Standard insurance coverage
The first thing to know is that Medicare rarely covers you abroad (exceptions include when a problem occurs near the U.S. and Canadian border). Private American health insurance companies might cover you for emergency care, but even with this, some policies have tremendous restrictions and don't cover things at 100 percent. You also might be denied coverage if, say, the insurance company thinks that you were overtreated, or there's a problem with translating the medical record. Even if you are covered, you'll need to pay for your treatment upfront and, again, coverage will probably be for emergency care only — not long-term care or medical evacuations.
Travel insurance coverage
For trips to underdeveloped or remote destinations, look into travel insurance with medical care and medical evacuation coverage. You can buy separate policies or, sometimes, add coverage to an existing policy. Some policies also help to cover repatriation costs in the event of a death. Premiums can be high, particularly if you are over a certain age, have preexisting conditions or plan to engage in high-risk activities such as scuba diving or mountain climbing. Research options customized to your needs on a site like InsureMyTrip.com, a travel insurance aggregator. Also, look at short-term memberships with medical evacuation companies, which have their own medical staffs, operate their own air ambulance fleets and offer a variety of other medical services and benefits.
Overseas care decisions can be complicated
I've served as an evacuation physician for several overseas cases. In Central America, I transported a stroke patient who had recovered little after a month in a private hospital's ICU. Further, the travel insurance plan deemed his care to be too expensive and demanded evacuation. On return to Canada, he was placed in a non-ICU ward and died several days later. In another case, the treatment of a failing heart attack patient was altered upon returning to the United States, and he walked out of the hospital two weeks later. These cases illustrate that decisions involving overseas care aren't always clear cut — and neither are the evacuation outcomes. Keep in mind, though, that you can face similar care and insurance-coverage scenarios here in America.
U.S. wilderness evacuations
There's a growing tendency for local evacuation authorities (state park services, federal services, etc.) to request reimbursement for the cost of evacuating disabled or injured people from the back country. What's more, most health insurance companies exclude any coverage for activities deemed high risk. Check with your carrier about contingencies surrounding your intended activities and location.
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