5

In general, people who test positive for COVID-19 are not allowed to board a flight to the US.

Some CDC interim guidance says: "However, there may be circumstances that warrant transportation by air of persons with COVID-19 or who have been exposed to COVID-19. For example, persons with COVID-19 may need medical care that is not available at their location."

I am concerned specifically about the following scenario: I live in the US and I have health insurance. I am also planning to purchase travel medical insurance for an upcoming trip outside the US. If I get COVID-19 while outside the US, the care available at my destination will probably be adequate, but suppose the following were to happen:

  • It takes several months for me to recover. (I am fully vaccinated, so this is unlikely, but not impossible.)
  • I hit the coverage limit of my travel insurance plan, and continuing to stay in the hospital may cost hundreds of thousands of dollars, depending on how long it takes me to recover.
  • My travel medical insurance covers evacuation back to the US on an air ambulance.
  • It's not medically necessary for me to return to the US while still sick, but it's financially necessary: in the US, my regular health insurance will cover me at an in-network hospital, and I will not be billed hundreds of thousands of dollars out of pocket.

Is the US government likely to approve medical evacuation by air back to the US under such circumstances?

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  • 1
    Note that you need to triple check the terms of your travel insurance. They may exclude explicitly or implicitly anything related to Covid-19, and they may also consider you are not covered in any country where travel is not advised to by anyone of their liking, including the Department of State (which currently has dozens of countries on levels 2 and up advisories) or the CDC…
    – jcaron
    Jul 30 at 14:25
  • 2
    One factor to consider is that hospitalisation is typically cheaper outside the US. In Western Europe for example, €1000 to €1500 a night for regular hospital care (less for longer-term follow-up care, more for ICU) so if you are indeed covered you might not reach your insurance limit so easily. OTOH, a month in ICU can run up to 100k.
    – Relaxed
    Jul 30 at 14:39
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    @Relaxed yes, I remember reading stories of tourists being 'extorted' to pay $5-10k for treatment in South America and thinking its a great deal rather than a 'rip-off' :)
    – JonathanReez
    Jul 30 at 17:54
  • At first I thought your question was asking about being evacuated out of the US when sick due to financial reasons, and that made a lot more sense to me. I would think being evacuated back into the US would only make your financial troubles worse.
    – Kyralessa
    Jul 31 at 20:17
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Is the US government likely to approve medical evacuation by air back to the US under such circumstances?

Medical evacuations do happen but they can be expensive (hundreds of thousands of dollars wouldn't be uncommon for an evacuation by air ambulance). CNBC had an article about this in April:

The Centers for Disease Control and Prevention require air passengers to present a negative Covid test (or proof of recovery) before entering the United States.

“Extremely limited” exemptions are allowed for emergency travel, according to the CDC’s website.

Covac Global’s services fit this exception, said Thompson, adding that the company has never been precluded from bringing a member home. Medical travel must be via certified air ambulance, under the care and recommendation of a physician, and detailed paperwork must be filed with the CDC, U.S. Department of State and Department of Homeland Security.

“This is the only way a positive Covid-19 patient can enter the U.S.,” said Thompson. “We have had many people call up if a charter or even their own aircraft will be able to bring them home, and the answer is no.”

So while they are likely to approve medical evacuations, that likely means that you do need an air ambulance service rather than a regular flight (or even your own private plane).

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  • Technically you can also fly to Mexico (no test required), then cross overland, but if you're able to do that without a doctor by your side, you're probably not going to test positive.
    – JonathanReez
    Jul 30 at 5:23
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    @JonathanReez there are even cases where people continue to test positive even long after they're no long symptomatic or contagious (similar to your #4?). The Dutch rules have a special exception for that allowing you to travel home with proof of that situation, see Positief blijven testen na coronabesmetting here (maybe with some plugin translating the page, it's the 3rd collapsable tab on that page). I haven't found that exception for travel to the US.
    – JJJ
    Jul 30 at 5:29
  • are there any statistics on how frequent this is? I can only find isolated cases in the media which tells me it’s very rare.
    – JonathanReez
    Jul 30 at 5:54
  • @JonathanReez I'm not sure. I guess it's also a bit rare to find out even if it concerns yourself, you'd have to keep testing repeatedly to find out that you still test positive. I think it would only happen in cases where you need a negative test to continue your life, for example to leave quarantine or to go to work. If you just need for some one-time trip then I'm not sure you would keep testing every week even when your trip is already out the window. I assume you just wait until you feel better and then get on (without a negative test).
    – JJJ
    Jul 30 at 18:23
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To expand on @JJJ's answer, there are four possible scenarios post-infection:

  1. You recover at home or after a brief stay in the local hospital. Assuming you're fully vaccinated, under the age of 65 and have no major pre-existing conditions, the odds of this are around 99.9%.
  2. You take a long time to recover but can at least survive without supplemental oxygen, while also testing negative for COVID. In this case you just hop on a plane (in a wheelchair if you have to) and go back home unassisted. This will be the case for the vast majority of people who won't fall into category #1.
  3. Your condition is so bad that you need a constant supply of oxygen and a doctor by your side. This will definitely require a medevac flight which will be very expensive.
  4. Your condition isn't too bad but you keep testing positive for COVID for months in a row. This can happen but is extremely unlikely, otherwise we would constantly hear about such cases. If you do become the 1 in a million case where this occurs, you would likewise need a medevac flight to get you home, possibly a bit cheaper since you won't require active care. Interestingly, Dutch rules have a special exception for that allowing you to travel home with proof of that situation, see Positief blijven testen na coronabesmetting here, but not the US (thanks, @JJJ)

Overall your odds of needing a medevac flight due to COVID alone are very much negligible as a vaccinated person. I'd be much more worried about getting into a car accident during my stay than about getting infected with COVID. If you weren't worried about getting the flu during your travels in 2019, there's zero reason for you to worry about COVID in 2021 (post-vaccination).

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  • I thought USA allowed both negative test and proof of recovery?
    – xngtng
    Jul 31 at 10:13

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