cruise ships care

June 1, 2020

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Medical Emergency on a Cruise Ship: What Should You Do?

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Do cruise ships have doctors, nurses, medical centers or hospitals?

Do cruise ships have medical facilities with doctors and nurses on board? The short answer is yes.

When you board a cruise ship you become part of a community of people of all ages who will be together for several days, a week or more. On large cruise ships carrying thousands of passengers and crew, your community may be the size of a town or even a small city. To handle any health issues that come up in this floating metropolis, cruise lines employ doctors and nurses who work out of an onboard medical center.

To be clear, the onboard facility is not a hospital – it's more akin to a health center or ambulatory care unit. The professionals who work there have training in emergency medicine and the equipment to stabilize a patient even in dire circumstances. Mostly, though, what they deal with are things like sprained ankles, upset stomachs and people who have forgotten to pack medication.

For more cruise guides, reviews and tips, sign up for TPG's cruise newsletter .

That said, in the wake of the COVID-19 pandemic, many cruise lines have expanded their medical care facilities on ships and added new requirements for medical personnel. Royal Caribbean , for example, now requires all its doctors to have training in acute respiratory illness and has added an infection control officer who oversees the line's infection control plan on each ship.

If you have an emergency on any cruise ship, you can push a button on your stateroom phone for help – the equivalent of dialing 911 from your home phone. For minor ailments, you can visit the medical facility during set office hours.

Who are the medical personnel?

The American College of Emergency Physicians, in conjunction with the Cruise Lines International Association, sets strict standards for who treats patients, as well as guidelines for medical facilities, on ships operating from the U.S. Similar authorities are involved for international cruises. All medical staff are both certified and experienced.

Under the ACEP standards, physicians must have three years of post-graduate/post-registration experience in general and emergency medicine or be board-certified in emergency medicine, family medicine or internal medicine. Staff also must be certified in advanced life support or have certification or physician specialist training in areas such as emergency medicine, anesthesiology or critical care.

Ships that carry children under age 12 are required to have at least one physician with training in pediatrics or with an equivalent emergency training that involves kids.

Training requirements for nurses also are quite detailed. Typically, one of the nurses is a trained paramedic and all nurses are experienced registered nurses.

Medical staff varies by ship size, but typically ships have a doctor and at least two nurses. The world's largest cruise ships may have two doctors and five or six nurses. River ships and small ships that hover close to shore have less staff since they can easily access health facilities on land.

Cruise lines find shipboard nurses and doctors via worldwide recruitment companies. Medical personnel typically work on ships on two- to six-month contracts.

Doctors and nurses report to a chief medical officer at the cruise line's headquarters, who is available 24 hours a day to deal with emergencies.

What to expect at a cruise ship medical center

Cruise ship medical centers usually are located on a lower deck, set apart from crowded areas and close to the back-of-the-house crew facilities. The medical personnel treat both passengers and crew.

While medical personnel are on call 24 hours a day, most passengers visit during scheduled hours. Carnival Cruise Line 's facilities, for instance, are open on embarkation day from 8 to 9 a.m. and 3 to 5 p.m; on sea days from 9 a.m. to noon and 3 to 6 p.m.; and on port days from 8 to 10 a.m. and 4 to 6 p.m.

Inside the medical center you'll find a waiting room – where you will fill out medical history forms as you would in any doctor's office – and exam rooms. Only if your medical situation requires it will you see a separate area with hospital beds, a small surgical suite where wound suturing and other minor surgeries may be conducted, or the ICU or isolation rooms.

Equipment in shipboard medical centers includes defibrillators, cardiac monitors, external cardiac pacing capability, a ventilator, oxygen tanks, x-ray machines and lab equipment. Some lines add technology; for example, select Carnival ships have thrombolytic therapy (to break down blood clots) and pulse oximetry (to test oxygen levels). There will also be wheelchairs and stretchers.

Pharmacy supplies include seasickness pills, aspirin and other over-the-counter products, antibiotics and limited supplies of prescription medications, as well as emergency medications such as those needed for advanced cardiac life support.

Serious situations

While most medical complaints on ships are routine, the medical team is equipped to perform life support services and stabilize anyone seriously ill. Personnel trained in medivac procedures would then generally medically disembark the patient on a stretcher at the next port of call and have the person transferred to a hospital.

If an extreme case occurs at sea, the U.S. Coast Guard (or equivalent local authority overseas) will be called in to hoist the patient off the ship by boat or helicopter.

No one likes to think about it, but your ship may also have a morgue with refrigerated units.

Who pays for treatment

Cruise ship doctors work as independent contractors and may charge a basic hourly fee. There will be additional charges for medications and tests.

All must be paid for at the time of service and will be billed to your shipboard spending account. You'll receive a receipt to submit to your health insurance company for possible reimbursement. Be aware: Many personal insurance policies purchased at home do not cover you while traveling outside the U.S.

Related: A guide to travel insurance for cruises

If you purchased separate travel health insurance from your cruise line or a third-party provider you will still be required to pay for the services up front and may have to wait several months to be reimbursed.

Planning a cruise? Start with these stories:

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• A quick guide to the most popular cruise lines
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What you need to know about medical care on cruise ships

If you get sick at sea, here's what you can expect.

From aqua parks to Michelin star chefs, cruise lines aren't shy about advertising their high-end amenities. But what the ads don't reveal is that the medical facilities on board are likely to be far less grand. "People assume that they will have access to the same medical care on a cruise that they do on land, but this is hardly the case," says Natalie Newman, M.D., who has served as a ship doctor on several cruises. And cruise-ships pose some unique health risks, too, from  infections that can spread quickly in the boats close quarters to insect-borne diseases at ports-of-call.

Understanding the realities of medicine at sea can help keep your  "Love Boat" dream trip from turning into a "Poseidon Adventure" medical disaster.

1. Infections spread easily

A cruise can be just what the doctor ordered to beat the winter doldrums. But it can also expose you to some nasty infections. Norovirus, which is so common on boats that it's called the cruise-ship virus, causes vomiting and diarrhea. Scrupulous hygiene is key to containing this highly conta­gious disease, which is not limited to ships. Wash hands after every trip to the bathroom and before every meal. Soap and water is best, though a hand sanitiz­er that's at least 60 percent alcohol is OK. The good news: Most people get better in a day or two.

2. Mosquitoes can come aboard

The Caribbean and Central America, two popular cruise-ship destinations, are now home to dengue fever and chikungunya (ChikV), diseases once found almost only in Africa and Asia. Both can cause high fever, headaches, and joint pain that last about a week. Mosquitoes carrying both have also been found in Florida. To avoid bites , when on shore cover up as much as possible and avoid tight clothes, dark colors, and perfume. Natural repellents with 20 percent picaridin worked well in our tests. Deet-based products also work, but we recommend avoiding those that are more than 30 percent deet.

3. Cruise ships aren't hospitals

Many ships have a doctor on board who, like Newman, is trained in emergency medicine—but not all of them. According to international maritime law, they aren't required to; a crew member with medical training is sufficient, says Ross Klein, Ph.D., author of "Paradise Lost at Sea: Rethinking Cruise Vacations." The medical facilities are generally more like an infirmary or walk-in care clinic than a "floating" hospital. You might find a ventilator and a small X-ray machine and the doctor may be able to perform simple laboratory tests to check for infection or electrolyte or blood sugar levels. But there's no MRI or CT scanner, intensive care unit, or blood bank (although the crew has usually been blood-typed and may be asked to serve as donors if a passenger needs a transfusion). 

4. In an emergency, you may be on your own

"We're all used to getting medical care where and when we need it, but that's not the case mid-sea," Klein said. You probably could get basic treatment, such as stitches or IV fluids, but for anything serious, there's a very good chance that you will have to disembark at the next port of call—whether you want to or not. It's up to the ship's medical personnel, not you, to decide, Newman says. You'd be treated at a local hospital, and the ones in more remote areas may not have the same standards of medical care or facilities available in the U.S. And once you recovered, you'd have to arrange another way to get back home.

What if you have a heart attack or develop appendicitis miles from dry land? Don't assume the Coast Guard will airlift you out. Bad weather can make flying a helicopter dangerous, and the Coast Guard isn't obligated to take that risk. Even in calm waters, if the ship is 500 miles or more away from shore, it's unlikely that the Coast Guard will respond, Klein said.

Read about your consumer rights on cruise ships .

5. Get ready for sticker shock

Check with your health insurance company before you set sail to be sure, but most plans don't cover medical services you get on board, according to Newman. (In fact, this is usually the case anytime you receive medical treatment from a doctor or hospital outside the U.S.) This means you pay out-of-pocket. The bill can range from a few hundred to several thousand dollars "People don't realize the extra expense they will incur for each medical service received," Newman says.

Travel health insurance is your best protection. Consumer Reports recommends avoiding commission-driven policies sold by tour operators, cruise-line representatives, and travel agents. Instead check out an online broker, such as insuremytrip.com , that sells coverage from multiple companies and allows you to tailor a plan to your needs. Ask for quotes, but be sure you're comparing apples to apples. What's covered under policies can vary. For example, some may not include emergency evacuation.

6. Your ship does not have a CVS

Most ships do have common prescription drugs on board, but you can't count on it. What's more, if you needed one, you'd be charged full price—not just your insurance co-pay—for each drug dispensed on the ship. That also goes for over-the-counter medications, such as aspirin and sea-sickness pills, as well as bandages. Be sure to pack enough of any prescription medication you take to last the entire trip —and a little extra in case you are waylaid for any reason. Write down the brand and generic names of the drugs, the dosage, and the dosage frequency, too, and keep the list with you in case you need to get a refill in a foreign port. You might want to bring along any over-the-counter drugs (painkillers, antacids, etc.) you think you might need, too, as you'll pay far less for them at your local supermarket or drug store than you will on board.

7. A cruise is no place to convalesce

Taking the time to rest and pamper yourself after surgery or a major illness is a good idea—as long as you stay on terra firma. About one out of five people who are hospitalized are readmitted within 30 days of discharge and you don't want to be in the middle of the Caribbean if you are one of them. The same goes for people who have a long-term condition that requires strict medical management. Even if your doctor clears you for travel, consider the type of monitoring or treatment you need to receive regularly, such as dialysis or checking for blood thinner levels. According to Newman, doctors often give their patients their blessing, assuming that the ship's doctor will do whatever needs to be done. "On one trip, I had five passengers who were taking blood thinners and they needed regulation in order to avoid a stroke or a blood clot," she says. "Only one of them was within an acceptable therapeutic range. One physician sent along a note, expecting me to stabilize the patient's blood levels."  

8. The cruise itself may put your health at risk

Norovirus and motion sickness aren't the only health concerns to think about when you're on a cruise. Falls and cardiac problems are also quite common. The CDC estimates that injuries, typically from slips, trips, or falls, account for 12 to 18 percent of shipboard medical visits. Obviously anyone can fall, but for people who use a cane, walker, or wheelchair, wet decks, rough waters, and the occasional cocktail can be a formula for disaster.

Studies have identified that the highest likelihood of sudden cardiac death occurs on holidays associated with overindulgence—Christmas, New Year's, Thanksgiving, and the Fourth of July. Given the rich food, 24/7 buffets, and copious amounts of alcohol available, you can put a cruise vacation in the same category. While the mechanism is not clear, triglycerides—a type of fat that's present in your bloodstream after a large meal—can cause coronary artery inflammation, a common prelude to a heart attack. Large amounts of food and alcohol can set off adrenalinelike substances that can cause a fatal abnormal heart rhythm. Most deaths aboard ships are from heart problems, and most liners are equipped with a dedicated morgue.

9. You can sue the cruise line, but you will lose

Courts have ruled that a cruise line may not be held vicariously liable for the negligence of a ship's doctor, and that "a cruise ship is not a floating hospital." To the surprise of many disgruntled passengers, there's no medical malpractice for care rendered aboard a ship. "The physician is a private contractor," Klein says, "and don't think that the cruise line will accept liability—that's been tested all the way up to the Supreme Court of Florida."

—Orly Avitzur, M.D

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Cruise Ship Travel

While cruising is a popular way to travel, there are some health concerns to be aware of. Find out more about health issues on cruises and steps you can take to stay safe and healthy during your trip.

If you are feeling sick before your voyage, do not travel and ask your cruise line about rescheduling or reimbursement options. If you feel sick during your voyage, report your symptoms to the ship’s medical center and follow their recommendations.

Common Health Concerns During Cruise Travel and What You Can Do to Prevent Illness

• Respiratory viral illnesses like COVID-19 ,  flu , and RSV :  Follow core prevention strategies to protect yourself and others. Get your annual flu shot , stay  up to date on your COVID-19 vaccines , and check if you're eligible for an RSV vaccine . Check directly with your cruise line before travel about any health requirements. If you have a weakened immune system , talk with your healthcare provider about your cruise travel plans. Wash your hands frequently or use hand sanitizer . Stay home and away from others if you have respiratory virus symptoms. Do not travel until your symptoms are improving and you have not had a fever for 24 hours (without meds). For 5 additional days, take precautions including covering your nose and mouth with a tissue to prevent spreading germs when you cough or sneeze. Consider wearing a mask in crowded or poorly ventilated indoor areas or avoiding those areas all together.
• Gastrointestinal illness:  Symptoms of vomiting and diarrhea, primarily caused by outbreaks of norovirus , have been reported. To prevent gastrointestinal illness, wash your hands with soap and water before eating and after using the bathroom, changing diapers, or touching things that other people have touched, such as stair railings. Avoid touching your face. For more information, visit CDC’s  Vessel Sanitation Program  website.
• Seasickness:  Cruise ship passengers may experience seasickness or motion sickness. If you know you get seasick or think you may be likely to get seasick, talk to your healthcare provider about medicine to reduce your symptoms. Some common medications, including some antidepressants, painkillers, and birth control pills, can make seasickness worse.
• Sunburns:  Apply sunscreen with SPF 15 or higher when traveling. Protecting yourself from the sun isn’t just for tropical beaches—you can get a sunburn even if it’s cloudy or cold.
• Bug bites:  On your trip, use insect repellent and take other steps to avoid bug bites. Bugs, including mosquitoes and ticks, can spread diseases such as malaria, yellow fever, Zika, dengue, chikungunya, and Lyme. Many ships visit ports where these diseases are a concern.

Before Your Trip

Check CDC’s destination pages for travel health information . Check CDC’s webpage for your destination to see what vaccines or medicines you may need and what diseases or health risks are a concern at your destination.

Make sure you are up to date with all of your routine vaccines . Routine vaccinations protect you from infectious diseases that can spread quickly in groups of people. Outbreaks of chickenpox, flu, and COVID-19 have been reported on cruise ships.

Many diseases prevented by routine vaccination are not common in the United States but are still common in other countries. Crew members and fellow travelers often board a cruise ship from destinations where some diseases are more common than in the United States or where vaccination is not routine.

Make an appointment with your healthcare provider or a travel health specialist  that takes place at least one month before you leave. They can help you get destination-specific vaccines, medicines, and information. Discussing your health concerns, itinerary, and planned activities with your provider allows them to give more specific advice and recommendations.

Plan for the Unexpected

Prepare for any unexpected issues during your cruise ship travels with the following steps:

Prepare a  travel health kit  with items you may need, especially those items that may be difficult to find at your destination. Include your prescriptions and over-the-counter medicines in your travel health kit and take enough to last your entire trip, plus extra in case of travel delays. Depending on your destination you may also want to pack a mask ,  insect repellent , sunscreen (SPF 15 or higher), aloe, alcohol-based hand sanitizer, water disinfection tablets, and your health insurance card.

Get travel insurance.  Find out if your health insurance covers medical care abroad. Travelers are usually responsible for paying hospital and other medical expenses out of pocket at most destinations. Make sure you have a plan to  get care overseas , in case you need it. Consider buying  additional insurance  that covers health care and emergency evacuation, especially if you will be traveling to remote areas.

If you need medical care abroad, see Getting Health Care During Travel .

After Travel

If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider and tell them about your travel. Avoid contact with other people while you are sick.

More Information

• Cruise Ship Travel in CDC Yellow Book
• Tips for Healthy Cruising
• Maritime Guidance

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What licensed medical staff/doctor and services are available onboard a Royal Caribbean cruise ship?

Every Royal Caribbean ship offers limited professional medical services through licensed (international or domestic) physicians and nurses. All Royal Caribbean Group ships have shipboard medical facilities that are built, staffed, stocked, and equipped to meet or exceed guidelines established by the American College of Emergency Physicians Cruise Ship & Maritime Medicine Section.

Depending on the size of the ship and number of passengers and crew members, each RCG ship has two to three licensed doctors and three to five licensed nurses available to passengers and crew members 24/7. Our doctors do not have NPI numbers, as that is a US-based requirement, instead they use tax IDs. 

Our medical facilities are stocked with a variety of equipment including cardiac monitors, automated external defibrillators, ventilators, x-ray machines and processors, laboratory equipment, a formulary of acute care medications, and a variety of minor surgical and orthopedic supplies. Our doctors also have access to online informational resources and 24-hour support from shoreside medical professionals for additional assistance. Royal Caribbean Group also requires all doctors and nurses to maintain Advanced Cardiac Life Support (ACLS) training. In responding to medical emergencies, our goal is to first stabilize emergency patients and, when necessary, evacuate the patient to an appropriately equipped and staffed shoreside medical facility.

If you have been treated onboard, and need to request your medical records, please fill out the request form .

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Does Medicare cover you on a cruise ship?

Published by Medicare Made Clear®

Original Medicare (Parts A & B) may cover medically necessary health care services on a cruise ship, if the ship you’re on when you receive the care is in a U.S. port or no more than 6 hours away from one when you get the services. That means the ship can be in the water, but must be within six hours of a U.S. port. Also, the doctor must be legally allowed to provide medical services on a cruise ship.

Original Medicare will not cover any care you get on a ship that’s more than six hours from a U.S. port, even if it’s an emergency.

How to get Medicare coverage for an international cruise

Some Medicare Advantage plans (Part C) may offer coverage for foreign travel, along with other benefits not provided by Original Medicare. Talk to your plan provider to see if you would be covered while cruising in international or foreign territorial waters and what your costs might be.

Certain Medicare supplement insurance plans cover foreign travel emergency care, including care on a cruise ship. Check the details with your plan provider to understand what is and isn’t covered as well as how much it may cost.

Travel insurance coverage for international medical care

You may also investigate buying travel insurance specifically for your trip. In addition to providing protection against trip cancellation, theft or other mishaps, some plans will cover you if you need medical or hospital care while you’re outside the U.S. Plans vary, so talk with your insurance agent/producer, travel agent or insurance provider to learn about your options. Travel insurance is separate and distinct from any Medicare or Medigap plan.

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September 05, 2024

POCUS (Point-of-Care Ultrasound) for Cruise Ship Health Care

Written by: Lori Green BA, RDMS, RDCS, RVT

Planning a cruise ship vacation allows one to experience destinations throughout the world that offers relaxation and adventure based on your desired itinerary. The combination of activities available on board, robust dining options, and exciting on-shore excursions make a cruise ship vacation a very enticing option to consider.

No one plans on becoming sick or injured while on vacation, but unfortunate medical issues do arise. Cruise ships are essentially floating cities offering many amenities, but also a robust medical team to take care of most minor non-emergency health care issues. Occasionally, more serious traumas and health conditions such as fracture or heart attack occur and may require expanded capabilities and/or the possibility of the passenger disembarked to obtain on-shore medical care.

Cruise Ship Health Care Guidelines

Medical facility requirements on board cruise ships are based on a variety of factors including, but not limited to ship size, cruise itinerary, anticipated passenger mix, and number of medical visits.

According to the Cruise Lines International Association (CLIA), “As a result of cooperative efforts between experienced cruise ship physicians and ACEP (American College of Emergency Physicians), CLIA ocean-going cruise lines worldwide carrying 100 or more persons on board, traveling on itineraries to international waters, have agreed to meet or exceed the requirements of the ACEP Health Care Guidelines for Cruise Ship Medical Facilities as revised January 2019. ACEP's guidelines address the facilities, staffing, equipment and procedures for medical infirmaries on cruise ships traveling outside territorial waters of the coastal state. Patients requiring more comprehensive facilities or treatment are typically referred to a shoreside medical facility.”

ACEP POCUS Guidelines for Cruise Ship Medical Facilities

The ACEP Guidelines for Cruise Ship Medical Facilities, adopted in 2019, were updated in 2023 to include the utilization of Point-of Care Ultrasound (POCUS) on-board all CLIA ships, which will become effective January 1, 2026. As of this date, the guidelines stipulate that at least one physician on board must be trained and competent in the core POCUS applications.

POCUS refers to limited ultrasound exams performed at the bedside to answer specific clinical questions that may guide the clinical assessment and treatment decision. The basic core POCUS applications outlined in the guidelines include ultrasound physics, knobology, vascular access, procedural guidance, extended trauma assessment (E-FAST), and evaluation for deep venous thrombosis (DVT).

POCUS Training

Technological advancements have resulted in more affordable, portable/hand-held ultrasound devices that can be utilized as an accurate and important medical imaging tool in the hands of an adequately trained medical provider. Training should include lecture presentations combined with comprehensive, small group hands-on scanning sessions utilizing standardized patient models and inanimate phantoms for needle guidance techniques.

Gulfcoast Ultrasound Institute (GCUS) has developed several training options that are specifically designed for the maritime medical team and the core POCUS applications included in the ACEP Guidelines for Cruise Ship Health Care. Programs can be conducted at the GCUS education facility located in St. Petersburg, Florida, at the cruise ship port, corporate facilities, or on board the cruise ship. Private one-on-one programs can also be coordinated if desired.

Training Options: Traditional Education Format

GCUS offers the option to coordinate a live, traditional format course(s) including live didactic sessions, featuring expert faculty along with hands-on skills training for a custom tailored, comprehensive POCUS course.

Blended-Education Format

The GCUS blended-education format program provides learners access to the didactic modules in an interactive, online course, specific to POCUS for Cruise Ship Medicine which covers the basic ultrasound applications outlined in the ACEP Cruise Ship Health Guidelines, after which, your group(s) participant’s attend a GCUS hands on scanning workshop to practice those particular skills. The blended-education format offers a flexible option for organizations such as Cruise Lines, because learners can complete the online didactic component at their convenience, from anywhere in the world, so long as they have access to a WiFi enabled device. This helps to streamline the timeframe needed to successfully complete a comprehensive hands-on training for busy maritime medical professionals around the world.

Gulfcoast Ultrasound Institute, Inc.

Gulfcoast Ultrasound Institute, Inc. (GCUS) has been the leading education provider in diagnostic ultrasound since 1985, with nearly 40 years and 200,000 medical providers from around the world who have attended our programs and/or utilized our educational resources. In addition, GCUS was one of the first education providers to offer hands-on courses for POCUS Emergency Medicine/Critical Care Ultrasound applications in the United States, beginning in 1994 and expanding to other practice specialties with Point-of-Care application as the technology has evolved.

GCUS is directly accredited with commendation by the ACCME to provide AMA PRA Category 1 Credit(s)™ and many of our courses are also approved for ACEP credit.

Be prepared to integrate POCUS skills into clinical practice for Cruise Ship Health Care and meet the implementation deadline of January 1, 2026. Visit our website or call today for more information.

www.gcus.com

727-363-4500

About the Author

Lori Green BA, RDMS, RDCS, RVT

Lori is the President and Program Director of Gulfcoast Ultrasound Institute, Inc.

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Table of Contents

What to look for in cruise insurance

Factors we considered when picking the best cruise insurance companies, an overview of the best cruise insurance, best cruise insurance options, more resources for cruise travel insurance shoppers.

Cruising is back, but many travelers are still reluctant to board ships alongside thousands of other travelers. Cruise insurance has you covered if:

You need to be reimbursed for canceling your trip.

Your flight to the port gets delayed.

You need to pay for medical care if you get sick on board.

You need to fly home in case of an emergency.

Of course, there's much more than just this list that cruise insurance can cover.

No matter the reason you might be looking for coverage, here are some of the best cruise insurance companies available to help bring you peace of mind on your next experience at sea:

World Nomads .

Berkshire Hathaway .

Travelex Insurance Services .

Travel Guard by AIG .

When shopping for cruise insurance, make sure to look for coverage that offers the following:

Trip delay and cancellation.

Medical expenses, including emergency evacuation.

The option to cancel for any reason (including COVID-19).

Adventure activities if you’re planning certain onshore excursions.

Cruise insurance isn’t much different than traditional travel insurance. Any good travel insurance should cover cruises in addition to travel by air or car.

After our analysis, we've determined these are some of the best cruise insurance options available.

» Learn more: The best travel credit cards right now

We used the following factors to choose top insurance providers to highlight:

Specifics of coverage: Including what coverage plans include and whether they offer useful coverage and benefits for cruises specifically.

Amount of coverage: Including the maximum payouts for trip cancellation and trip interruption claims.

Cost: We compared prices to determine average costs across basic plans.

Customizability: We checked to see if policies allow users to customize options to suit their specific needs.

» Learn more: The guide to cruise travel insurance

We searched for quotes from several companies for a seven-day trip in February 2023 from the U.S. to Mexico. The traveler was 35 years old, from Georgia, and planned to spend $2,500 total on the whole trip, including airfare.

The average price of each company’s most basic coverage plan was $124. These policies didn't include optional add-ons, such as Cancel for Any Reason coverage or coverage for pre-existing medical conditions .

» Learn more: Should you insure your cruise?

Here’s a closer look at our five recommendations for cruise insurance and what makes them unique.

Allianz Global Assistance

What makes allianz global assistance a top choice for cruise insurance:.

Multiple policies are available for international and domestic travel.

Plans offer trip cancellation and interruption coverage for COVID-19.

Offers emergency medical and transportation.

For our test trip, Allianz Global Assistance’s basic plan cost $106, slightly below average.

World Nomads

What makes world nomads a top choice for cruise insurance:.

Adventure activities like mountain biking and scuba diving are covered, perfect for land-based experienced (though which sports are covered varies from plan to plan).

Offers comprehensive travel insurance plans for domestic and international travel.

Larger-than-average coverage for baggage loss and delays.

For our test trip, World Nomad’s basic plan cost $63, well below average. But the actual trip cost isn’t taken into consideration for trip cancellation and interruption coverage.

Berkshire Hathaway Travel Protection

What makes berkshire hathaway travel protection a top choice for cruise insurance:.

A wide range of comprehensive plans cover cancellation, emergency medical and transportation coverage, and emergency travel assistance.

A cruise-specific plan includes some compensation for cruise disablement and the most emergency medical and evacuation coverage of any of these plans.

There are many plans available, including plans that cover adventure activities.

A Berkshire Hathaway WaveCare cruise-specific plan was $202, quite a bit more than average, but with the most medical evacuation coverage.

Travelex Insurance Services

What makes travelex insurance services a top choice for cruise insurance:.

Three comprehensive plans are available.

Kids-included pricing is available with the Travel Select plan.

There's an option to add accidental death and dismemberment coverage to the basic plan.

The Travel Basic plan from Travelex Insurance Services cost $116 for our sample trip; just below the average for plans listed here.

Travel Guard by AIG

What makes travel guard by aig a top choice for cruise insurance:.

Cancel For Any Reason coverage is available as an optional upgrade on two plans.

A pre-existing condition waiver is also available as an add-on.

Travel Guard by AIG offers a basic Essential plan for $133, just a little higher than average, but adding coverage may raise that price.

Bookmark these resources to help you make smart money moves as you shop for cruise travel insurance.

The best travel insurance companies.

The best credit cards for cruises .

What is travel insurance?

Is travel insurance worth getting?

10 credit cards that provide travel insurance .

How to maximize your rewards

You want a travel credit card that prioritizes what’s important to you. Here are some of the best travel credit cards of 2024 :

Flexibility, point transfers and a large bonus: Chase Sapphire Preferred® Card

No annual fee: Wells Fargo Autograph℠ Card

Flat-rate travel rewards: Capital One Venture Rewards Credit Card

Bonus travel rewards and high-end perks: Chase Sapphire Reserve®

Luxury perks: The Platinum Card® from American Express

Business travelers: Ink Business Preferred® Credit Card

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• Regent Seven Seas Cruises

Best of Moscow by high speed train

By shuguley , February 15, 2014 in Regent Seven Seas Cruises

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Sure would appreciate someone who has taken "Best of Moscow by high speed train" from St. Petersburg could please share their impressions of this shore excursion. From the description this sounds like a very long day.

Wondering how the 4 hour train trip was in terms of accommodations, etc. Also what time did you leave the ship and what time at night did you return? Were both legs of the trip on the high speed rail (I read that slower trains also travel the same tracks)?

My wife and I are considering this excursion. We thought that if we are making all the effort to go to Russia then how could we pass up going to Moscow, walking in Red Square, seeing St. Basil, etc.

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If you are considering this on the 2015 June Baltic cruise on Voyager; my suggestion is don't. There is so much to do in St. Petersburg and although a train is one of my favorite ways to travel the time would be far better spent in St. P.

Thanks for the advice. Yes, this would be on the Voyager during the 2015 season but not yet sure exactly which cruise.

We did the Moscow excursion "on a different luxury line", but from your brief description it sounds very much like the same trip, so I will operate on that assumption. It is a VERY long day! We left the ship at 5:30 AM and returned at 12:30 AM. The highspeed train trip is comfortable, and while they call it "Business Class" it does not compare well to the equivalent class on say Rail Europe. When we did it in 2011, we did have highspeed both ways, and the trip back seemed much longer as the adrenaline and excitement had worn off!:D

Moscow itself is not that terribly different from any other big city in the world, but this Cold War kid never thought he would ever stand in Red Square, never mind walk the grounds of The Kremlin, or tour The Kremlin Palace, or see (but not visit) Lenin's Tomb, or visit The Armoury. But he did, and he loved every minute of it! Yes, it is a long day, and you barely scratch a scratch on the surface, but it is worth it. There is a tremendous amount to see in St. Petersburg, but every Baltic cruise goes to St. Petersburg, so you can go back if you choose to. Not every cruiseline offers you the chance to see Moscow.

I have not personally done this tour, but our last time in St Petersburg, the private guide that we hired for a day was leading the regent tour to Moscow on the high speed train the next day. He said it was way better than the previous alternative, which was flying to Moscow and back. He said that you actually got to Moscow faster because you didn't have to deal with airline checkin etc. it did seem like a very long day to me, and there is so much to see and do in st. Petersburg that I didn't consider doing it.

countflorida

We toured to Moscow from St. Petersburg via the hi-speed SAPSAN train last September, from a Baltic cruise on the Oceania Marina. You need to have a two-night, three day port call in St. Petersburg to take this tour because the tour typically leaves the ship around 5:00 - 5:30 AM and doesn't return until after midnight the next day. We didn't take the ship's tour; we made private arrangements with TravelAllRussia for three days of touring, the first and third days in St. Petersburg and the second day the tour to Moscow by train. Our cost for the private tour for three days was about the same as what the ship charged for the excursion to Moscow alone. There are a number of private tour agencies that operate in St. Petersburg and offer the Moscow train tours; we would strongly recommend them over the ship's tours.

All three days had private guides with car and driver. The second day, the driver picked us up at the ship and took us to the train, but we were alone on the train, and met in Moscow by the guide on the station platform. After our tour and dinner, we were brought back to the train and after the return train trip met by the driver and taken back to the ship. Because you are alone on the train you must have your own Russian visas.

If this is your first visit to St. Petersburg, I would agree there is much more to see there. We found Moscow somewhat a disappointment, particularly Red Square. The Kremlin and the cathedral in Red Square were also worth seeing. But the best thing we saw was the Moscow subway! I worked for the Washington Metro system back in the 1980s as it grew from 40 to 80 miles and although I was in the computer area, I learned a lot about the challenges of running a subway system. We used the Moscow system to get across the city from where we had dinner to the train station, and I was amazed at the cleanliness', speed of operation, the short headways maintained, and the courtesy of everyone involved. A very impressive experience!

We had been to St. Petersburg before, and so had the time to take a day and go to Moscow. Also, I really like trains, and the SAPSAN is a German train set running on Russian rails. Seats are like first class domestic air, spacious but not too plush or comfortable, but with enough room. Not too much recline, and almost 8 hours on the train in two shots is a lot for an old man. They come through and sell drinks, candy, etc. but the sellers don't speak English and no one around us helped, so we had just poor coffee once coming, and brought stuff with us for the trip back. Not too much to see from the train either, particularly on the return when it is night the whole way.

If you decide to go, take a private tour and avoid the overly expensive ship's tour. I'm glad we did it, but wouldn't bother to repeat the tour; we've seen Moscow.

Thanks so much to all of you for the thorough and thought insight. Yhe information you have provided is most helpful.

countflorida: Your detailed post is very helpful. We are not quite ready for a Baltic cruise but should do so within a year. Time enough to do our pre travel research, bookings and visa gathering.:) Thank you!

Emperor Norton

Sure would appreciate someone who has taken "Best of Moscow by high speed train" from St. Petersburg could please share their impressions of this shore excursion. From the description this sounds like a very long day.   Wondering how the 4 hour train trip was in terms of accommodations, etc. Also what time did you leave the ship and what time at night did you return? Were both legs of the trip on the high speed rail (I read that slower trains also travel the same tracks)?   My wife and I are considering this excursion. We thought that if we are making all the effort to go to Russia then how could we pass up going to Moscow, walking in Red Square, seeing St. Basil, etc.

I did this on Seabourn. IMO DONT. Take Aeroflop (er Aeroflot). The train has non folding seats where you are literally knee to knee with your fellow passenger (facing each other). Further they don't believe in air conditioning. It's also the worlds slowed bullet train. I think I would have found more enjoyment wandering around the St. Petersburg and Moscow airports.

Countflorida,

This is a little off topic,, however we had planned a river cruise in Russia but decided we would rather stay on land and have booked about two weeks with Travel-All-Russia using the private guide and driver. I'm curious as to how you found them as a tour company.

The guides they provided were fine. We had a different guide each of the days in St. Petersburg, but both were flexible, pleasant, knowledgeable and spoke English very well, as did the guide in Moscow, incidentally. She was a bit aloof, distant, not too friendly, but otherwise fine. In fact, she was the one who suggested taking the Metro, which unexpectedly became one of the highlights of the Moscow excursion. If I have a complaint with AllTravelRussia, it is with their plan and its execution (more later).

I had requested emphasis on World War II (in Russia, the Great Patriotic War) sites and info. In scheduling us, they weren't careful about dates and a couple of the sites we wanted to see were scheduled on the third day, after we'd been to Moscow. But both sites were closed that day of the week, and that info was readily available, right on web sites describing them. Also, the included meals (lunches in St. Pete, dinner in Moscow) were not what we asked for: light meals with some choices, so we could avoid things we didn't like and choose things we did like. My request was ignored; we were given full Russian meals with a fixed menu, no choice. On the first day, a fish dish was the entre, but I am allergic to fish. Fortunately, I had the e-mail I'd sent with me and showed it to the guide, and she was able to change my entre to chicken, which was very good actually. But we didn't want a 3-4 course lunches or dinner (in Moscow). We had the guide drop the lunch the third day, although we never got any credit or refund. But, particularly in contrast to the ship's tours, the prices were so reasonable we didn't worry too much about it.

The people who were on the ship's tour to Moscow saw us boarding the same train for which they were forced to queue up and wait on the way back, and asked us what we had done. I was candid and open so they were not happy when I explained what we had arranged and particularly what it had cost. Also, when we returned to the ship, we found they had laid on a late supper for those who had gone to Moscow, so up we went and had something. Well, it turns out the late supper was supposed to be just for those on the ship's tour, but we and others on 'independent' tours, there were a dozen or more of us, crashed the party, actually got there first, and they didn't realize it until the larger group arrived and there weren't enough tables/places set. By that time, the 'independents' had all gotten served and were eating; what could they do?

A couple from the larger group sat down with us and asked us about our tour, and they were the ones I told about our arrangement and its cost. They turned to others who’d been with them and announced the details, loudly enough so the whole room heard, which started a lot of bitching and complaining. I gathered they weren't very happy with the ship's tour to begin with, and this was the straw that broke the camel's back. We finished up and beat it out of there, but overheard later that one of the excursion staff came to check on something and ran into a real mess. I caught a cold on the trip, which forced me to bed the second day following in Tallinn, so by the time we reappeared we heard about the contretemps' but apparently no one recalled who started it, thankfully.

Because of what happened to us, I would probably not use AllTravelRussia if I were to go again, or if I did, I would be sure to get confirmation of every detail of the tour. They do have good reviews generally, and we were certainly helped by their visa department and liked the guides and drivers. Their weakness, I say now with full 20:20 hindsight, is that once the sales person who plans the tour, sells it to you and collects your money, he (or she) transfers the plan to their Russia office for implementation; there is no follow-up to make sure it gets done right. And that is where our problems arose; we paid for a custom tour but got a standard package with a few destinations switched, and no one checked them out, even to see when they were open the day we were scheduled to go. If you check every detail that’s important to you, it should be OK, but that’s a hell of a way to have to do business, in my opinion.

Thank you for the 20/20 hindsight observation on your Russian tour operator, and better priced than the ship's excursion cost.

Thanks very much for the feedback.

We had the same experience as you so far as price. We originally booked a Viking Cruise but, hearing some things about the river cruises that made us unhappy, looked into other options. T-A-R cost the same or less than a cruise and had us in hotels for 11 days. We opted for the private tour. They have three tour levels, based on hotels. We originally opted for the four star as it did not cost much more than the three star hotels. Finally we decided to throw it all in and upgraded to five star. In Moscow we will be at the newly opened Kempinsky which is two blocks from Red Square. In St. Petersburg it is the Grand Hotel Europe, one of the most vaunted luxury hotels in Russia. Location is important for us as the tours use up only part of the day so being in the center of everything for our independent touring is important. As with many other cities, the less you pay, the farther out of the center of town you are.

We have been working with our salesman in D.C. and he seems to get back to us with the changes we want. He recently returned from Russia so is up on everything. When I asked they said they paid the full TA commission if I wanted so I got my usual TA on board so he is watching our back and giving us that extra level of comfort. He also set up our air, which I know pays him little or nothing, and got us business class for much less than T-A-R wanted for economy, though it took working for a while with a consolidator. He's happy to get his 10 percent on this trip without having booked it. He also took care of the trip insurance. We've been doing a lot of research on the CC sister site Trip Advisor and will write a report there. We will, I guess, become a source of info for CC members after having spent 5 days in Moscow and 6 in SP.

• 4 months later...

scubacruiserx2

Anybody considering a day trip to Moscow from St. Petersburg on the Sapsan may want to look at our travelogue filled with pictures.

http://boards.cruisecritic.com/showthread.php?t=1927687

Very informative. Thanks dor sharing. Jeff

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Lavrov warns US not to mock Russia's 'red lines'

By Dmitry Antonov and Mark Trevelyan

MOSCOW (Reuters) - Russian Foreign Minister Sergei Lavrov, responding to a question about the potential delivery of long-range U.S. missiles to Ukraine, warned the United States on Wednesday not to joke about Russia's "red lines".

Lavrov said the U.S. was losing sight of the sense of mutual deterrence that had underpinned the balance of security between Moscow and Washington since the Cold War, and that this was dangerous.

He was commenting on a Reuters report that the U.S. is close to an agreement to supply Ukraine with long-range JASSM cruise missiles that could reach deep inside Russia - for which Ukrainian President Volodymyr Zelenskiy has been lobbying.

"I won't be surprised by anything - the Americans have already crossed the threshold they set for themselves. They are being egged on, and Zelenskiy of course sees this and takes advantage of it," Lavrov told a Russian TV interviewer.

"But they should understand - they are joking about our red lines here. They shouldn't joke about our red lines."

President Vladimir Putin has repeatedly warned the West since launching what he called his "special military operation" in Ukraine in 2022 not to try to thwart Russia, which has the world's biggest arsenal of nuclear weapons.

But Washington and its allies have increased military aid to Ukraine, including by providing tanks, advanced missiles and F-16 fighter jets.

That has prompted some Western politicians to suggest Putin's nuclear rhetoric is a bluff and that the U.S. and NATO should go all-out to help Ukraine win the war. Zelenskiy has said Ukraine's incursion into Russia, launched on Aug. 6, makes a mockery of Putin's red lines.

Lavrov said Washington knew where these limits lay but was wrong if it believed the consequences of any escalation of the war in Ukraine would be suffered mainly by Europe.

"They have a genetic conviction that no one will touch them," Lavrov said. This, he said, undermined all the principles that had underpinned strategic stability with Washington since Soviet times.

"This feeling of mutual deterrence - for some reason they are starting to lose it. This is dangerous," he said.

Lavrov alluded to remarks by White House national security adviser John Kirby, who said in June that President Joe Biden had repeatedly said Washington was not looking for "World War Three".

Kirby said a major escalation of the Ukraine war could have "disastrous consequences, potentially, across the European continent" and would not be good for U.S. interests.

It was the second time in just over a week that Lavrov has cautioned the U.S. that a third world war would not be confined to Europe.

The Kremlin said on Wednesday Russia was making changes to its nuclear doctrine because Washington and its allies were threatening Russia by escalating the war in Ukraine and riding roughshod over what it called Moscow's legitimate security interests.

It has not said how it plans to update the policy document setting out the circumstances in which it might use a nuclear weapon, or when the changes will take effect.

(Reporting by Dmitry Antonov in Moscow and Mark Trevelyan in London, Editing by Timothy Heritage)

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