Generally if you get medical evac insurance, it's going to be to either Puerto Rico or the states, as if you need medical evac, there are not many (or any) hospitals in the Caribbean that will suffice. TTOL sponsor SkyMed will take you HOME, yes. They are the only ones that guarantee that, as far as I know. Other medical evac policies might well take you to the states, but that might be Miami, for instance, which if you live in Washington State, that might not be very convenient for you and your family. We live in Florida, so Miami would be fine. You can check out SkyMed via the TTOL sponsors page. If you go from that link, versus going to SkyMed directly, and you book with them, TTOL gets a small commission. You can also compare all kinds of travel insurance side by side via TTOL sponsor Insure my Trip. Again, if you go via the TTOL sponsor link, TTOL gets a small commission. And in either case, it doesn't cost YOU any more to go through the TTOL link, versus directly to their home page.