How old are you?
How often to you travel annually?
Do you have any chronic medical conditions for which there is an increased risk of one of them becoming acute (Atrial Fibrillation and history of heart attack are two examples)?
Generally if you are under 65 and in good health, cost might outweigh the risk of a separate medical evacuation policy. There are medical evacuation provisions in most trip insurance policies. Make sure you understand the limits. They usually involve who decides, how a decision is made to transport you and where you will be transported to. They can be quite restrictive.
The highest cost involved in a medical evacuation is usually that associated with getting you from a remote area to a local hospital where you can be stabilized. Most trip insurance policies with medical evacuation policies will have this coverage but it will have a monetary limit. Get the highest one you can afford. A Medivac by Helo can cost $150K or more. I don't know enough about hospital facilities in the BVI to comment on the type of care you can receive but, for example, lets say you are on Anagada, have a heart attack and need a Medicvac to Tortola. That is going to be costly.
The lesser cost is getting you transported back to the states (assuming that is where you are from). If you are stable, you can ride commercial transport. If not, you'll go by special ambulance airlift and that can cost a bundle.
I'm sure you already know that your health care insurance, including Medicare, if you have it, will not cover the cost of your care in a foreign county. This is where you have a higher risk, regardless of age, and need some decent coverage. A simple injury like a fracture can cost you $10k easily if you need a procedure involving surgical correction of the fracture.
I'm over 65 and have a chronic medical condition which could become acute. We travel 4-6 times out of the US annually. I have a Medical Evacuation policy with MedJet Assist that is annually renewing. It covers both myself and my wife who is not at risk. There is not a better policy out there for Medical Evacuation.
The only complaint I have is that in order to get medical insurance coverage, I'm usually paying again for that policy's medical evacuation provisions. In checking with MedJet on this, if there is co-insurance for medical transport, the two insurers will share costs with the trip Insurance policy paying to their limit and then MedJet paying the rest.
The advantage of MedJet assist policy is that a decision to transport will be made by the onsite attending MD in consultation with your MD. Where you go is up to you. Assuming you are medically stable as determined by the on site MD, how you go (air-ambulance or commercial) is up to MedJet. If you go commercial, you will travel with a nurse in first class and so will your wife or legal partner.
