The IPMI policy schedule says “emergency medical evacuation up to USD 1,000,000”. The Travel Care Air 2026 guide says an ICU jet from Bangkok to the US runs US$120,000 to US$180,000. The two numbers look like a comfortable arithmetic. They are not the same product.
What standard IPMI buys is a Singapore evacuation under a “nearest appropriate medical facility” clause. What MedjetAssist buys, when you are still under 75, is a transport to your home hospital once you are stable. What AirMed buys, for any age, is the same with no published age cap. What no product buys is an acute-stroke evacuation that beats the local mothership clock. This piece is the route × mode × age-tier matrix that maps the actual cost curve and what the available cover does and does not do.
This is decision analysis, not advice; verify any specific with the carrier, the operator, and a licensed broker before acting.
The route × mode matrix
Verified 2025/2026 figures from operator price guides and the IAS Medical NHS-audited “from” rate sheet. USD conversions at USD/GBP 1.26 (project mid-rate, May 2026).
| Route | Mode | Price band | Source |
|---|---|---|---|
| Bangkok → United States | ICU jet | US$120,000–180,000 | Travel Care Air 2026 |
| Asia-Pacific → United States (general) | ICU jet | US$100,000–200,000+ | Travel Care Air |
| Outer-island origin → United States | ICU jet | up to US$300,000 | Travel Care Air remote-locations tier |
| Bangkok → United Kingdom (London) | ICU jet, bed-to-bed | from £65,000 (~US$82,000) | IAS Medical |
| Chiang Mai → United Kingdom (London) | ICU jet, bed-to-bed | from £60,000 (~US$76,000) | IAS Medical |
| Transatlantic (USA ↔ UK benchmark) | ICU jet | US$80,000–150,000 | Travel Care Air |
| Bangkok → Singapore | ICU jet (short hop) | ~US$15,000–30,000 | Travel Care Air / MTI 24/7 regional |
| Manila → Singapore | ICU jet | ~US$15,000–30,000 | regional bands |
| Bali → Singapore | ICU jet | ~US$30,000–50,000 | regional bands |
| Bali → Australia (Sydney/Melbourne) | ICU jet | ~AUD 80,000–150,000 (~US$52,000–98,000) | Medical Rescue Bali; triangulated |
| Manila → United States | ICU jet | ~US$120,000–200,000 | APAC band |
| Bali → United States | ICU jet | ~US$100,000–200,000+ | APAC band |
| Ho Chi Minh City → United States | ICU jet | ~US$100,000–200,000+ | APAC band |
| Phnom Penh → France | ICU jet | inferred ≥ US$130,000 | no published rate |
| International stretcher + escort (commercial flight) | commercial | US$15,000–75,000+ (plus 6–12 paid seats) | Air Ambulance 1 |
| International stretcher + escort (typical) | commercial | US$25,000–30,000 plus 8 seats | Air Ambulance 1 |
| Medical escort only (ambulatory) | commercial | US$3,000–25,000 | Air Ambulance 1 |
| In-country HEMS (helicopter to capital) | helicopter | ~US$5,000–40,000 | StatPearls / industry triangulation |
| Repatriation of remains, BKK → US (full body) | air freight + funeral | THB 100,000 (~US$3,333) | US Embassy Bangkok / Siam Funeral, Oct 2024 |
| Repatriation of remains, BKK → US (cremation + ashes) | air freight | THB 46,000 (~US$1,533) | same |
| Repatriation of remains, SE Asia → UK/US | varies | US$5,000–15,000 | Homeland International; triangulated |
No operator publishes a list price. The bands above are from operator marketing copy, which has every incentive to publish the floor. The 2024–25 audit of medical-air-service quotations cited in Travel Care Air’s guide and the IAS Medical NHS-audited rate sheet are the cleanest references. The remote-origin tier is where the cost curve breaks: the same patient, a hundred miles further from a runway, costs roughly twice as much.
What the policy schedule actually covers
The headline cap is the overall plan benefit, not the evacuation sub-limit. Read what the policies actually say.
| Insurer / plan | Overall plan limit | Evacuation sub-limit | Entry age | Renewal age | Destination clause |
|---|---|---|---|---|---|
| Cigna Global Silver | US$1,000,000 | 100% covered, dispatched by International SOS | 18+ | no upper cap | ”closest appropriate medical facility” |
| Cigna Global Gold | US$2,000,000 | same | 18+ | no upper cap | same |
| Cigna Global Platinum | unlimited | same | 18+ | no upper cap | same |
| Allianz Care Base | US$1,350,000 | included | up to 75 | unspecified | not specified |
| Allianz Care Enhanced | US$2,700,000 | included | up to 75 | unspecified | same |
| Allianz Care Signature | US$5,000,000 | included | up to 75 | unspecified | same |
| GeoBlue Xplorer | varies by tier | US$250,000 cap; repatriation US$25,000 | 74 | renewable to 84 | ”most direct and economical route” |
| Bupa Global Major Medical / Select / Elite | varies | included; specific cap not published publicly | not published | not published | ”nearest appropriate place of treatment” |
| SafetyWing Nomad Insurance Essential | US$100,000 lifetime | US$25,000 if acute onset of pre-existing | up to 69 | not specified | nearest appropriate |
| SafetyWing Nomad Insurance Complete | US$250,000 (US$100,000 for 65–69) | included | sign-up to 64 | indefinite | nearest appropriate |
| IMG travel-medical tier (0–49) | varies | US$50,000 | 0–49 | tier-specific | varies |
| IMG travel-medical tier (50–59) | varies | US$30,000 | 50–59 | tier-specific | varies |
| IMG travel-medical tier (60–64) | varies | US$15,000 | 60–64 | tier-specific | varies |
| April International MyHealth | US$2,000,000 overall | included; sub-limit not separately published | quote-based | quote-based | quote-based |
| Pacific Cross Major Medical (Thailand) | US$1,000,000/yr | included worldwide | up to 75 | renewable to 99 | worldwide |
Two readings sit in this table. The first is that the policy says “evacuation” and pays for one. The second is that the policy says “to the nearest appropriate medical facility” and the destination is Singapore from anywhere in Thailand, the Philippines, Vietnam, Cambodia or Indonesia for almost every acute presentation. Cigna’s contracted dispatcher International SOS makes the routing call, and ISOS routes to the regional centre of medical excellence (Singapore Mount Elizabeth, Singapore Gleneagles, Singapore National University Hospital), not to the member’s hospital of choice. The headline US$1M is real. The Singapore destination is also real. The two together are not “evacuation to home country” by any standard reading.
Cigna, Allianz Care, Bupa, Pacific Cross — almost every standard IPMI dispatches under a 'nearest appropriate medical facility' clause, routed by International SOS. Bangkok → Singapore ICU jet ~$15–30k. The $1M overall benefit is real and is for that flight, not the one home.
The membership-program decision
The membership products fill the gap between “Singapore” and “home”. The economics:
| Program | Annual fee (indiv / family) | Age caps | What it actually buys |
|---|---|---|---|
| MedjetAssist Annual | US$315 / US$425 (broker quotes US$295–474) | 0–74 standard; 75–84 Diamond (phone-only, 1 transport/yr); not available 85+ | Transport to member’s hospital of choice once admitted ≥150 mi from home and stable to fly; no medical-necessity gate |
| MedjetHorizon | additional fee on top of MedjetAssist | same | adds security/political-evac assist |
| AirMed International Annual | US$265 / US$385 | no published age cap | Stable + admitted abroad → flown home; 90-day-abroad rule unless Expat tier |
| AirMed Expat Annual | US$595 / US$935 | same | same, extended-stay permission |
| AirMed Secure | US$440 / US$600 | same | same + security |
| Global Rescue Annual | from US$329 (7-day from US$119) | 75–84 Extended Plan by application; 85+ medical transport not included | Field rescue + medical transport ≥100 mi from home, to hospital of choice |
| International SOS Individual | quote-based; “from US$67” | not specified | Medical evac to nearest appropriate facility, US$1M cap; US$100k security evac |
| AirMedCare Network | US$65–85 (US domestic only) | senior tier | US domestic helicopter/plane only |
The three real choices for a Western expat 50 to 75 are MedjetAssist, AirMed International, and Global Rescue, with International SOS as the corporate variant. MedjetAssist is the cleanest “transport to your hospital” product, at the cost of the 75-year cliff. AirMed is the only one with no published age cap, at the cost of the 90-day-abroad rule unless the Expat tier (US$595/yr) is bought; for a Bangkok-resident expat that is the version that actually applies. Global Rescue is the rescue army for remote and hostile locations and is the right answer for the traveller who actually climbs, sails, or visits politically unstable places. None of them duplicate the IPMI schedule; all of them buy what IPMI does not.
The marginal cost of the membership product against the marginal benefit is the cleanest arithmetic in this piece. US$315 per year for MedjetAssist against a US$120,000 to 180,000 home-country transport that IPMI will not fund: a 380-to-570x leverage if the event occurs. The premium is small for what it buys.
The age curve, in one table
This is the structural finding the marketing buries.
| Age tier | Still available at standard premium | What thins | What disappears |
|---|---|---|---|
| Under 65 | Full IPMI evacuation; all membership programs | — | — |
| 65–69 | IPMI evacuation; SafetyWing Essential ends at 69 | SafetyWing Complete caps at US$100k for 65–69 | — |
| 70–74 | Last entry window for Allianz Care, GeoBlue Xplorer (74), Pacific Cross | New IPMI policies become hard to obtain | — |
| 75 | GeoBlue Xplorer renews to 84; Pacific Cross renewable to 99 | Allianz Care entry refused; most new IPMI policies refused at fresh enrolment; MedjetAssist standard ends, Diamond replaces with 1 transport/yr cap | New IPMI shopping at 75 finds an empty shelf |
| 75–84 | MedjetAssist Diamond (phone, questionnaire, 1/yr); Global Rescue Extended Plan; AirMed (no age cap); GeoBlue Xplorer if continuously renewed | Most new policies; many evacuation riders | New IPMI enrolment essentially unavailable |
| 85+ | AirMed International (no published cap); Pacific Cross continued renewal | MedjetAssist Diamond ends | MedjetAssist; Global Rescue medical evac (becomes fee-for-service); new IPMI |
Source: Allianz Care, GeoBlue Xplorer, Pacific Cross, SafetyWing, Cigna Global, MedjetAssist, AirMed International, Global Rescue policy schedules and product pages · checked 2026-05-30
The structural reading: at 75 the standard cover does not disappear. It becomes unbuyable for the first time. Continuous renewal of a policy entered before 75 (GeoBlue to 84, Pacific Cross to 99, Cigna with no upper cap) preserves the benefit; new shopping at 75 walks into a wall. At 85, AirMed International is essentially the last product standing, and only for residents the carrier still serves. The retiree who plans on “I’ll buy the cover later” is planning to buy a product that will not exist by the time he wants it.
What the policy schedule does not cover
Standard IPMI evacuation routinely excludes pre-existing conditions, psychiatric repatriation, self-inflicted injury, pregnancy beyond a defined gestation, war or civil-unrest zones, and substance-related incidents. The acute-onset-of-pre-existing rider that travel-medical plans offer caps at approximately US$25,000 for ages 14 days to 64, and US$5,000 to US$10,000 for ages 65 to 79. That is the cap that actually applies to most older expats with a documented diabetes, hypertension or coronary diagnosis on file.
Psychiatric repatriation is the line the industry handles least transparently. Healix International and the small set of specialty providers describe it as a bespoke service involving an escort psychiatrist, sedation protocol, commercial-airline refusal risk, and significant operator preparation time. No standard IPMI schedule prints it as included. Operator-quoted cash cost is typically US$50,000 to 100,000. The expat whose decline is psychiatric rather than cardiac is not in the same product as the expat who has a heart attack.
When evacuation is the wrong answer
Time-critical conditions are the line. Acute ischaemic stroke has a thrombolysis window under 4.5 hours from symptom onset. STEMI to primary PCI under 90 minutes is the standard. An ICU-jet flight Bangkok to LAX is approximately 14 hours of flight time plus 6+ hours of dispatch, ground, customs and bed-to-bed transfer time. At hour 0 of either event, the patient is far outside the window before the aircraft is airborne. The aeromedical clinical guidance is unambiguous: for acute stroke or STEMI presenting to a Bangkok or Manila JCI-accredited hospital, the right call is the local mothership, not the flight home. The companion piece on the stroke and cardiac uninsured bill makes the in-country bill explicit; on the clinical leg, the bill is also better.
The flight itself is not zero risk. Fixed-wing medical-transport crashes have a fatal-outcome rate of approximately 35.6 percent per the published aeromedical-safety literature; HEMS crashes approximately 20 percent; ground ambulance approximately 2 percent. The absolute incidence is low (crashes are rare), but the conditional consequence is severe. Cabin altitude at typical jet cruise creates approximately 8,000-foot-equivalent hypoxia and Boyle’s-law gas expansion that worsens pneumothorax, pneumocephalus and recent surgical wounds. Recent craniotomy requires a 14-day delay. Unstable pneumothorax requires at least two weeks post-resolution. Thoraco-abdominal surgery less than 7 to 10 days old is a relative contraindication. The literature is in StatPearls and in the peer-reviewed flight-stressors review from February 2026.
The clinical anti-correlation matters because the IPMI medical officer who authorises the dispatch reads these guidelines. The carrier will refuse to authorise a stroke evacuation outside the window on medical-necessity grounds. The retiree who plans on “they’ll fly me out” is planning against a clause that does not exist in the schedule he holds.
The remains line
The cleanest line in the cost curve is the funeral. The US Embassy in Bangkok publishes a Siam Funeral quotation dated October 2024 at THB 100,000 (~US$3,333) for a full body home and THB 46,000 (~US$1,533) for cremation with ashes returned. The standard IPMI repatriation-of-remains cap is approximately US$25,000 on most policies. For once the cover comfortably exceeds the bill.
The companion piece on dying in Thailand walks the consular paperwork. The figure to hold here is simply that the line in the policy that says “repatriation of remains, up to US$25,000” is the only line in this entire analysis where the published cap is meaningfully more than the published bill.
Cold close
The IPMI policy schedule is honest in its own terms. It says “evacuation to the nearest appropriate medical facility” and pays for one. The expat reading the brochure heard “evacuation home”. The two are different products, and the gap between them is what MedjetAssist, AirMed International and Global Rescue sell at US$265 to 595 a year, while supply lasts.
The structural reading: under 65, the cover is wide and the products compete. Over 75, the cover is thin and most products refuse new enrolment. Over 85, AirMed International is essentially the last product standing. The decision is not whether to buy an evacuation rider; it is whether to buy continuous cover early, before the shelf goes empty.
The other reading is harder. Most events that end the long-stay expat’s runway are time-critical, and most time-critical events do not fly. The bill at the Bangkok or Manila private hospital is the bill the cover is for. The bill for the flight home is for the survivor, not the patient. The remains line is the only line in the schedule that prices the bill correctly.
Questions
How much does an air ambulance from Bangkok to the US cost?
An ICU-equipped fixed-wing air ambulance from Bangkok to the United States runs approximately US$120,000 to 180,000 in 2026 quotes, with the broader Asia-Pacific to US band reaching US$100,000 to 200,000+ and remote-origin missions (Phuket, Bali, outer Philippine islands) pushing toward US$300,000. None of the major operators publish a list price; the bands above come from Travel Care Air, MTI 24/7 and Medical Air Service marketing and are the floor, not the ceiling. A commercial-flight stretcher with medical escort, available only if the patient is stable enough to fly without a ventilator, runs US$15,000 to 75,000+ plus the cost of six to twelve commercial seats.
What does standard IPMI evacuation cover actually do?
It flies the patient to "the nearest appropriate medical facility", which from a SE Asia origin is Singapore in most cases — not the home country. Cigna Global, Allianz Care, Bupa Global and Pacific Cross all use this language; Cigna dispatches via International SOS, which makes the routing decision. The headline US$1,000,000 or US$2,700,000 plan limit is the overall annual benefit, not an evacuation sub-limit. Where separately published, the evacuation sub-limit is much smaller: GeoBlue Xplorer US$250,000, SafetyWing Essential US$100,000, IMG travel tiers US$15,000 to US$50,000 depending on age band. Standard IPMI also excludes pre-existing conditions, psychiatric repatriation, self-inflicted injury, war zones, and substance-related incidents.
What is the age cap on medical evacuation cover?
Allianz Care declines new entry at 76. GeoBlue Xplorer enters to 74 and renews to 84. SafetyWing Nomad Insurance Essential enters to 69; Complete enters to 64 and renews indefinitely. Pacific Cross enters to 75 and renews to 99, the strongest in the regional market. IMG travel tiers do not enter above 64. MedjetAssist standard membership ends at 75; the Diamond plan covers 75 to 84 with a one-transport-per-year cap; nothing at 85+. AirMed International is the only mainstream membership product with no published age cap. The market reality at 75 is that continuous renewal preserves the benefit; new shopping at 75 finds an empty shelf.
When is evacuation the wrong call?
For time-critical conditions where the treatment window is shorter than the flight. Acute ischaemic stroke has a 4.5-hour thrombolysis window. STEMI to PCI under 90 minutes is the standard. A Bangkok to US flight is approximately 14 hours of flight time plus 6+ hours of dispatch, ground and customs handling — at hour 0 of an acute event, the patient is far outside both windows before the aircraft is airborne. The aeromedical literature also documents 8,000-foot-equivalent cabin altitude hypoxia, Boyle’s-law gas expansion in surgical wounds and pneumothorax, and approximately 35.6 percent fatal-outcome rates in fixed-wing medical-transport crashes. For acute stroke or STEMI the right call is the local JCI-accredited hospital, not the flight home.
How much does repatriation of remains cost?
The US Embassy in Bangkok publishes a Siam Funeral quotation dated October 2024 at THB 100,000 (approximately US$3,333) for a full body home to the United States and THB 46,000 (approximately US$1,533) for cremation with ashes returned. Broader SE Asia to UK or US figures triangulate at US$5,000 to 15,000. The standard IPMI repatriation-of-remains cap is approximately US$25,000 on most policies, comfortably above the actual bill. It is the one line in the entire evacuation cost curve where the cover actually covers.