‘If insurance firms kept their promises, we would not exist’ says Medical Air Service
Mikulski estimates the average cost of US-Europe flight to be about $100,000, but this figure can go higher, especially if the patient lives on the US west coast.
There are a host of reasons why someone must get home quickly when they fall ill on holiday. Most people believe their travel insurance will take care of things when something goes wrong. But often this is not the case, Adam Mikulski, founder and general director of Medical Air Service told CJI.
“If insurance companies kept every promise they make during their marketing efforts, then we as a company would not exist,” he said.
German medical air transport company Medical Air Service, which operates a global network of business-jet air ambulances, sees more than 20% of its annual business in July and August each year. It predominantly repatriates US citizens. In July and August 2025, 25.8% of all cases involved someone travelling to the US.
“Usually, these are people returning home. Americans travel around the world in summer, but if they fall ill, they want to return home. If you count all missions involving the US, including domestic travel and missions where the patient wants to leave the US, you arrive at 36.2% of all missions,” said Mikulski.
Since founding the company in 2009, Mikulski has discovered that, when planning their travels, many holidaymakers, regardless of age or whether they have pre-existing conditions, do not take the medical situation of the location they are visiting into account.
“Some of them are visiting, for example, remote islands where there isn’t even a hospital — or at least not one that meets the standards they’re used to. In other cases, they don’t consider their pre-existing conditions and if they might worsen while they travel. When they contact us, they’re usually in an unfamiliar situation with a lot of unknowns,” he said.
He believes language is a huge barrier to receiving care, even in places where medical capacity is sufficient. “When talking to medical personnel about illnesses there is lots of specific vocabulary involved,” said Mikulski. “You might not always get very far with English, and most travellers do not speak the local language.”
For US travellers, Europe is a particular hotspot during the summer months, plainly due to the number of visitors on the continent. Although Medical Air Service’s case numbers are skewed by the system itself.
“If Americans don’t travel far, either domestically or going to Canada or Mexico, it’s more likely that the insurance coverage will still apply, or that at least they will not need a medical flight. For us, there is a certain tendency towards Europe in summer, because that’s far away enough that you definitely have to fly,” he said.
When a customer calls, it is quite likely that the need to get home will be urgent, “tomorrow at the latest”, says Mikulski. As with anything last minute, the bill is hefty, especially on long-distance routes like Europe to the US. “It comes at a cost that is difficult for many people to afford, especially because people are usually saying they want to get out of wherever they are right now.”
“Many people don’t have the time to do crowdfunding successfully to raise that kind of money if they want to go home that soon. Most of the people that are travelling with us are actually people who can afford it out of their own pocket if the insurance doesn’t step in,” he said.
Mikulski estimates the average cost of US-Europe flight to be about $100,000, but this figure can go higher, especially if the patient lives on the US west coast.
“We also try to work with alternatives that do not involve private jets with medical equipment, possibly using scheduled commercial flights where a stretcher can be installed specifically for that flight. That would bring the cost down to about $30,000. But at the same time, there are medical limitations on when we can actually do that. For example, if you’ve just had a stroke, you may not be able to fly commercially,” he said.
There is no clear trend on the age or background of patients that Medical Air Service flies, but the company expects the number of missions to continue to grow year-over-year. Mikulski said there is a “slight tendency” towards transporting older people, but overall it is a “mixed bag”.
“There are young people who are simply risk-takers. There are also people who make decisions that do not make sense,” he said. Mikulski recalled a case in which he repatriated a woman who was 32 weeks pregnant and had insisted on going to Nepal. “Something happened with the pregnancy, and she obviously wanted to get home immediately,” he said.
Mikulski confidently predicts continued growth in medical repatriation missions.
“We expect growth not just next year, but every year, because all the statistics and forecasts show that people around the world are travelling more and more. We see that the desire to travel is there, despite the wars and everything else happening in the world. For example, there are many orders for new commercial aircraft and new cruise ships. The entire industry is preparing for people to travel more, not less,” he said.
“That is why we look to the future positively. We know that people want to travel, no matter their age. And with more people travelling, we expect the business to grow because, unfortunately, people will always fall ill.”
