Car Insurance - VERY IMPORTANT

helpful info:
http://www.dmv.org/insurance/overseas-auto-insurance.php
short answers:
credit card, maybe
home car insurance, doubtful

If you have the wherewithal to figure it all out, more power to you, but I generally just say "whatever" to the rental agency and hope for the best. Who can understand all the legalese and jargon?
Probably best to err on the side of the best coverage possible when driving in Italy--you sometimes have to drive in narrow streets and the opportunities to scratch a car are plentiful.

I think you are best served to check with both your credit card issuer and insurance carrier. The answer to your question will depend on the specific credit cards and insurance policy you have.

Also specific to Italy I believe there is mandatory insurance requirements with rental cars.

Who are you renting a car through? Do they have mandatory collision coverage required in Italy? Please check. AmEx offers car insurance with at a flat fee. However, they do not have coverage in Italy. Having driven in Northern Italy from Venice, Bologna, Milan, and points north I would recommend biting the bullet and paying the rental agencies fee. When driving through some of the small towns and bigger cities it is one less thing to worry about.

It is not rocket science but rocket hit it pretty well. Call your agent but most likely your US insurance will not. This is one time not to be cheap. Too many posting here and elsewhere about cc coverage not working. And there have been some postings when it did but if it doesn't then it is a big problem. You are here, they are there, and most likely they have your credit card number so you are in a lose, lose situation.

Read the credit card coverage very carefully. For it to apply, you must decline the CDW offered by the rental company. But in Italy you are not allowed to decline it --- it is mandatory. Apparently in Italy you must have insurance through an Italian company. At least that is how I understand it.

Call your Credit Card company and get it in writing what they cover and where. Unless you live in Europe, your home car ins. will NOT cover you. Had that discussion with my ins. company 6 months ago. Only cover US and Canada. No Mexico.

Unless you have a truly exceptional specialized auto policy, your US auto policy will NOT cover you in Italy, or anywhere else that is not the US or Canada.

Credit card coverage will be dependent on your specific card and its benefits. All my cards EXCLUDE Italy and 4-6 other countries. Again, unlikely your credit card will provide coverage for a rental in Italy.

The "basic" mandatory coverage that comes included with the rental agreement will likely leave you with somewhere between $500-$3000 responsibility. It varies by rental agency.

You can buy the "super cover" the car agency offers, or find such coverage through somewhere like Lloyds. When I had a rental in Italy I did a web search for 'super/excess coverage in Italy' and found many options for coverage from London based entities. What I paid for a week of coverage was equal/less than the one day charge from Hertz.

The good news and often misunderstood is that in Italy the price you see includes CDW ; it has a deductible but protects you from a major financial obligation. You cannot decline it.
From there you can figure out if you have coverage some other way to cover that deductible (you might but will pay first and then need to get reimbursed), willing to risk it, or want to pay for the Super CDW to get that deductible down to zero or close to zero.

Compared to other areas of the world considering the CDW is included I consider Italy car rentals to be fairly inexpensive.

if you fall into the last category and want to pay for Super CDW your best option is renting through AutoEurope you can book an EuropCar, Hertz or Avis through them and purchase the Super CDW for a reasonable cost on their website. You will find on the car rental companies direct websites paying for Super CDW is either impossible online or prohibitably expensive.

The policy through Auto Europe is a true drive away policy, not a pay yourself, collect receipts, get reimbursed which is how any credit card coverage or 3rd party policy you may be able to buy separately would function which is honestly a pain if something were to happen.

Insurance is a money maker so the best fiscal option is to risk it and just take the included CDW but that is more risk than most want to take.

You can no longer be sure that the price quoted (the first price you see) includes the mandatory CDW that Italy requires. Certain car rental companies and some internet consolidators are now playing the "snag you with the lowest quote price until you read the fine print" game. Only then do you discover what the price is with the mandatory CDW included.

In Italy, you can't rent a car without CDW, which is why most quote prices tend to be higher there. You can't turn down the CDW, even if you are accustomed to using that feature on your credit card elsewhere.

Consumers MUST read the fine print of each quote to be sure that your car quote includes the mandatory CDW. I also recommend taking a screen shot of the first quote that catches your eye and the fine print associated with that quote. Numbers have a way of changing without notice by the time you get to end of the rental process.

Certain credit cards will cover deductibles and other costs, even with Italy's mandatory CDW. Since CDW is mandatory in Italy, consumers can't refuse it when they rent a vehicle. It's not a box that you can check and say, "I'll take it."

Credit card car rental coverage varies from card to card. You need to research what the policy is for the credit card you wish to use.

Good advice from the above comments.
I can add that very few credit cards cover Italy and even fewer car insurance companies cover you outside US and Canada.
You can't decline CDW in Italy, and I always get the zero deductible insurance option with www.autoeurope.com or www.kemwel.com (two consolidators part of the same corporate group).
The zero deductible option they offer is only $4 extra a day, but you gain piece of mind. Insurance Deductibles with rental cars in Italy are at least 1,000€, and that is no small change. Maybe your credit card might cover that deductible (check with your credit card before assuming), but even if they do, in case of damage, you still have to pay the rental company upfront, and then seek reimbursement later from the credit card. With the AutoEurope zero deductible deal, nothing to pay upfront in case of damage. You walk away fresh like a rose (there is only an administrative processing fee to pay, which is not that big).

I totally agree with Roberto. I rent through AutoEurope or Kemwel and always chose the "no deductible " insurance option. In addition to body damage, it also covers undercarriage, glass and tires. It's inexpensive peace of mind.

Your credit card MAY cover car rental in Italy -- Chase Sapphire Reserve said they did, as long as I waived the non-mandatory coverage offered by the rental company. But other Chase cards may not, so call them up (and make a note of date, time, what they said and who you spoke to.)

Unless you have a general liability policy with universal coverage, your US auto insurance or homeowners insurance will not cover your Italian rental car. I have only seen these on the very wealthy, as they don't make a ton of sense for normal folks.

It is highly recommended that you review your credit card policies for coverage. Without preconceived expectations of what to expect based on other people's cards. You see a variety of things above. No one's experience above describes my experience. I have a junky AmexBlue Cash card that offers full rental car coverage, globally, up to the replacement cost of the car. The only reason I maintain this card is for the odd purchase where the coverage is useful, as it's a meh card, with great features. To trigger the insurance, all I have to do is rent the car on the card. I don't have to decline coverage, I don't have to accept coverage. It's a special card. So, do read your card's coverage. You can probably find it on the bank's webpage. Be sure you are reading the correct document for your specific card. Amex offers a wide variety of cards, and none of them have the exact same benefits. So, read it without an expectation, and you might be surprised by what your cards offer.

Re: Laura and Max

Laura: definitely some cards do cover Italy. I also have the Chase Sapphire Reserve. While the fine print reads you must decline CDW, customer service at Chase says you are Ok if you are forced to get it. I only hope that is the case if you actually have a claim. Point 2 is this is most definitely a you pay first, get all the paperwork / receipts and deal with a processing company not Chase directly to get reimbursed. Not saying that is a major hassle but definitely more of a hassle than buying the zero deductible from Auto Europe or the car rental place directly those are "walk away: policies which is different.
You are better off taking your chances with the Chase coverage and worst case having to go through the paperwork to get back your few hundred Euros's should something happen but I know of many travelers would gladly pay a few euros extra per day to not have this potential obligation and stress which is why I like to point out the difference.

Max: I could be wrong but Amex has always excluded Italy so global coverage but then read the fine print and notice Ireland, Italy, Jamaica and maybe a couple of others are excluded. Definitely double check for your piece of mind regarding your specific card, maybe Amex on certain cards changed their policy recently.

Our home car insurance policy covers us abroad; we have checked that and you should do before traveling abroad. We have never had to test it. Many insurance policies specifically exclude Italy so be sure your credit card ( and your particular card as they differ with the same carrier) covers it. An answer here is meaningless; it will depend on your particular policy and credit card.

Tom: I would reply to a couple of your points:

Everyone says "With auto insurance you just walk away," are there
personal instances that demonstrate that this is true??? No police
report, no pictures, no witnesses, no other driver information? I
suspect the paperwork is nearly identical between auto insurance
claims and credit card insurance claims.

Yes, if you purchase zero deductible and have scratches and similar issues, you just literally return the car and walk away. Not sure about a major accident but minor issues which would otherwise be charged for there is no paperwork at all and nothing for you to do. This has happened to me.
A major accident may be different but most cases are not major accidents they are a couple hundred euro for some scratches, broken tail lights, side mirror, etc... these type of things are common in Italy.
If same thing happens with a credit card coverage, you pay for it on your credit card.
Have to then file a claim with the company the credit card uses (not directly to the bank) and they send you a check later if they in fact cover it. I have read numerous positive stories on this and they all say it is a paperwork intensive process and takes months before they get the check. Those are the positive stories and yes it should work just fine just take more time and effort on your behalf.
I am not fear mongering or even recommending against it just pointing it out as some would rather pay a little extra for more piece of mind so the differences should not be dismissed.

Then people say you have to pay upfront. So what? If they charge your
credit card you then call the credit card and give some info over the
phone, maybe a form, and then the charges are removed. It's not like
you actually have to cover the damage with your own funds.

That's not correct, you would have to pay from your credit card and then be reimbursed likely by a check at a later date.
In this linked article, there are quite a few comments below about overseas incidents. In most all cases the poster happily reports they were covered but describe it is paperwork intensive and waiting for a check.
https://thepointsguy.com/guide/cards-primary-car-rental-coverage/

Someone mentioned glass, I've never seen auto insurance that covers
glass (or tires). Other exclusions are vandalism, this is often called
out in auto insurance as not covered. I mention these because credit
card insurance often DOES cover this stuff. Another note, your
AutoEurope insurance coverage is NOT what is in effect at the time of
rental, it's what the rental company gives you in their rental
contract. The AutoEurope terms are a PROMISE of future coverage, which
may not actually be in the policy you get from the rental company (it
really happened to me, not the same).

That definitely varies so important to check. Yes AutoEurope is not the provider but gets you the insurance they offer at the set price from the rental company, which is why their's does function as true walk away coverage.

I guess bottom line is you have to research it for every rental and
every credit card as the answer may change, but my rentals will always
include a credit card insurance angle of some kind.

I usually do as well because I think it is worth the risk and don't; want to pay extra when I don't have to. In some short term rentals though if the Zero deductible cost is no high, I do opt for it though.

Jane: curious how much is your home car insurance deductible?
Many have a $500 deductible, with the Italy max penalty to you since CDW is included you are probably talking 1000 euro. It may not make sense to file a car insurance claim on your policy for covering a little over your deductible and then have your rates likely go up in future years.

Just pointing out I would think twice about that, depending what your deductible on your policy is and how much liability you have o the said incident.