In this guide
  1. How onboard billing usually works
  2. Real examples
  3. The evacuation problem
  4. How to protect yourself
  5. Sources
General information, not medical advice. This guide explains common options and official guidance. It can't account for your health, medicines or itinerary. Talk to your own doctor or pharmacist before your cruise. Medical disclaimer.

A visit to a cruise ship’s medical center is usually not included in your fare, and the CDC notes that even over-the-counter medicines can cost more onboard than at home (CDC Yellow Book: Cruise Ship Travel). Here’s how billing typically works, followed by some real examples.

About these examples: they come from news reports and traveler forums. They show the kind of charges people have reported, not what you will pay. Prices vary by cruise line, ship, year and treatment.

How onboard billing usually works

  • Charges go on your onboard account. The chair of ACEP’s cruise ship medicine section told KFF Health News that medical charges are typically added to a passenger’s onboard account, which must be paid before leaving the ship. You can then submit receipts to your insurer (KFF Health News, 2024).
  • The ship generally won’t bill your insurer for you. In the KFF case, Royal Caribbean did not accept “land-based” health insurance plans. Cruise Radio likewise reports that cruise lines don’t accept travel insurance onboard; you pay and claim afterwards (Cruise Radio, 2024).
  • Home insurance may not help. KFF notes that many health plans don’t cover care on cruise ships. Medicare sometimes covers medically necessary care on a cruise ship, but not if the ship is more than six hours from a U.S. port (KFF Health News).

Real examples

SituationReported billSource
Severe seasickness: IV fluids and anti-nausea medicine (Norwegian Bliss, Alaska)$2,297 total ($2,085 services, $116 medicines, $96 supplies)Cruise Radio, June 2024
Three seizures, observation, blood test, anticonvulsants, then evacuation by rescue boat (Royal Caribbean)$2,500.22 onboard, before ER and ambulance costs ashoreKFF Health News, May 2024
Kidney stone treated onboardAbout $4,000 (forum report)Cruise Critic forum
Urinary tract infection visitAbout $311 (forum report)Cruise Critic forum
Seasickness injectionAbout $167 (forum report)Cruise Critic forum

The seasickness bill was itemized. Cruise Radio reported $219 for admission, $219 for the doctor’s consultation, $228 for nursing fees, $131 per IV bag and a separate charge for a pulse-oximeter reading.

The evacuation problem

The bigger financial risk is usually not the onboard bill but what happens next. If you need care the ship can’t provide, you may be taken ashore. The U.S. State Department says air-ambulance evacuation back to the U.S. can cost $20,000 to $200,000 (State Department). The CDC’s travel insurance chapter cites $25,000 within North America to over $250,000 from remote locations (CDC Yellow Book).

How to protect yourself

  1. Check your health plan before you go: does it cover care on a ship or abroad, and how do you claim? (CDC)
  2. Consider travel medical and evacuation cover. See travel insurance vs. medical evacuation cover.
  3. Keep every itemized receipt and the medical report. The CDC notes that poor documentation is a main reason claims get refused.
  4. Pack the basics so a minor problem doesn’t mean a paid visit. See our cruise medicine cabinet packing list.
  5. Don’t delay care to save money. If you’re seriously unwell, go to the medical center.

Sources