If something goes wrong at sea

Let me start with the reassuring number, because it is the true one. The CDC publishes that about 95% of acute illnesses or injuries on cruise ships are treated or managed onboard. You see the doctor, you get treated, you carry on with your holiday.

This article is about the other five per cent, and about the words in your ticket contract that nobody reads until they matter.

Being seen

Royal Caribbean publishes that guests feeling unwell "can be immediately evaluated by medical staff, with an in-stateroom visit or by video tele-consultation." You do not necessarily have to walk down there yourself, which is worth knowing at three in the morning.

Being confined to your cabin

Every major line reserves this right, and the wording is broader than people expect.

Royal Caribbean's contract allows the carrier to "confine to a stateroom or quarantine... disembark or refuse to embark the Guest" where in its sole opinion the guest is "detrimental to himself or the health, welfare, comfort or enjoyment of others."

Princess: the carrier may "disembark or refuse to embark You, confine You in a stateroom, quarantine You, restrain You... if, in the sole opinion of Carrier, the Captain or any physician, You or any minor or other person in Your care during the Cruise are unfit for any reason for the Cruise."

Carnival's captain may "disembark any Guest whose physical or mental condition or behavior would be considered... a risk to any Guest or crew member." Norwegian's is similar.

These are not unreasonable powers on a ship at sea with thousands of people aboard. They are just far-reaching, and they are decided by the ship, not by you.

Being taken off the ship

Royal Caribbean is honest about the limits in a way I respect: medical care onboard and in ports of call "may be limited or delayed and medical evacuation may not be possible from the Vessel while at sea or from every location to which the Vessel sails."

The CDC notes that evacuations "can present logistical challenges and pose additional risks to ill patients." A helicopter off a ship is not a taxi. It happens when it is both necessary and possible.

Who pays, in the lines' own words

Royal Caribbean	Guest pays for all medical care "including the cost of any emergency medical care or transportation incurred by Carrier." If the line pays it first, you reimburse them.
Princess	You agree "to indemnify the Carrier for all medical or evacuation costs or expenses incurred on Your behalf."
Norwegian	Passengers needing specialised care "may be evacuated at their expense."
Carnival	Its US terms provide that disembarked guests receive no refund and pay their own repatriation expenses.

On cost, the only official figure we could find is the CDC's general medical evacuation range: from about $25,000 for transport within North America to over $250,000 for more distant and remote locations. That is for medevac generally, not cruise-specific, so treat it as the order of magnitude rather than a quote.

The CDC adds a detail people get wrong: "The decision to medically evacuate is at the discretion of the insurance company; it is not made at the request of the traveler."

And Medicare, one more time

The CDC states it plainly: "Except in limited circumstances, the Social Security Medicare program does not provide coverage for medical costs incurred outside the United States, nor does it cover medical evacuation."

Its recommendation for cruise passengers is equally plain: verify your coverage, and if it is not included, consider buying insurance that covers medical evacuation and health services on ships and abroad. We have a full page on that.

General information from published cruise line contracts and CDC sources, not medical or legal advice. Contract terms change and vary by line, region and sailing — read the one attached to your own booking.