When it comes to travel, can we be over-prepared? What if ‘not being prepared’ can seriously affect our long-term finances? Buying travel insurance may cover many unexpected incidents. However, if we are abroad or in hard-to-access parts of the U.S., will we (or our loved one) be airlifted to receive the life-saving medical attention we need? And how far will we still be from home?
Medical air transport is a very costly service worth exploring while we are at home, and not when we are in the middle of an emergency. The service is offered in two formats. One has a manageable cost whether we use it or not. The other costs us nothing unless we use it, but leaves us open to some portion of costs not being covered. Both are worth exploring.
Whether a senior is traveling abroad, or just away from home on business or visiting family, any medical emergency brings forward one desire: to be near home. The medical air transport industry has grown around that demand.
These services are entirely separate from medical coverage.They tend to be available until age 85 and take on two distinct formats: fee-for-service and membership. With fee-for-service, a senior (or a senior’s representative) contacts a company on a one-time basisto request medical transport service. There is no formal relationship. The understanding is that the service will be paid partly or entirely by travel or other insurance, Medicare benefits and/or out of pocket.
In the case of a membership, the senior pays a set annual premium to a company and has the right to a certain number of flights per year. The company offering the membership is typically functioning in a ‘broker’ role, finding third-party aircraft that are available for the transport when it is needed, instead of owning the aircraft itself.
Each format brings pluses and minuses. However, when it comes to something as crucial as medical air transport, a senior wants as much certainty as is possible at that often-emotional, a volatile and urgent moment of an emergency.
While it is natural to want to travel once jobs and other responsibilities no longer tie us down, we do want to be transported home in case of medical emergency, if we can be moved safely. We may need a way to reach medical facilities that have the specialized medical care our condition requires, mainly if we are in foreign lands or remote locations in the U.S.
Such transport services are called a medical evacuation, or ‘Medevac.’ In a more local environment, we might refer to them as air ambulances.Typically, medical air transport is used only in the most severe situations, after exhausting all other options or when time is a critical factor. We would need to be a certain distance from home, usually over 150 miles.
Our needs could range from an emergency plane ride home to a private airplane outfitted with life-saving equipment. Whatever the need, medical air transport will be expensive. Coverage may be an integral part of a travel insurance policy, a complement to it or a stand-alone service. The transport is either performed as a one-time fee-for-service or as part of a membership you buy.
Fee-for-service options: Hopefully, we will have taken out travel insurance before traveling. In case of an emergency requiring a transfer to another medical facility or repatriation, we would contact a fee-for-service company that offers Medevac services. Most Medevac coverage in travel insurance policies is secondary, which means you pay for the service in advance and then file a claim for reimbursement after all other insurances pay their part. That can mean considerable out-of-pocket monies for an extended period, all of which can cause extra stress where budgets are limited.
Fee-for-service companies often assist customers through the pre-authorization process with insurers, yet insurance companies can still deny claims partially or entirely. This is usually due to the insurer’s interpretation of pre-existing conditions, noncompliance with the precise order required for pre-authorization or choosing a transport company not in the insurer’s network.
In your rush to solve the problem, you may choose the first available transport company. Say you pay upfront, assuming you will figure it out later. Later you discover the chosen company was not within the network authorized by your insurer, although it was well-known and reputable. That mistake could cost tens of thousands of dollars. You must read the fine print of your insurance policy, do your homework before you travel and know who you are going to call, if needed.
With fee-for-service, the company may use its aircraft if one happens to be conveniently located, or it may contract third-party aircraft from within a formal or informal network. These could be a combination of helicopters and fixed-wing aircraft to respond to different circumstances.
Companies that own their aircraft are called direct air carriers. Many direct air carriers have outstanding reputations regarding highly qualified medical and aviation professionals, plus top-not chair craft and hospital-level equipment within them. However, again, depending on where you are injured or fall sick, you may have to be flown on an aircraft approved by that company. This flexibility allows companies to respond to emergencies more quickly, wherever you are.
On the upside, most fee-for-service companies have no restriction on age or health conditions, as they merely agree to transport you that one time. There is no long-term contract.On the downside, while these companies offer many advantages, the anecdotal stories of insurance companies declining payment for service leave the senior vulnerable to owing on very hefty transport bills. Unfortunately, the complexity of meeting the rigorous pre-authorization and payment requirements in moments of high stress allows too many of such instances.
Memberships: Membership plans for medical air transport are purchased entirely independently of any travel insurance we may have obtained. For a set fee, we are given access to a certain number of medical-related flights, usually one or two per year. Companies offering memberships usually do not own their aircraft, but rely on access to third-party aircraft. (Situations are less than clear-cut: some companies offer both membership and fee-for-service options and may own some aircraft and supplement with third-party aircraft.)
Companies that do not own their aircraft are called indirect air carriers. Indirect air carriers are only as good as the aircraft, crews and medical teams that are in their network, so you want to check out the company you select.
Robust memberships may handle all transportation issues for you worldwide and will bring you to your chosen hospital near home, regardless of your condition or the cost. More restricted memberships may have limitations on distance transported, medical conditions accepted, total cost covered or choice of medical facility. You must ask questions before buying.
Memberships tend to offer plans for adults under age 75, and then a senior plan that covers from age 75 to 85. Few companies provide memberships to seniors over 85. At 85 and above, the likely solution is one of the fee-for-service companies.
Why consider medical air transport options if you have travel insurance? Travel insurance tends to evacuate you to the nearest hospital that the insurer determines could handle your medical condition. Many do not guarantee to return you to your home country if traveling abroad. However, as long as you qualify, both fee-for-service and memberships can return you to your home area.
The subject of medical air transport is complicated by the many forms it can take. Cost is significant, whether a monthly fee or in the form of what the insurance carrier might not pay.You want to know about warranties, how easy it is to put the service to use and how difficult to cancel. Because you may be interacting with the company under stress, you want to know how easy communications will be.
As seniors, we also want to know what services a company offers and if it has age restrictions. To ensure how safe the transport itself is, we want to know the company’s accreditations and whether they have their own fleet or broker out the work.
Whether you opt for the membership format or fee-for-service, there is specific information you will want to gather. Ideally, you will be doing this with a cool head, at home, long before you ever need the service. Referrals and online research will provide the names of the primary service providers. Exploring review websites, as well as the Better Business Bureau website, will help define a company’s reputation. Two issues to look for are how supportive the company will be in dealing with insurance companies and if reviewers mention any ‘hidden’ costs.
Today, deceptive websites can make small operators with insufficient resources look like major players. For starters, the site should include a full street address, not a P.O. box, and a local phone number instead of just a toll-free number. Access to assistance must be 24/7/365. Medical air transport is not something you can leave in the hands of amateurs. Doing your due diligence is critical.
Determine if the company is a direct or indirect air carrier, meaning it owns its aircraft or it is a broker. (With a membership, it will usually be a broker, although exceptions do exist.) Some people prefer direct air carriers; however, the company may not have an aircraft available if you fall ill while on an exotic bucket-list trip and will have to call upon an aircraft in its network.
You want to know the range of the company’s geographic coverage to be sure it can go however far you plan to travel. Also, ask if you will be able to designate to which hospital or facility it will take you.Ask if it has the flexibility to provide medical air transport when your doctor orders that you be moved from one facility to another, as well as under dire circumstances that call for advanced life support.
Accreditation for medical air transport services is voluntary at the federal level, although some states have some requirements of their own. Regardless, you want to confirm that the company is accredited and certified by organizations such as CAMTS (Commission on Accreditation of Medical Transport Systems)or AAMS (Association of Air Medical Services), as well as certified by the Federal Aviation Agency (FAA) with a valid charter flight license (FAA 135 Certificate).
Membership: The selection process for the membership format of medical air transport is relatively simple. After qualifying the companies according to the steps described above, your selection will be based on the annual fee charged, the full range of services offered, how a traveling companion is handled, plus any age restrictions and constraints on pre-existing conditions the company imposes.
Fee-for-service: Selecting a fee-for-service medical air transport company is more complicated. Because you are potentially liable for any fees not covered by insurance companies, you need clarity on a series of issues. A company may require the transport be a ‘medical necessity,’so you must understand precisely how that is defined, and then how it is confirmed (i.e., with a doctor’s letter).
Explore whether the company works with your insurance and/or travel insurance company and what the relationship has been. You want to have in writing the precise contact and pre-authorization process that you (or your surrogate) will follow in case of an emergency, as the urgency of the situation may not leave you with time to ask questions. Also, check whether your Original Medicare Part B and whatever Supplement Plan you have can contribute to covering part of the expense.
Two areas differentiate what seniors prioritize from what other people do when buying services: age-friendliness and health-related value.
Age friendliness: As we get older, we want more and more certainty when it comes to “what will happen if?” When traveling, one way is to have thought out what will happen if we are injured or fall ill far from home. If the company has specific senior programs, that implies it has considered all the quirks that put seniors at ease in such difficult circumstances. How easy does the company make communicating during the ‘due diligence’ phase and enrollment, long before we ever need the service?
Standard and individual plans tend to be available to age 75. Senior plans, when available, may cover ages 75-85 and offer more limited benefits. Fewer companies provide services to seniors over 85.
Health-related value: As your health declines, the potential need for medical air transport increases. Whether it is an incident that occurs in a remote place or an illness or accident that requires specialized care, you want to know you can reach a medical facility capable of providing the medical care you need.Knowing you have access to efficient and affordable medical evacuations removes one more stressor at a time when you need to focus all your energies on healing.
Annual memberships start around $250 for an individual and $400 for a family. With some companies, this allows for two medical trips per year for people below a certain age (often 75) and one trip per year for people above that age. Several providers offer shorter terms as well, including 8-, 15-, 21- and 30-day options. For expatriates, students and faculty who live abroad, some companies provide long-term packages. The federal Airline Deregulation Act of 1978
Following the federal Airline Deregulation Act of 1978, states can no longer regulate the rates, routes or services of any air carrier. That includes air ambulance and other air transport services. States were left unable to protect users from predatory pricing in a time of need. For example, one large service provider that charged an average of $13,000 in 2007 charged over $50,000 in 2016. Recently, for the industry, the average has been around $33,000 per trip.
Typically, with fee-for-service, the first segment of those costs will be picked up by a travel or health insurance policy (including Medicare) and any additional insurance the senior might have. Any residual then falls to the transported party to pay.
If you have medical air transport in your insurance plan, you must know the network of service providers approved by that policy. The same goes for any membership or fee-for-service medical air transport plan. Any provider not in your plan’s network can result in devastating costs for which you will be held responsible, with little or no recourse.
Industry sources indicate that the actual cost of providing such services averages between $7,000 and $10,000, which leaves ample profit margins. An industry trade group justifies its pricing strategies by saying that many patients are on Medicaid or Medicare, which only pay between $200 and $6,000, and they need to make up the difference. Therefore, those with private insurance will be hit with the highest bills, yet there is no guarantee their insurer is going to accept all – or even part – of the charges.
When looking at medical air transport, whether as a membership or a fee-for-service solution, the evaluation criteria include the cost, the warranty, the ease of putting the plan to use, how easy it is to cancel and how friendly the company’s customer service is.
Cost: One of the most significant differences between opting for a membership or a fee-for-service situation is in the nature of the cost. With a membership, you pay a set fee whether you use the service or not. With fee-for-service, you only incur costs if you use the service, but you face more uncertainty in what is covered and what is not.
Warranty: Medical air transport companies do not seem to offer any warranties. Memberships are typically non-transferable and non-refundable. With fee-for-service, an examination of the fine print in the contract will most likely absolve the service provider of any responsibility that cannot be strictly and directly linked to its own negligence.
Ease: Every step of the process should be easy, from initial conversations with a potential provider, to enrolling and to calling upon the service in an emergency. Help should be ‘only a phone call away.’
Cancellation: Since fee-for-service is a one-time interaction, only memberships would be concerned with cancellation policies. In most cases, members can cancel at any time, but membership fees are typically non-refundable.
Customer support: The measure of excellent customer support is in how many different ways you can interact with the medical air transport company, the hours the company’s non-emergency customer support is available and the existence of 24/7 emergency support. In the case of fee-for-service arrangements, in addition to the usual expectations, customer support should include the company having staff specially trained to work with insurance companies to maximize the reimbursement you get for the costs of the service.
Examining the coverage offered by each potential supplier of medical air transport services is a priority because services can vary so widely.
For example, some companies retain sole discretion over the medical facility you will be taken to, which could be far from your home, and their responsibility ends there. Others will take you to the medical facility of your choice, even offering what is called bedside-to-bedside service. This is where the company schedules all ground and air transport to your selected destination, coordinates with sending and receiving entities and, if needed, works with your insurance company to verify benefits.
If you could build an ideal package, this is how it would look:
- No cost limitations, so no out-of-pocket expenses regardless of what it costs to bring you home with critical care from medical crews;
- No‘ nearest appropriate medical facility’ limitation, so you could choose the destination;
- No pre-existing condition clause, so no waiting periods before qualifying for the service;
- No medical necessity requirement, so no need for approval from your doctor and the insurer’s doctor;
- Wraparound service, such as bedside-to-bedside, where all details are professionally handled;
- Generous coverage for a traveling companion so you are accompanied back home;
- Low‘miles from home’ requirement, the minimum distance from home to qualify you for transport;
- Full evacuation services, plus commercial flight medical escort if you are ever too fragile to fly alone commercially to a medical destination, but a specialized aircraft is not needed; and
- An unlimited number of separate transports per year.
While it is unlikely such a plan would ever be affordable, the listing allows you to pick the essential elements that you want to be sure to include.
Medicare: Medicare may pay for emergency medical air transport in a helicopter or fixed-wing aircraft if your health condition requires immediate and rapid ambulance transportation that ground transportation cannot provide. One of the following must also apply: your pickup location must be hard to reach by ground transportation, or distances or traffic would keep you from getting the care you need by ground ambulance.
However, Medicare only covers services to the nearest appropriate medical facility. Under Original Medicare Part B, you will pay 20 percent of the Medicare-approved amount of the service, plus any Part B deductible you have not met for the year.
Hardship cases: U.S. charitable organizations provide access to free medical air transport for people in financial need who must reach specialized health-care facilities. Services are often provided by volunteer pilots using their aircraft, fuel and time. They fly transplant organs and organ transplant candidates, people in clinical trials or those receiving repetitive treatments including chemotherapy, and many others. Thousands of pilots transport tens of thousands of people around the U.S.These services can be found through online research, and possibly through referrals by doctors and hospitals.