car rental insurance

I generally do. The deductible is as high as 1000 euro and it just takes a little dent to reach that expense.
Unfortunately in Italy neither your US based car insurance nor your credit card will cover you for anything. Not sure about the Czech Rep.
It's basically piece of mind.

If you are finding the prices for rental in Italy too high, look at Kemwel. Even though they are a sister company to AutoEurope, Kemwel's rate for an automatic with zero deductable was much lower than AutoEurope's (or anyone else's that my friend, who did the legwork, found). Kemwel is a broker; our actual car was from Hertz.

Actually, you should investigate whether you already are protected. I have US car insurance in NH. I called Geico and they said I was covered for the deductible in Italy. I also checked on my ordinary Chase Visa and I was covered there as well.

You better get that on-the-phone bit in writing. Callers at sales centers don't aways give sound advice. Besides, the question was regarding zero-deductible. My daughter ignored my advice and took the deductible (that AutoEurope was pushing) for a rental in Italy. (That's another reason I prefer to avoid middlemen for rentals, but that is another matter entirely.) When she returned the car, they found a small scratch. The repair ate up the full deductible (300 euros, I think). That seems to happen a lot in Italy.

Also, many people have posted that cars rented in other countries could not be taken into the Czech Republic. If you're renting from Italy, make sure you can do this.

There are apparently a few credit cards that will cover car rental damages in Italy, but they are VERY few. Be SURE to get this in writing if you are told that yours does.

Please check the facts before posting broad statements. US Visa cards WILL cover the deductible on Italian rental cars if you follow the requirements: http://www.nerdwallet.com/blog/credit-card-benefits/rental-car-insurance/

In Ireland last year I was offered, at time of pickup, the opportunity to pay an extra 20 euro per day (4 days total) for zero deductible. I took it. Two days later in Tralee someone hit my door when we were parked, and kept on going. 80 euro invested; 1350 euro saved. No hassle at all when we returned the car to Budget. Take it.