Medical Evacuation: What Expats Need to Know

What Is Medical Evacuation?

Medical evacuation (medevac) is emergency transport to a medical facility when local care isn't adequate. It's one of the most important — and expensive — types of coverage for anyone living abroad.

Evacuation might mean:

• Transport from a remote location to the nearest hospital
• Transfer from a local hospital to a better-equipped facility
• International flight to your home country for specialized treatment
• Air ambulance with medical staff and equipment

Without insurance, you're responsible for the full cost — which can easily exceed $100,000.

Types of Medical Evacuation

Emergency Evacuation

Transport in a medical emergency when local facilities can't provide necessary care. This is the core of medical evacuation coverage.

• Heart attacks, strokes, severe trauma
• Conditions requiring specialist care not available locally
• Situations where delay would cause death or permanent harm

Medical Repatriation

Return to your home country for ongoing treatment or recovery. This may be medically necessary or medically appropriate (different standards with different insurers).

• After initial emergency treatment stabilizes you
• For complex care better delivered at home
• When local treatment isn't meeting your needs

Compassionate Evacuation

Some policies cover evacuation for non-medical emergencies:

• Political evacuation due to civil unrest or war
• Natural disaster evacuation
• Security evacuation from dangerous situations

Note: Not all health insurance includes this. Check your specific policy.

Bedside Visit

Some policies pay for a family member to travel to you if you're hospitalized abroad for an extended period. This isn't evacuation but is often included with evacuation benefits.

How Much Does It Cost?

Evacuation costs vary dramatically based on location, distance, and medical requirements:

Why Air Ambulances Are So Expensive

• Aircraft: Specialized medical jets cost $5,000-15,000 per flight hour
• Medical team: Doctors, nurses, paramedics accompanying you
• Equipment: ICU-level equipment onboard
• Logistics: Permits, landing fees, ground transport at both ends
• Return flight: Aircraft often returns empty

Factors Affecting Cost

• Distance: Longer flights cost more
• Location: Remote areas require helicopters or multiple transports
• Medical condition: More severe = more equipment and staff
• Destination: International evacuations cost significantly more
• Timing: Weekend/holiday evacuations may cost extra

What Insurance Covers

Medical evacuation coverage typically includes:

Usually Covered

• Air ambulance (fixed-wing or helicopter)
• Ground ambulance transport
• Medical escort/team during transport
• Medical equipment during transport
• Hospital-to-hospital transfers
• Repatriation when medically necessary
• Return transportation after recovery

Sometimes Covered (Check Your Policy)

• Repatriation when medically "appropriate" (vs. strictly necessary)
• Family member travel to your bedside
• Accommodation for accompanying family
• Political/security evacuation
• Natural disaster evacuation
• Search and rescue costs

Usually Not Covered

• Evacuation when adequate care is available locally
• Non-emergency transfers for convenience
• Evacuation for pre-existing conditions (if excluded)
• Self-arranged evacuation without insurer approval
• Evacuation from countries under travel warnings (varies)

What Happens During an Evacuation

Here's the typical process when medical evacuation is needed:

Critical: Contact Your Insurer First

In an emergency, call your insurer's 24/7 assistance line as soon as possible. They coordinate everything — attempting to arrange your own evacuation may result in:

• Claim denial (self-arranged without approval)
• Suboptimal medical decisions
• Higher costs (professional evacuation services are negotiated)
• Logistics problems at the destination

How Much Coverage Do You Need?

The right amount depends on where you live and travel:

Consider Your Risk Factors

Recommendation

For most expats, $250,000 - $500,000 in evacuation coverage provides solid protection. If you live in very remote areas or travel frequently to developing regions, consider unlimited coverage. The premium difference is usually modest relative to the protection.

Repatriation of Remains

No one wants to think about it, but repatriation of remains coverage is important for families:

What It Covers

• Preparation and preservation of remains
• Required documentation and permits
• Transport to your home country
• Sometimes includes cremation abroad as an option

Typical Coverage Amounts

• Basic: $10,000 - $25,000
• Standard: $25,000 - $50,000
• Premium: $50,000 or unlimited

Why It Matters

International repatriation of remains involves complex legal requirements, international shipping regulations, and substantial costs. Without coverage, families face both grief and a significant financial burden, often $15,000-40,000 or more.

Common Questions

Does medical evacuation cover search and rescue?

Usually not by default. Standard evacuation coverage starts once you're reached by emergency services. Separate search and rescue coverage may be needed for hikers, climbers, or those in very remote areas. Some comprehensive plans include it; others offer it as an add-on.

Can I choose where to be evacuated?

Generally, no. The insurer's medical team decides the appropriate destination based on medical need and logistics. This is typically the nearest adequate facility, not necessarily your home country. However, once stabilized, repatriation may be arranged.

What if I arrange my own evacuation?

Self-arranged evacuation without insurer approval is typically not covered. In a true emergency where you can't reach your insurer, get treated and notify them as soon as possible. They may reimburse reasonable emergency transport, but there's no guarantee.

Does travel insurance include medical evacuation?

Most travel insurance includes evacuation coverage, but limits are often lower ($50,000-100,000 is common). For long-term living abroad, international health insurance typically provides higher evacuation limits and better coordination services.

What about evacuation from cruise ships?

Yes, evacuation from cruise ships (helicopter to shore or ship-to-ship transfer) is typically covered. This can be very expensive, so verify your coverage limits if you cruise frequently.

Are pre-existing conditions covered for evacuation?

It depends on your policy. If pre-existing conditions are excluded from your health coverage, evacuation for those conditions may also be excluded. Check your specific policy language.

How do I know if local care is "inadequate"?

Your insurer's medical team makes this determination in consultation with local treating physicians. They assess whether local facilities have the specialists, equipment, and capabilities needed to treat your condition properly.