Living on a Cruise Ship? Why Your Travel Insurance May Not Cover You

A few weeks ago, I had a minor heart attack. I’m fine, but it got me thinking. My wife and I are about to embark on a journey. We’ve purchased a condo on Avora Lumina, and our intention is to live at sea for part of the year and in one of our other homes for the remainder. So what if it had happened out there, somewhere in the middle of the Atlantic? Does my AvMed plan cover me? And if so, for how long? When I turn 65, will Medicare cover me when I travel?

I didn’t know the answers. And I’m not alone. Our Live At Sea community has discussed this topic on numerous occasions. Charles Couser put it best in our Facebook group back in May: “It’s the ultimate lifestyle, but it always brings up one massive question: how the heck does travel insurance work when you’re gone for that long?”

The short answer is that it mostly doesn’t. Travel insurance was built for trips—two weeks in Italy, a Caribbean cruise—and it does that job well. But when the trip doesn’t end, you’ve got a different problem, and it needs a different product.

Travel insurance wasn’t built for this

One member of our group found out the hard way that their Allianz annual policy had a 45-day limit on any single trip. Other policies stretch to 90 days or six months. In other words, “annual” describes how long you own the policy, not how long you can be gone.

What most of us need instead is international medical insurance, often called expat or nomad insurance. These policies are designed for people who spend long stretches outside their home country, and they don’t carry the short trip limits. Don’t get me wrong—they aren’t automatically built for someone whose address is a ship, either. Some insurers require you to keep residency in a particular country. Others restrict how long you can be aboard or where you’re covered. Which is why I’d get it in writing that the policy covers continuous residential cruising before paying a dollar.

What our members actually carry

One member who spends eight months a year aboard told us they went with IMG for international medical and evacuation coverage, and they keep Medicare and Medigap for their time back in the United States. A travel advisor in the group carries an annual Allianz policy personally but steers clients to different companies depending on their situation, because someone cruising three months a year has very different needs from someone who sold the house. Another member recommended Alex Routh, who specializes in expat insurance.

My takeaway? Talk to a specialist. I’ve bought a lot of things online because the price looked good. This shouldn’t be one of them.

The pre-existing conditions trap

This one is now personal. Many people considering this lifestyle are retired or close to it, and plenty of us have a medical history—diabetes, heart disease, cancer, or in my case a heart attack a few weeks old. The fact is, an insurer agreeing to sell you a policy doesn’t mean it covers the condition you’re most likely to need treated. Some policies exclude pre-existing conditions outright. Others require medical underwriting, impose waiting periods, or charge more.

Picture buying a residence aboard a ship, planning five years of sailing around the world, and then learning in a foreign hospital that your heart isn’t covered. Not good! Disclose your history accurately and have the insurer spell out every exclusion in writing. For a lot of retirees, this could be one of the biggest financial decisions they make before moving aboard.

Evacuation: the nearest hospital isn’t your hospital

Say you have a serious emergency mid-crossing. The ship’s medical team stabilizes you, and the cruise line coordinates what happens next, which could mean diverting to a port or arranging an evacuation when that’s medically necessary and operationally possible. But who pays? And where do they take you?

Most evacuation coverage gets you to the nearest appropriate facility. Think of an ambulance: it takes you to the closest hospital that can treat you, not your favorite one. Getting you home is a separate benefit, and often a separate product. There are medical transport memberships that will take you to your hospital of choice, but some limit how long you can be away from home, and some won’t arrange a pickup from a ship at all. To be clear, having “evacuation coverage” doesn’t mean someone sends a helicopter to the middle of the ocean and flies you home.

Don’t forget about home

So does my AvMed plan cover me at sea? I pulled out my plan documents to find out. The good news is that US private insurance doesn’t count the days you’re away the way Canadian provinces do. As long as I stay enrolled and keep my Florida home, the plan stays in force whether I’m gone two weeks or ten months. The bad news is what it pays for while I’m out there, which is emergencies only. Non-emergency care outside the US is excluded, prescriptions filled abroad aren’t covered, and if I need an air or water ambulance, I pay 50 percent after the deductible. Half of a helicopter bill isn’t a number I want to learn at sea. One thing in my favor—it’s an ACA plan, so it can’t exclude my heart as a pre-existing condition. Many international policies can.

Back to my Medicare question. Medicare doesn’t cover care outside the United States, apart from a few narrow exceptions. Some Medigap plans add foreign travel emergency coverage, but as of this writing it applies only during the first 60 days of a trip, pays 80 percent after a $250 deductible, and carries a $50,000 lifetime limit.

To be clear, that includes emergencies. A heart attack in the middle of the Atlantic isn’t one of the exceptions. The good news is that Medicare doesn’t count your days away, so as long as you keep paying your Part B premium, you stay enrolled, and that 60-day Medigap clock restarts each time you come home and leave again. Remember, too, that the best time to buy Medigap is the first six months after you start Part B, when insurers can’t turn you down for your health history. For those of us with a heart attack on the record, that window matters.

Don’t get me wrong—that doesn’t mean you can’t be gone for more than 60 days. You can stay away as long as you like and keep your coverage. It means an emergency on day 61 isn’t covered by Medigap, and without another policy you’d pay the whole bill yourself. Even inside the 60 days, a $50,000 lifetime limit doesn’t go far against a serious hospital stay or an evacuation. Which is why I’d carry international medical coverage for the whole time aboard. I’d also ask the Medigap insurer what counts as ending a trip. Does a stop in a US port reset the clock, or do you have to go home?

Canadians have a different issue. Provincial health coverage depends on residency and on how many days you’re physically in the province, so spending most of the year away can cost you your eligibility. The same concern applies in other countries with public systems. And it cuts the other way too—some international policies exclude or limit treatment in your home country. So check both directions before you buy.

The three layers I’d want

If I were starting from scratch—and I suppose I am—I’d look at three layers:

• International medical insurance. The foundation. It should work across the countries you’ll visit, specifically allow extended or continuous residential cruising, and cover care aboard, care ashore, and your existing conditions.
• Medical evacuation and transport. Know where they’ll take you and who pays. If getting to your own hospital matters, look for a transport service that offers it and allows long stretches at sea.
• Home-country coverage. Medicare, Medigap, a private plan like mine, or a provincial system. Know what you keep and what you have to do to keep it.

Some of these overlap, and you may not need three separate products. What matters is that there are no gaps.

Seven questions I’m asking

1. Will this policy cover me if I live aboard for six months, a year, or permanently?
2. Do I need to maintain a residential address in a particular country?
3. Are my pre-existing conditions covered?
4. Does it cover treatment aboard the ship and in the countries we’ll visit?
5. What happens if I need an emergency evacuation at sea?
6. Can I be transported to my home country or preferred hospital?
7. Will I still be covered when I’m home, and could living at sea affect my domestic coverage?

I’m asking for every answer in writing. What a salesperson tells you isn’t always what the contract says.

Golden Nuggets

• Travel insurance is for trips. Living at sea needs international medical insurance.
• “Annual” doesn’t mean a year-long trip. Check the per-trip limit.
• Confirm in writing that the policy covers residential cruising.
• A policy that excludes your pre-existing condition excludes the care you’re most likely to need.
• The nearest suitable hospital and your hospital at home are two different destinations.
• Talk to a specialist.

Frequently Asked Questions About Insurance When Living at Sea

Does travel insurance cover living on a cruise ship?

It may cover an eligible cruise, but don’t assume it covers living aboard for months or permanently. Maximum trip lengths, residency requirements, and medical exclusions can leave gaps. Ask the insurer to confirm in writing that your policy covers your planned residential cruise.

Does annual travel insurance cover a year-long cruise?

Not necessarily. An annual policy can cover multiple trips over a year while limiting the length of each individual trip. Some Allianz annual plans, for example, have a 45-day maximum trip length. Check your specific policy before booking an extended stay.

What type of health insurance should I consider for long-term cruise living?

International health insurance is worth exploring for extended time abroad. However, “expat” or “nomad” branding doesn’t guarantee suitable coverage. Confirm that the policy allows residential cruising and covers your destinations, treatment aboard the ship, care ashore, and the full duration of your stay.

Will insurance cover pre-existing medical conditions?

Coverage varies. A policy may exclude certain conditions, require medical underwriting, or impose waiting periods and benefit limits. Disclose your medical history accurately and request written confirmation of how each condition will be covered before purchasing.

Does Medicare cover medical care on a cruise ship?

Original Medicare generally does not cover care outside the United States, with limited exceptions. It may cover medically necessary shipboard care when the ship is in a U.S. port or within six hours of one, provided the doctor meets Medicare’s requirements. Some Medicare Advantage plans offer additional foreign travel benefits.

Is Medigap enough for an extended cruise?

Medigap’s foreign travel emergency benefit has significant limits. Plans offering it generally pay 80% of eligible charges after a $250 annual deductible, with a $50,000 lifetime maximum. The emergency must begin within the first 60 days of the trip. That makes it insufficient as your only overseas medical protection for a months-long stay.

Does medical evacuation coverage mean I’ll be taken home?

Not automatically. Evacuation benefits commonly provide transport to the nearest appropriate medical facility. Transport to your home country or preferred hospital may require a separate benefit or membership. Confirm the destination, approval requirements, trip-length restrictions, and whether transport from a ship is included.

Christina Berry posted in our group in October that she and her husband are researching a residential cruise purchase a few years out, and insurance is one of their top three priorities, right alongside choosing a ship and finding an international bank. She’s doing it in the right order. I did it backwards. We bought the condo first, and it took a heart attack to get me asking.

I’m not an insurance advisor, and rules and products vary, so speak with a licensed professional before you decide. But figure out the insurance before you sell the house, not after.

Have you already solved this? Tell us what you carry in the Live At Sea group. I’d like to know.