Is there something specific about Italy that is raising these questions in your mind?
If not, and it's just a general trip planning consideration, I would offer that you should
a) read the T&C's of any travel insurance option carefully, so you know what's covered
and what's not. Reputable companies still offer multiple options.
b) think about your risk profile (age, physical condition, travel savvy, etc) and whether
that justifies the concerns you're raising
c) weigh the cost of refundable flights, as these come with caveats as well.
If this is the first of many big trips you might take, taking overly large precautions each
time will add up in terms of cost and effort. But if this is a one time thing and you are
concerned about some aspects of your personal situation, and you are planning far
ahead of time, then it may be worth doing the things you're asking about.