Should Patients With a Terminal Illness Travel?

Whether embarking on a dream vacation, visiting loved ones or moving to another location, terminally ill patients can travel to their desired destination with some planning and effort. However, healthcare professionals highly recommend that patients first check with their physician for medical clearance to ensure they can travel safely. There may be circumstances when travel is not advisable, dependent upon prognosis, symptoms, or decline. Some risks associated with travel for terminally ill patients include:

• Reservation revisions or cancellations due to complications or progression of illness
• Urgent medical care is needed while away from home
• Emergency medical evacuation in the event the patient needs to return home for specialized care
• Death due to stressors associated with travel or patient decline

Insurance Considerations

For patients receiving hospice care, benefits may be transferable and applied to another hospice company near a chosen destination. Staff often arrange to have another hospice company on standby if their coverage area does not extend that far. If there is no hospice provider available and a medical emergency occurs, the patient may need to go to an Emergency Room. In that case, the Medicare hospice benefit may not apply.

It is also essential that any terminally ill person who plans to travel checks with their insurer to determine if it will pay for care in the location they’re visiting, especially if traveling internationally. In all but three limited circumstances, Original Medicare does not pay for services received at a foreign hospital (a hospital outside the contiguous U.S. states, Hawaii, Alaska or the U.S. territories of Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands). Medigap plans may cover up to 80% of the costs you incur when visiting a foreign country but always check with your insurer to learn what’s covered and what may not be. Medicare replacement plans (also called Medicare Advantage Plans or Medicare Part C) typically follow the same rules as Original Medicare, so the cost of care provided in a foreign country, including drugs and emergency services, will almost certainly fall on the patient or their estate. 

Essential considerations when traveling by airplane

While air travel may be challenging due to cabin pressure and stressors associated with security, terminally ill patients can travel by air if no alternative options are available. Traveling with a companion who can manage all travel details during the patient’s trip is best. Also reach out to the selected airline to arrange special assistance before finalizing plans. This assistance may include oxygen, wheelchair transport, special boarding, seating, or meal accommodations. All medications and essential documentation, including a DNR if warranted, should always accompany the patient.

For those with exceptional challenges, companies like Medical Air Service or Angel MedFlight offer advanced medical care air transportation. These worldwide air ambulance services provide a flying ICU for patients with extensive medical needs.

Pre-existing conditions waivers for travel insurance

Since terminally ill patients have a higher risk of postponed, interrupted, or canceled trips, travel insurance may be ideal for protecting their investment. These policies can be expensive but may be worth the cost, particularly when planning to travel abroad.

However, it is important to note that many travel insurance companies do not offer waivers for pre-existing conditions. Companies offering a waiver generally require the patient to disclose all pre-existing conditions to guarantee coverage. This requirement helps to ensure a refund or partial refund should there be a trip delay, cancellation, or medical costs associated with a terminal diagnosis or comorbidities while away from home.

For example, Allianz Global, one of the largest insurers for travel, defines a pre-existing medical condition as follows: an injury, illness or medical condition that presented symptoms or caused someone to seek diagnosis, treatment by a doctor, or prescribed medications (new or additional) anytime within 120 days before and including the plan’s purchase date. Allianz Global Assistance does NOT cover pre-existing Alzheimer’s disease, bipolar disorder, or certain mental or nervous health conditions. Additionally, travel insurance will not pay for any non-emergency care, elective care, long-term care or experimental treatments the patient receives during their trip. 

Ultimately, it is always up to the consumer to understand what is covered and what is not when purchasing a travel insurance policy. It is also wise to note if there is a cap on the maximum amount of coverage offered. 

Sources

“A Guide to Travel Insurance for Cancer Patients”. Allianz. https://www.allianztravelinsurance.com/travel/medical/travel-insurance-for-cancer-patients.htm?accam=F202942&gclid=CjwKCAiAxP2eBhBiEiwA5puhNQNqlbTb1TA0VL4fd05xn3TQzKGGgJlgRYkF7nMorAzlqQQoOaMpnxoCkt4QAvD_BwE 

“Fact Sheet: Medicare Coverage Outside the United States”. Medicare.gov. https://www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-States.pdf

“Pack Safe: Oxygen – Compressed and Liquid”. Federal Aviation Administration. https://www.faa.gov/hazmat/packsafe/more_info/?hazmat=33 

“Can terminally ill patients fly commercially, or should an air ambulance be used?” Medical Air Service. https://www.medical-air-service.com/blog/can-terminally-ill-patients-fly-commercially-or-should-an-air-ambulance-be-used_8018.html 

“Advanced Medical Care and Air Transportation”. Angel MedFlight. https://angelmedflight.com/request-air-ambulance-medical-flight/