Traveling beyond the reach of medical care? Here’s what to do first.

A bit of advance planning can be a literal lifesaver

Travel illnesses don’t make for the most glamorous stories, but ailments can accrue like airline miles for frequent fliers. I’ve used phrase books to wheedle antibiotics, in Thai, Portuguese and Spanish, out of pharmacists on three continents. Itching and alone in rural Chiapas, Mexico, I once called my physician dad while covered in chiggers. “I can’t think of any terrible, tropical diseases carried by chiggers off the top of my head,” he said, sounding pensive. “But it’s hard to think there aren’t any.” (I was fine.)

Of course these woes aren’t limited to travel abroad; you can be outside the bounds of immediate medical care while hiking along the Appalachian Trail or Gates of the Arctic, America’s most remote national park.

If bugs, bacteria and sundry discomfort come with the hobby, I’ve since learned that a little preparation cuts down on frantic phone calls and pharmacy trips. It’s true whether you’re packing for a week-long cruise or headed deep into the wilderness.

Get essential meds before you leave

When you’re going where quality medical care is inaccessible, your primary-care provider might be willing to pre-prescribe medications and antibiotics for common travel ailment, such as traveler’s diarrhea. You can also order a customized, region-specific travel kit including pre-prescribed meds from Duration Health, which range from the $169 Mini Med Kit covering basics (infections, nausea, digestive illnesses) to a $1,679 Lifesaver version with two EpiPens.

“A lot of it is what I wished I had with me before I was a doctor,” said Terez Malka, one of Duration Health’s physicians, who writes pre-prescriptions and supports travelers by email. While climbing Mount Kilimanjaro in January, she saw the kits in action. “100 percent of the group got traveler’s diarrhea,” she said. “Everyone having their azithromycin prescription before we set out on the trail probably saved the trip.”

Bring regular meds and travel-specific items in their original vials; those count as valid prescriptions at airport security and customs. (It’s also a good idea to email yourself a copy of prescriptions.) Keep in mind that though many travelers make it through with no issues, some countries ban medications that are legal in the United States. Adderall, which is used to treat ADHD, is banned in Japan. Singapore requires travelers to apply for special approval when packing some anti-anxiety medications and sleeping pills. The Centers for Disease Control and Prevention recommends contacting the embassy of your destination, plus anywhere you might have a layover, to check what medications might not be allowed.

Make a communication plan

Sometimes, keeping in touch just means getting the right SIM card for your cellphone. But if you’re going beyond reliable cell service — on an overnight hiking trip, for example — you may want to consider one of the compact satellite messaging devices now sold by companies like Garmin and SPOT.

These devices work in most of the world and generally come with a monthly or annual service fee. Some are set up for textlike, two-way messaging while others have preset messages and emergency alerts. “When you hit the SOS button … it goes to a highly qualified team of dispatchers that work to find you the best available assets for a rescue,” said Gabe Roura, SPOT’s regional sales manager for eastern United States. “It could be local law enforcement. It could be the Coast Guard. In some cases, it could be a private rescue firm.”

Info about the SOS can also go to a trusted emergency contact at home. Consider choosing someone who is good in a crisis, said Zanna Baker, who directs television and film projects for adventure expedition company Secret Compass. Baker emphasized that while companies like Garmin offer support, a levelheaded friend or family member might assist with emergencies by marshaling resources in your location. “You want somebody who is going to be calm about communicating,” she said. “With a [Garmin] inReach it’s just a message. So what happens next?”

Usually, the next step is getting in touch with on-the-ground contacts who might be able to organize a rescue. Baker suggests creating a list of area resources in case of emergency, such as a local friend, a guide company or even a well-connected hotelier willing to make some calls.

Understand on-the-ground options

Excellent medical care is available in much of the world, emergency room physician Eugene Delaune says, who also advises insurer Allianz Travel on critical medical decisions. Teams like Delaune’s help determine whether travelers can access needed care on-site or if they require evacuation.

“When you move someone, it’s not usually home; it’s usually to the closest facility,” he said. “Say you’re in Tanzania and you get in a car wreck. … I say, ‘We need to get her to Nairobi right away.’” Another option is to contact the nearest U.S. consulate or embassy. The U.S. State Department can assist with locating medical services abroad. Consulate affairs officers offer 24/7 emergency assistance by phone at 888-407-4747 or 202-501-4444.

While it’s best to bring medications from home — the CDC notes that counterfeit pills are common in some countries — you can generally get an emergency refill with a copy of your prescription. That documentation is also essential if you need medical care and don’t know the local names of your prescribed drugs.

“When I’m working in the ER it’s a huge disadvantage if people can’t tell me what meds they’re taking,” Delaune said. He also recommends those with a history of cardiac problems carry recent EKGs in their wallets so local physicians can offer fully informed care.

Know what your insurance covers

Paying for treatment is another story. U.S. consulates won’t help with unexpected bills, and Medicare and Medicaid don’t generally cover medical expenses outside of the United States. Private insurance will often pay some international medical expenses, Delaune said, but usually only after filing a claim. Travelers relying on private health insurance may have to shell out, then sort it out afterward. Health care in the United States is among the most expensive in the world, which partly explains the growing trend of Americans seeking treatment abroad; still, emergency procedures can be pricey anywhere.

Travel insurance that covers medical care, Delaune noted, is more likely to front you the money for immediate expenses. In some cases, you’ll be on the hook later; read the fine print. While some travel insurance offers primary insurance coverage for emergency medical and dental care — meaning the travel insurer is the first to pay out — others only offer secondary coverage, so you’ll first have to submit any claims to your health insurance.

And always beware the exceptions: During a 2017 trip to Vietnam, Jeannie Walla, 73, of Los Angeles, was touring rice paddies in the sidecar of a guide-chauffeured motorcycle when the vehicle flipped into a flooded field, trapping her underneath. Later, Walla called her travel insurance from a nearby hospital and asked what to do if her back was broken or her condition deteriorated. “He said, ‘I don’t know where we would send you, but I know we wouldn’t pay for it,’” she recalled. “It was ridiculously unhelpful.” The motorcycle trip had voided her coverage; many travel insurance policies list adventurous activities as exclusions.

For surefire access to a U.S hospital, consider emergency medical evacuation insurance. Sobered by her close call in Vietnam, Walla signed up for annual medical transportation coverage from Medjet, whose plans start from $99. It paid for itself sooner than she expected.

In 2019, Walla fell from the stone base of a pyramid in Giza, Egypt, dislocating a finger and breaking her hip and wrist. The nearest hospital was full of feral cats. She needed surgery, and a Cairo surgeon hinted she’d receive higher-quality care back home. Her upgraded coverage secured her an ambulance escort to a private flight bound for California. “Metjet showed up and said, ‘We’re going to get you out of here,’” she said. “It was music to my ears.”

More travel tips

Vacation planning: Start with a strategy to maximize days off by taking PTO around holidays. Experts recommend taking multiple short trips for peak happiness. Want to take an ambitious trip? Here are 12 destinations to try this year — without crowds.

Cheap flights: Follow our best advice for scoring low airfare, including setting flight price alerts and subscribing to deal newsletters. If you’re set on an expensive getaway, here’s a plan to save up without straining your credit limit.

Airport chaos: We’ve got advice for every scenario, from canceled flights to lost luggage. Stuck at the rental car counter? These tips can speed up the process. And following these 52 rules of flying should make the experience better for everyone.

Expert advice: Our By The Way Concierge solves readers’ dilemmas, including whether it’s okay to ditch a partner at security, or what happens if you get caught flying with weed. Submit your question here. Or you could look to the gurus: Lonely Planet and Rick Steves.