compulsory insurance requirements positively, especially in the U.S. market, where most travelers don't purchase a policy, and insurers also predict the benefits will trickle down to travel advisors.

Recent published reports have highlighted potential plans for compulsory insurance in Egypt, marketing campaigns in Japan encouraging travelers to purchase insurance before entering the country and the possibility of a nominal fee on travelers entering Thailand to help cover expenses in the event of a traveler's death.

Other countries, including Russia, Turkey and more than a dozen in the Schengen Area, the 26 European countries that have eliminated passport and other types of border control inside the area, have in place requirements of some sort that call for travelers to provide proof of medical coverage for the duration of their stay.

In most cases, these destinations' motivation has been to relieve stress on a country's medical system after tourists make use of its services, then leave without paying the bill, said Stan Sandberg, co-founder of TravelInsurance.com.

"I think a lot of countries are starting to consider the impact on their national health systems of foreign travelers coming in, hurting themselves and becoming, effectively, a tax on their healthcare systems," Sandberg said. 

According to the Japan Tourism Agency, 27% of visitors enter the country without travel insurance. The Japan National Tourism Organization (JNTO) said the country's Office of Healthcare Policy has established a working group that is trying to encourage visitors to get insurance before visiting Japan, including by distributing information overseas about travel insurance.

Diplomatic offices outside Japan are also working with local governments to encourage visitors to secure travel insurance that includes medical coverage, the JNTO said, and signage has been installed in airports encouraging insurance.

Other countries, including Ecuador, have in recent years instituted policies requiring proof of a traveler's medical insurance.

Jenna Hummer, director of public relations for travel insurance aggregator SquareMouth, said, "We're definitely seeing, on a whole, that it's becoming a more popular thing for countries to require."

In response to that trend, SquareMouth is creating a landing page with the top 25 destinations for U.S. travelers, including information on whether or not insurance is required in each.

For most leisure travelers, especially those coming from the U.S., a travel insurance policy with adequate medical coverage makes the most sense to satisfy requirements in Ecuador and other countries, said Matt Popowski, external communications specialist with Allianz.

Generally, the cost of purchasing travel insurance depends on factors such as the traveler's age and trip cost. According to insurance comparison site InsureMyTrip.com, the cost of insurance usually amounts to between 4% and 10% of a trip's price.

Isaac Cymrot, vice president of industry relations for Travel Insured International, said, "It's going to come down to the individual, but in most cases ... they're likely going to have to look to some form of travel protection to fulfill the need."

That's because most domestic health insurance policies in the U.S. do not provide coverage while the policy holder is abroad. The U.S. State Department recommends travelers purchase travel insurance and notes that Medicare and Medicaid, in general, don't cover medical costs overseas.

"A very, very few policies will cover you," Hummer said. She added that some higher-end credit cards might also provide some coverage to travelers. But, "typically, your U.S. domestic coverage plans, like your United and your Aetna, do not [cover policyholders] outside of the U.S."

Hummer noted that some Medicare supplements can provide coverage overseas, but outside of that, coverage from U.S. domestic plans is limited. And they wouldn't cover medical evacuation if it was necessary, which is a common component in travel insurance plans.

Marketing campaigns and insurance requirements are most likely aimed at markets such as the U.S., because in markets like Canada and Europe 70% to 80% of travelers already purchase policies, said Greg Johnson, vice president of business development at the Arch Insurance Group.

"Americans opt in at a lower rate, so a lot of that marketing awareness campaign is likely targeted to the American leisure traveler to bring their awareness up on the topic," Johnson said.

Mandatory insurance requirements will likely be a boon to travel advisors, Johnson said. In some cases, agents are apprehensive about bringing up insurance after planning a client's dream vacation. But compulsory insurance, or even fees like Thailand is proposing, gives advisors an opportunity to talk about the benefits of travel insurance.

Johnson said, "I think it just makes it an easier introduction into the topic to say, 'Are you aware the country you're traveling to now has a fee or is requiring travel insurance?'"

Cymrot said it also gives advisors a chance to highlight their proficiency, adding, "It's definitely an area where advisors can tout their expertise and use this as an opportunity to say, 'Hey, look, if you're going to book travel, this is one of the reasons why [you should book with us]: We're going to make sure you know all of the requirements to get into a country.'"


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