If you haven't taken your trip to Canada or bought insurance yet, this may help. I just attended a pretty low key presentation by SkyMed. The rep said that if one of their members requires hospitalization and can be stabilized for an air ambulance flight, they will take the member and spouse back home from anywhere in Canada (and elsewhere in North America) and they pay for the transport. She said that medical necessity is not required for their service. There is also no requirement for approval from doctors or insurance administrators. All the member has to do is ask for it. Their service includes transport by ambulance, helicopter, and jet. She was very specific in the presentation about taking the members home, not just to the nearest adequate medical facility. I don't know how this works for fulltimers who don't actually have a fixed home location. I guess they would just pick a place where they have good healthcare coverage or where they have family or maybe they can just say their home is near a specific hospital like the Mayo Clinic. The SkyMed rep also said that any pre-existing conditions do not apply after the first 90 days of membership. She said that transport for hospitalization caused by something unrelated to a pre-existing condition is covered immediately. So if you have medical insurance coverage in the USA, this could greatly reduce your costs by bringing you from Canada where you have little or no health insurance coverage to your home hospital where you probably have pretty good coverage. You can check them out for yourself at skymed.com. I'd be curious to know what you think about them. I haven't bought from them yet but I'm leaning that way. So please post what you find out.