Q: My aunt and I were visiting Mexico and due to a medical emergency she had to be evacuated back to a hospital in the US because we felt that adequate care couldn’t be provided in Mexico. This emergency medical transport cost over $40,000. Is this an unreasonable amount, or is this what such evacuations cost?

A: They can cost that and more, depending on where in the world the medical emergency occurs and the patient’s condition. Considering the relatively low cost, and the huge upside financial risk, I consider emergency medical evacuation insurance essential for anyone who travels outside the US and Canada, and even more so for those who travel to under-developed countries.

Standard health insurance it does not cover   emergency medical evacuation, which usually involves the urgent transfer of an injured or sick person, who cannot be moved safely using commercial transport, often from a less advanced medical facility far from home to another, better-equipped hospital nearer to home. You need to buy such coverage separately from a company that specializes solely in emergency evacuation or from a travel insurance vendor.

When buying a policy or membership, ask these questions:

Will you be transferred to the nearest “appropriate” hospital as determined by the evacuation agency or insurer, or, rather, to a hospital of your choosing, such as one closer to home where your personal physician and family members can assist in your care? Who decides if you will be evacuated? A doctor appointed by the insurer or agency, or do you (or your appointed representative) get to choose?

Are there pre-existing condition clauses? Is there an upper limit to the cost of the evacuation (since these trips can sometimes exceed $100,000)? What is the upper age limit for coverage?

Arguably the most comprehensive medical evacuation assistance is by two Birmingham AL-based membership programs that specialize in this kind of service: Medjet Assist (www.medjetassistance.com), and AirMed (www.airmed.com). As long as you’re 150 miles or more from home, once you’re medically stabilized either will fly you to whatever hospital you or your family request.

MedJet charges $225 per year for a single membership for individuals up to 75 years of age or $350 for a family of up to two adults and five minor children. A “Diamond Plan” for travelers aged 75-85 costs $395 per year. Coverage for individual trips is also offered. AirMed charges $250 per year for single travelers up to age 75 or $350 for a family of seven. One distinction between the two firms is that AirMed owns and operates its fleet of three custom-designed aircraft whereas MedJet charters aircraft from air ambulance firms as needed.

Both companies are careful to state that they do not provide “insurance”: rather, they are membership programs, in much the same way that the AAA offers services for its members.

TravelGuard, however, is an insurer. This travel insurance specialist introduced a medevac policy last April that includes $25,000 in insurance for medical expenses as well as medical evacuation coverage with no cost limit.  Rates for travelers under 75 years of age range from $69 for a trip of up to ten days in duration to $185 per year for an annual plan ($119/$370 respectively for those aged 75-85).

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