Every travel health guide gives the same instruction. Carry a letter from your doctor describing your conditions, your medicines and your allergies. Bring copies of your prescriptions. Keep everything in its original packaging.
It is good advice. What most guides leave out:
- Who pays if you get sick, because for most Americans on Medicare, it is not Medicare.
- What that letter should actually say.
- Which of your ordinary medicines could cause trouble at a foreign border.
This is the US version of that checklist, with each rule linked to the agency that sets it.
Disclosure
I am a doctor, and I founded exora, a personal health record app. It appears once, near the end, and I am explicit there about what it is not. Everything before that works whatever you use, including paper.
Medicare mostly stays home
This is the most common misunderstanding, so it is worth being plain. Medicare’s own page on travel outside the U.S. says: “Medicare usually doesn’t cover health care while you’re traveling outside the U.S.” The State Department is blunter. Its medicine and health page says “Medicare does not cover medical costs outside the United States.”
There are narrow exceptions, and they are rarely the situation a traveler is in:
- Foreign hospitals, in rare cases. Medicare says it may pay for inpatient hospital, doctor and ambulance services in a foreign country in limited situations, such as when you are in the US, have an emergency, and a foreign hospital is closer than the nearest suitable US hospital.
- Cruise ships. Part B may pay for medically necessary care on board only if the ship is in a US port, or no more than 6 hours from one, when you get the care.
- Not prescriptions. Medicare says its drug plans “don’t cover prescription drugs you buy outside the U.S.”
What about other Medicare coverage? According to Medicare’s comparison of Original Medicare and Medicare Advantage, some Medigap (Medicare Supplement) policies cover emergency care outside the US. Medicare Advantage plans “generally don’t cover medical care outside the U.S.,” though some offer an extra benefit for emergency and urgently needed care abroad. If you have either, read your own plan’s documents before you go.
Private insurance, travel insurance and evacuation
If you have private or employer insurance, the State Department’s advice is to check what it covers outside the US, and if it is accepted abroad, to take your insurance card and claim forms with you. It also warns that the US government does not pay medical bills abroad, and that in many places payment or a deposit is required before you are treated.
The expensive part is getting home. The same page says most plans do not pay for a medical evacuation by air ambulance back to the US, which it estimates “can cost from $20,000 to $200,000,” depending on where you are and your condition. It suggests considering medical evacuation insurance as part of your travel insurance.
Medicare adds: “Travel insurance doesn’t necessarily include health insurance.” If you have a condition, ask how a policy treats it before you buy.
The doctor’s letter, and what it should say
The State Department asks you to get a letter from your doctor explaining your medical condition, listing all your prescription medicines “by their generic names,” and to keep it with your medicines in their original package. Beyond that, here is what makes a letter useful abroad rather than decorative. I have written a few.
Diagnoses in plain clinical words, not abbreviations. “CAD, AFib, T2DM” means little to a triage nurse in Lisbon. “Coronary artery disease, atrial fibrillation, type 2 diabetes” can at least be looked up or translated.
Medicines by generic name, with dose and frequency. Brand names are national, and even generic names differ. The acetaminophen in a US pharmacy is called paracetamol in much of the world. “Tylenol twice a day” is close to useless in Rome; “acetaminophen (paracetamol) 500 mg, two tablets twice daily” works anywhere.
Allergies, and what the reaction was. “Allergic to penicillin” gets you a different antibiotic. “Penicillin: rash at age 12, no swelling or breathing trouble” lets a doctor make an actual decision. The CDC reports that about 10% of US patients say they have a penicillin allergy, and that when evaluated, fewer than 1% were truly allergic.
Devices and implants. A pacemaker, stent, joint replacement or insulin pump, with the model if you have it. Airport security and scanners both care.
Dated and signed, on letterhead. An undated letter is worth little to an official deciding whether to believe you about the medicines in your bag.
Carrying your medicines
Three authorities ask different questions: the TSA, about airport security; the destination country, about entry; and US Customs, when you come home.
At the airport: the TSA
The TSA’s travel tips say:
- You can pack medication in carry-on or checked bags, but the TSA “strongly recommends” carry-on, in case you need it.
- Pills and other solid medicines are allowed in unlimited amounts, once screened.
- Liquid medication over 3.4 ounces (100 mL) is allowed in carry-on bags in reasonable quantities for the flight. Tell the officer at the start of screening, and expect extra screening.
- The TSA “does not require passengers to pack medicine in prescription bottles,” but notes that some state laws govern how prescription medicine is labeled.
The TSA’s medication FAQ also recommends clear labeling. None of this says what the country you land in will allow.
At the border: the destination country’s rules
This is the rule that catches people out. A medicine being legal in the US tells you nothing about whether it is legal where you are going. The State Department puts it directly: entering another country with certain medicines, “even if they are legal in the U.S., could lead to your arrest or detention abroad.”
Its advice is to check with the foreign embassy of every country you will visit or pass through, “especially prescriptions like medical marijuana, ADHD medications, and sleeping pills,” because some countries require special permission or a government permit. The CDC’s Travelers’ Health FAQ makes the same point: some medicines sold over the counter or prescribed in the US can be illegal in other countries.
Check transit countries as well as your destination, and check well before you pack.
The State Department’s practical checklist for medicines:
- Bring enough for the whole trip, plus a few days for delays.
- Keep them in their original package, with your doctor’s letter.
- Take copies of your prescriptions. The prescription shows it was dispensed to you; the letter explains why you need it.
Coming home: US Customs and the FDA
US Customs and Border Protection’s prohibited and restricted items page says that if you travel with prescription or over-the-counter medicines, you need to comply with the rules the FDA enforces. CBP’s guidance:
- The medicine should be in its original container, with the doctor’s instructions printed on the bottle.
- Carry a valid prescription or doctor’s note, written in English.
- As a rule of thumb, bring no more than a 90-day supply.
- If the medicine is also a controlled substance, Drug Enforcement Administration rules apply too.
Buying medicine abroad to bring home is a separate question. The FDA’s personal importation page says that “in most circumstances, it is illegal for individuals to import drugs or devices into the U.S. for personal use.” The FDA describes narrow situations where its staff may use discretion, generally limited to no more than a three-month supply, but that is discretion, not a right. CBP adds that drugs sold in other countries may not have been evaluated or approved by the FDA.
Vaccines, and the part people leave too late
The CDC’s Travelers’ Health FAQ suggests seeing your doctor or a travel medicine specialist at least a month before you travel, and adds: “Be sure to bring your vaccine records to your appointment!” A clinic that cannot see what you have already had has less to go on. If you are not sure where your records are, this guide to finding your vaccination records walks through it.
Some countries require proof of certain vaccinations at the border. The best-known is yellow fever, recorded on an International Certificate of Vaccination, often called a yellow card. The State Department says to contact the foreign embassy directly for current requirements, and the CDC notes the proof “does not become valid until 10 days after the vaccine is given.” A last-minute appointment can leave you unable to show valid proof when you arrive.
I will not tell you which vaccines you need; that is what the travel appointment is for. The official sources are:
- CDC Travelers’ Health, with a page for each destination and a clinic finder.
- CDC Travel Health Notices, graded from Level 1, “Practice Usual Precautions,” to Level 4, “Avoid All Travel.”
- The CDC Yellow Book, now in its 2026 edition, which compiles the CDC’s travel health guidance. It is written mainly for health professionals.
- The State Department’s destination pages, each with a Health section covering local medical services and rules on prescription medicines.
Enroll in STEP
The State Department’s Smart Traveler Enrollment Program (STEP) is a free service that sends you email alerts from the US embassy or consulate where you are going. It also helps the embassy contact you, or your emergency contact, in an emergency. You register your trip with a Login.gov account, or choose a guest subscription if you only want the messages.
If you or a US citizen you are traveling with becomes seriously ill or injured abroad, the State Department says it can help you find local doctors or hospitals, contact family or friends with your permission, and explain options for sending and receiving money. Lists of local doctors and hospitals are also on the US embassy or consulate website for each country.
When you actually need care
Here is the moment all the preparation is for. You are unwell somewhere unfamiliar, possibly in a language you do not speak, and a clinician is asking what you take and what you have had.
What they need, roughly in order:
- Your current medicines.
- Your allergies, and what happened.
- Your main diagnoses.
- Any recent results or procedures relevant to why you are there.
That is the letter’s list. It goes badly when the folder is in the hotel safe, or the clinician does not read English. If you need a formal translation of records for treatment abroad, this guide to translating medical records explains which kind of translation fits which reader.
Where exora fits, and where it does not
Everything above works on paper, which needs no battery or signal. Carry the letter. But a letter is out of date the day after it is written, and the person most likely to need it is the person least likely to have it on them. exora is a personal health record app for that gap. exora is free to start, with an optional membership. You upload documents you already have, such as PDFs, photos and scans, and exora reads them for you, with a reading system built for medical records. It builds one record from them: conditions, medicines, allergies, operations and vaccinations, each with a date, each linked back to the document it came from. Three parts of it matter for a trip:
- Medicine names follow where you are. The record that says acetaminophen in the US says paracetamol where that is the usual name. That is the generic-names rule above, handled for you.
- A clinician can see it without an account. A doctor you show your record to opens it at exora.au/view from any browser, with nothing to install, and you end the access when you are done. They can switch its names into their own language, while longer sentences stay as written for now. Your own record reads in English, Spanish, French, Italian or Portuguese.
- A travel vaccine planner. Give it your destination and it lists what official sources recommend for that trip, checked against your history, early enough to take to your doctor or travel clinic. It relays those sources; it does not decide what you need.
Where it does not help, honestly:
- It is not insurance, and it does not replace declaring a condition to an insurer or checking whether your medicine is legal where you are going.
- It is not a doctor’s letter or a certified translation. A border official may still want the signed letter and prescriptions.
- It can misread. The reading is automated, so check anything that matters against the original document, which is always one tap away.
- No connection to any patient portal. You download or photograph your records and upload them.
- Your data is stored in Sydney, Australia. exora is an Australian company, it is not a HIPAA-covered entity, and it holds no certifications. The security page explains how your data is protected.
- It is not medical advice. It organizes and presents your information. It does not tell you which vaccines or medicines you need.
If you still need to collect your US records before you go, this guide to your right of access explains how to ask. If you are not visiting but moving, moving countries with your medical records covers what to request before you leave.
The short version
Medicare usually does not cover care outside the US, and most plans do not pay for an air ambulance home, so check your coverage and consider travel and evacuation insurance. Get a dated, signed letter with generic medicine names, real diagnoses and what your allergy actually did. Keep medicines in their original packaging, in your carry-on, with copies of your prescriptions, and check each country’s rules with its embassy before you pack. See a doctor or travel clinic at least a month out, with your vaccine records. Enroll in STEP. And keep the list of what you take somewhere that is not a folder at home.
Claims about coverage and travel rules are sourced to Medicare.gov, the State Department (travel.state.gov), the TSA, US Customs and Border Protection, the FDA and the CDC, all linked inline and checked on November 9, 2026. Rules change; this page will be updated as they do. This article is general information, not medical, legal or insurance advice. How exora handles your information is in our privacy policy.
