Cruise passengers warned over medical bills "Cruise companies have invested heavily [in facilities]: it is now commonplace to find hospital-grade facilities on board, with resuscitation facilities, laboratory and imaging tests available, a pharmacy and specialist doctors and nurses," he said. Many of the bigger cruise lines are US-owned and land-based care in the US, even for minor problems, can be very expensive and considerably more costly than the average UK passenger would ever expect. According to the report P&O and Cunard said all of their ships comply with the American College of Emergency Physicians Healthcare Guidelines for Cruise Ship Medical Facilities. Dr Dawood said most NHS users have no idea of the true cost of medicines when purchased privately. While most land-based pharmacies can keep costs down by carrying only a narrow stock, to be topped up frequently as new prescriptions require, this is not possible at sea: pharmacies must carry a large stock, catering to the needs of passengers around the world, each item having its own limited shelf life. Medical evacuation by helicopter is not uncommon on cruise ships - the cost of an airlift, especially if the ship will incur sea days, could run into tens of thousands. It is worth checking the policy's small print to find out the extent of any evacuation cover. Dr Dawood added: "Although I understand why the costs can be high I would not like to be at the receiving end of any of the horrendous experiences reported in the Which? article, which suggest that some of the companies might be piling on the costs unduly - perhaps in anticipation of the fact that most costs will be recoverable from insurance." Cruise passengers need to ensure that they have adequate medical insurance in place before travelling. Telegraph Travel consumer travel expert Nick Trend says only a tiny handful of insurers offer multi-trip policies for the over-75s. "Cruisers should note that some companies also offer special policies for cruising holidays, and these may be better value and have a higher age limit than standard travel insurance," he writes Among those recommended by him are Saga, Insurancewith and Intune, owned by Age UK. Are you covered? Do your research and close off the usual loopholes insurers use to avoid paying out for claims Be sure to disclose any pre-existing medical conditions in advance, particularly if your cover is offered by your bank Consider the excess when choosing between policies. Consider the cost of any items that may not be recoverable - such as medicines Consider a cruise-specific insurance policy, or one that caters to over-65s Travel with a good medical kit of your own so that common minor problems can be dealt with as they would at home; plus of course, a plentiful supply of any routine medicines Pack all prescription medicines in your hand luggage