This topic is of great interest to me recently and I have been doing a lot of research - that's not to say I know much though.
We live in Hawaii and seem to travel to the mainland once or twice a year and make an international trip to Europe or Asia about once per year. After retirement we will probably do about the same number of mainland trips but longer duration and probably 2 international trips and will expand the list of destinations.
I have traveled quite a bit on business in my life including to some places with "challenged" health care systems. My company actually sent us to a physician who specialized in travel medicine and developing world health care, not for care but for practical aadvice. She gave us a prescription for cipro, told us to pick up a bottle of imodium at the drug store and gave us a list of cities to self-evacuate to that have first rate health care. Her reasoning was that very few things are immediately life threatening besides bleeding, some infections, and diarhea. She said most developing countries have decent doctors, they just lack sterility and access to some medications. She said if something happens like a car accident your focus should be on getting stitched up and getting yourself to a developed country. The course of cipro was to take if we felt sick or were treated in a local hospital. The immodium was to shut your bowels down so you can fly and dont die of dehydration from diarhea. Constipation can be treated, death can't. She also said travel medical insurance was probably unnecessary because medical care is very inexpensive in most of the world and emergency care is often essentiall free.
My research started in 2021 when we were planning a trip to a country that required health insurance because of covid. I found a wide array of "things" offered that usually went out of their was not to call themselves insurance. I would put them in 3 categories:
1. Health insurance for travelers that covers medical expenses oversees. These are true insurance and sold by big insurance companies like Cigna.
2. Travel insurance usually covers things like trip delay, lost baggage, cancellation if you get sick, etc.
3. Evacuation insurance will pay to bring you home if you have a medical emergency while traveling. As others have said, you might be flying in a private jet with a staff of doctors and nurses or you may be in a coach seat. It also pays to bring your remains home.
In my research, I found that our regular insurance covers urgent and emergency care worldwide (Blue Cross and Kaiser) although the process seems opaque. I was able to find the forms and a "user guide" though so we decided we did not need this kind of insurance for now. Blue Cross seems to actually have a network of providers for routine care but it is not entirely clear.
For travel insurance our credit cards offer some pretty good coverage and we can self insure by being flexible. I have also found that there are unpubished perks to having status at airlines and hotels. We are loyal to United and Hawaiian airlines and they have almost always accomodated flight changes and other requests without fees and very proactively. I have a long history with united and my partner with Hawaiian both for business travel. Neither of us has must earned status now but their systems seem to have a memory. So for these reasons do not buy travel insurance.
We did buy evacuation insurance this year and plan to continue it. We paid $615 for two of us for a year through Global Rescue. That will cover 3-4 planned trips. Other major vendors include Medjetassist, Ripcord Rescue, Safetywing, and others. They will provide evacuation from point of injury (some only do it from a hospital accessible by normal ambulance) to a hospital of your choice anywhere in the world, repatriation of remains, and so forth. They will also provide security evacuation for about double the price. We did not buy that but plan a couple of future trips to sketchier areas and may include it then.
Do we need evacuation insurance? I sure hope not. Just like I hope I never have to use the fire insurance on my home. But reaching late 50s and already having had a couple of friends experience issues while traveling (though neither had to be evacuated) we felt the $615 was worth it for the peace of mind.
