We also have never purchased travel insurance, and with 10 trips to Europe have never had a financial loss that might have been covered. The savings in premiums will, in my estimation, cover any likely future loss.

We have emergency medical coverage through Medicare Advantage.

I think one needs to be specific in their expectations of 'travel insurance'. Often, to ensure you have sufficient medical coverage while away, it can only be purchased as a bundle it in a whole 'travel insurance' premium package. That is the only reason I buy travel insurance. Not all credit cards provide sufficient coverage for certain types of trips.

Some tours (Galapagos Islands or safari for example) may require a minimum repatriation coverage in order to participate.

It also depends on what country you are from as to what policy you buy what you need.
It always pays to read the policy before purchase to ensure you get what you want. And learn to read it again when you need to make a claim and word the claim accordingly.

I understand the need to have medical coverage while abroad. I am fortunate that my Blue Cross policy covers me world-wide, not all their policies do. If your primary reason for purchasing insurance is for medical coverage, there are excellent policies available that cover ONLY medical so to quote Limu the emu and Doug “Buy only what you need.”

I have saved enough over the years to pay for one or two more European vacations.

Not exactly sure how much you expect to pay for travel insurance, but I have purchased it for every trip to Europe I have taken (a total of 15 not including those for work where my employer provides that coverage) and I have spent maybe enough to cover a few days in London which is no where near even one European vacation in total. I have not felt the need for extra insurance when traveling domestically.

The actual travel coverage is nice to have, but not so important compared to medical and evacuation coverage.

I have filed for travel interruption once when my flight back from Paris was delayed for 48 hours and I could not find another flight to get on. I followed the rules stated in the policy about contacting them as soon as possible and so on. They were able to find me a seat on a flight home in the same class of service as my original flight but a different airline for the next morning and found a convenient hotel at the airport. This cost me nothing extra. They also paid for meals and the taxi back and forth to the hotel. It was worth the couple hundred I had to pay for the policy. Of course, spending a couple more nights in Paris at my own expense would have been OK as well, work could have waited. ;-)

Now the important part. Medical. I don't plan on getting injured or sick while traveling. No one does. But it happens. You can slip and fall breaking any one of numerous bones. You can get food poisoning requiring a hospital stay. Anything that can happen to you at home can happen away. I have been lucky that in 50+ trips to Europe over the past 15 years, I only got sick enough to require medical care once, and that was handled by a pharmacist in Milan. The medical insurance covered the €10 charge for the medicines I needed. Evacuation coverage is even more important. Sure, there is nothing wrong with medical care in Europe and I would have no problem with being treated there in most areas. But if you do suffer a major medical issue it is nicer to be at a hospital near home to recover. There will be no language barrier. Your regular medical insurance covers everything it normally does. Friends and family can visit you when allowed. Being stuck in a foreign country until you fully recover from whatever medical issue you have is just no fun. And the cost of flying you back home can easily top $100,000 if your medical condition is serious enough. Also, most medical coverage you might have will not pay for the care you receive in the foreign country directly requiring you to pay immediately in cash or put it on a credit card and then file for reimbursement from the insurance later. European medical care is NOT free for non citizens.

EDIT: You posted the note about having medical coverage as I was writing this. I am leaving the medical coverage part for those who may not know.

Luftmensch and MariaF have raised several points which bear further amplification.

1 Everything depends on your country of citizenship or residence. I’ll only address U.S. issues.

2 Medical and medical evacuation are the critical parts of travel insurance. Medicare does not cover recipients for expenses incurred outside the U.S., but medigap policies may. You have to check your own policy. The same is true for other health insurance.

3 It is possible, here in the U.S., to buy only the components of travel insurance that you want. A look on insuremytrip.com or squaremouth.com will help you find companies that don’t require a bundle of coverage.

4 Trip cancellation is the insurance element that seems to run up the price the most; and, as many have recently discovered, the exclusions render it less than helpful. The best strategy seems (to me) to avoid non-cancellable hotel and tour reservations.

The argument “I ‘ve never bought and I’ve saved so much money because I’ve never needed it” has been dealt with many times, but bears repitition. The utility of insurance depends on a relationship of cost to risk. That’s why, e.g., your auto coverage price varies depending on the value of the vehicle, how much you drive, etc. The risk of needing medical treatment and/or evacuation is low; but the cost can be astronomical, $50 - $100,000 for the latter.

As for the notion that by not getting insurance you’ll eventually save enough to pay for another trip, I can cite my own experience. Lately, we’ve gotten the med/ evacuation coverage for around $300 for 2 of us. It’s cheaper when you are younger; but just using that rate and not accounting for increasing prices over time, it comes to $6000 for our 20-some trips over 35 years of traveling to Europe. Not enough to pay for even one trip.
Sorry about the caps. My ipad did it, and I can’t seem to undo it.

Great article, Philip. Thanks for sharing. I hope people have not had to resort to filing a claim in the past, but what Insurance companies, before the pandemic, were policy holders the most happy with? It would be good to know which insurers, if any, to trust for future coverage.

We have seen too many medical emergencies and accidents (including a death) while traveling to know that this can happen to anyone. No one is immune. And repatriation is expensive. It’s like fire insurance for your home. You don’t need it until you do.

Trip cancellation is the insurance element that seems to run up the price the most;

I've never bought travel insurance in 40 years of European travel, but if I ever decided to, this is one part I would never bother to get. I can handle the cost of cancelling a trip.
As to medical coverage, I've always had that through my health insurance here. I might consider evacuation insurance at some point, though.

Insure only what you cannot afford the consequence of. For most of us, the loss that would be hard to accept would be medical and medical evacuation. Can you afford to payout for a medical evacuation chartered flight staffed with medical personal?

Interestingly, Europeans traveling to the US would likely need medical insurance more than Americans traveling to first world Europe because of the cost of medical care. Recent news report told of an older american who recovered from a COVID-19 two month hospitalization. The bill topped one million dollars. He was fortunate to have Medicare and the hospital likely had to take the Medicare assignment.

I have never opted to get travel insurance. Only once did I have to pay for a hotel room when I missed a connecting flight due to weather.

Do you carry fire insurance? Of course you do.Ever had your house burn down? Likely you have not. You carry insurance for low probability high impact events. Travel insurance should be no different. Having not had insurance and having no catastrophe is not at all predictive. Every time you travel without and, particularly if you have no or limited medical coverage and no repatriation insurance, you are rolling the dice. The odds are very much in your favor. But bad things do happen and I for one would not consider traveling uninsured. Lost hotel day, flight delay, lost bag-I could care less. A stroke with need for hospitalization, specialized transport home-that I want covered.

I go to Europe every year since 2001 and have purchase travel insurance every year since 2011 when I turned 65 and lost my medicare coverage in Europe. I am primarily concerned with having the medical coverage and the medical evacuation clause just in case. I get an extra umbrella coverage via Travel Guard and it is a small price to pay when compared to what i am paying for my total trip. Fortunately, I have never had to make a claim.

Typically we have purchased trip cancellation insurance for the components that don’t allow for full cancellation. We have used it twice, for unexpected medical issues. Once it repaid us for an expensive private architecture tour and the flights which were both non-refundable. The second repaid us for an apartment rental in Paris, which are often non-refundable, along with the flights. Total reimbursement was probably $9000, more than the total of policies purchased over several years.

NOT having comprehensive travel insurance saved my trip twice -- both times was diagnosed with serious (but not emergency) conditions shortly after making the final payment on a non-refundable, non-postponable expensive tour. Because I could not get my money back, I had to reconsider my knee-jerk "OMG, I need to cancel!" response.

For the first trip, the cancer surgeon said my tumor had probably been growing for 8+ years so three more weeks would not make a difference -- took the trip, saw an amazing total solar eclipse, came back and had the surgery and 6 months of treatment. For the second trip (also a solar eclipse) the MS support group pointed me toward cooling scarves to make it possible to endure the debilitating heat of China in August.

Current trips: Medical evacuation insurance and basic cancellation, trip delay, baggage coverage through Chase Sapphire Reserve credit card plus medical emergency insurance through Medigap G. No experience with claims. Fully cancellable accommodations.