Don't forget to invest in your health before takeoff

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You're out somewhere in your hometown and you twist an ankle, fall and, in the process, break an arm or a leg or your hip -- or worse. Or suddenly you show signs of some serious illness.

It's a terrible experience, but at least you are close to home and you know whom to turn to for help -- you can depend on a family doctor, and there's probably a nearby hospital to care for your needs.

What if you were far from home, in one of the places I've been in recent years -- the Andes of Peru, out-of-the-way islands of the South Pacific, remote areas of China or off the beaten path in Montana, Wyoming, the Dakotas, Alaska and parts of Africa, Australia, Eastern Europe and Southeast Asia?

Many people who agonize over such small details as how many pairs of shoes to take on their vacation somehow forget to plan for something that is far more important: What would you do if you had a medical emergency during your trip and needed to be medically evacuated?

A medical evacuation could cost dearly. It's very expensive -- typically tens of thousands of dollars, frequently topping $50,000 and sometimes even $100,000. It could devastate your family's finances. Yet very few people are covered against this possibility.

Most medical policies, HMO and PPO health plans provide no coverage, or extremely limited coverage, for these expenses. Medicare does not cover you outside the United States, nor do most Medicare supplements. If you believe one of your insurance policies or premium credit card supplements guarantees you medical evacuation, you would be wise to read the fine print very carefully.

Most likely every dollar, or nearly every dollar, of such an enormous expense would have to come out of your pocket.

Travelers who knowingly or unknowingly expose themselves to the risk of incurring an enormous bill for a medical evacuation make a big mistake. So do would-be travelers who decide not to visit their dream destinations because they have heard horror tales about people who have had to pay out large sums for a medical evacuation.

The smart thing to do is what highly experienced, knowledgeable world travelers do: Be certain that you have a travel protection plan that does what you want it to do.

Read the fine print very carefully and make sure you understand any disclaimers. Most plans have a cap, often set quite low, making you responsible for any expense in excess of the cap. Most simply guarantee getting you to the nearest medical center, a loophole scary to anyone who has seen what can pass for a medical facility in many parts of the world.