The real-life horror stories abound. An American has a massive heart attack in Africa and a special team of medical experts must fly in to evacuate him. The cost: $280,000.

A woman breaks her back while in Kenya. The cost to stabilize her, to lease a private Lear jet with medical staff, and to evacuate her: $74,000.

These two were lucky--they had expatriate insurance, which covers the costs of emergency medical evacuation to Western hospitals equipped to treat serious injuries and staffed by certified medical professionals.

But consider the case of another American woman who contracted a tapeworm while in Singapore and subsequently developed a brain infection. She had to return to the United States quickly in order to receive the expert-level of care she needed. The problem: She bought her health insurance from a foreign company while abroad, and it didn't cover treatment in America.

Had she known her options, she could have bought a comprehensive expatriate health insurance plan that covered medical care both overseas and back home.

Expatriate insurance tackles specials needs

Expatriate insurance, also known as global or international medical insurance, is a specialized type of health insurance designed specifically for people on extended stays outside of the United States. Though the insurance is specialized, access to it is by no means limited, especially given the increasing number of people leaving their homelands for extended periods of travel or residency abroad, often for many years.

While eliminating problems with geographic limits and the closed provider networks set by U.S.-managed care plans, expatriate insurance also addresses the other special needs of travelers who must cope with foreign health care systems. These include language translation, foreign currency exchange, transportation to Western treatment centers, and a variety of cultural issues.

The State Department has issued warning regarding the risks of having inadequate health coverage when you travel: "It is wise to review your health insurance policy before you travel. In some places, particularly at resorts, medical costs can be as high or higher than in the United States. If your insurance policy does not cover you abroad, it is strongly recommended that you purchase a policy that does. There are short-term health insurance policies designed specifically to cover travel."

Other health plans fall short

The reality is that most American health insurance plans are not intended to cover lengthy trips out of the country. HMOs, for instance, while covering emergency room treatment anywhere, generally offer additional coverage only through networks of doctors within your own state. Preferred provider organizations (PPOs) cover a greater portion of your medical costs only if you go to doctors in the network--and again, those networks are usually local. As for Medicare, it doesn't cover any health insurance expenses incurred outside the United States.

That said, you can't necessarily count on basic travel insurance, either. Travel insurance typically has a six-month limit on benefits, so, if you break your leg during your seventh month of travel, you're out of luck. And even if you were injured during your third month, if your treatment continues past the six-month mark, you often become responsible for medical expenses incurred after that point.

It’s also important to make sure you purchase your coverage in your home country, prior to your trip. If you opt to buy expatriate insurance from a foreign company once you're already overseas, for example, it's not likely to do you any good if you need to return stateside.

The Centers for Disease Control and Prevention (CDC) has issued its own recommendations regarding the importance of bringing certain documentation along when you travel: “If the health insurance policy provides coverage outside the United States, travelers should be advised to carry both the insurance policy identity card (as proof of insurance) and a claim form.”

The CDC points out that failing to make sure you have the right coverage can be a costly mistake. As they put it, "Although some health insurance companies will pay customary and reasonable' hospital costs abroad, very few will pay for medical evacuation to the United States. Medical evacuation can easily cost $10,000 or more, depending on the location and medical condition."

Multiple choices

Deciding which expatriate plan to buy depends on you and your family's personal needs, finances, and travel itinerary. If you're heading for London rather than the farthest reaches of Antarctica, you can probably do with less than $150,000 in emergency-evacuation coverage. If you're taking your family to Germany for two years, you might want to consider wellness coverage, especially for your children.

It's often a good idea to make a detailed list of all the features you definitely need in a plan, those you'd like, and those you can do without. Perusing the Internet, where many brokers list various plan benefits, is often helpful. These days, you can even purchase plans online after filling out a standard application form. There, you'll have to list any "medical impairments" you or family members have, but coverage can sometimes be issued immediately.

Plan pricing is varied and hinges on your desired menu of benefits, the area of the world you'll be living in or visiting, and other factors. It should be stated too that experts caution against shopping on price alone, because if a product is much less expensive than others, it often has major exclusions. As with any kind of insurance, the key is to make sure you are as covered as you need to be in order to feel safe.