Travel insurance required

I don't think it's required for citizens of countries exempt from visa requirement to Schengen area.
But make sure your policy covers you well, including medical care and evacuation.

Yes, you can be asked to show proof of medical coverage. I believe the term "travel Insurance" is often used in Europe, as in, having medical coverage when you travel. Italy (and other Schengen countries) don't care that somebody reimburses a hotel reservation you had to cancel, they care that if you fall ill or injure yourself, you will be able to reimburse the medical system.

I would think showing, if asked, a medical coverage card would satisfy most immigration agents.

You can also be asked for proof of onward travel (in less than 90 days), evidence of where you might be going or staying, proof that you have adequate funds for the trip, what the purpose of your trip is, and even that you are fit to travel.

All these are conditions of traveling on the Visa Waiver agreement that the US has with the Schengen area, and any country with the same privilege. These have been in place for decades.

Some are getting more attention now, mainly because as part of EES and ETIAS you will have to attest to questions about these things. In the past, and likely going forward, immigration rarely asked any questions beyond what your purpose of travel was, and how long you will be staying. Some people would get questions if it were unclear when and how they were leaving the area. But be young, maybe from a less desired country, look like you do not have much money, then you would encounter a whole different experience.

Might want to have a basic answer for each requirement, but likely you will not need it.

My policy covers emergencies but not evacuation I may be ignorant but what would I need evacuation for? Earthquake or natural disasters? Not really sure what this means?

For info about what medical evacuation is, read here

Many travel insurance policies have some medical expense and evacuation coverage. The medical expense will help pay for medical care. Evacuation coverage varies. Some will just get you to the nearest medical facility that can handle your problem. Others will, under the right circumstances, return you to a hospital in your home city. But, the devil is in the details. Always read the fine print.

Medical evacuation can cost well into six figures. We had a travel mate hospitalized in Italy for six weeks. Had she had the right kind of evacuation insurance, she could have been flown home on a medical jet and recovered in her home town. And hubby would not have had to live in a hotel for that time.

Suggest you do some google searches, get a general feel for what's available, and then return if you need specific info.

Evacuation insurance is meant to transport you, often by plane, from another country, to your choice of hospital or home in the U.S. The idea is that if you have a very serious accident or illness, you will likely be treated in a local hospital. In many countries with a better healthcare system than the U.S., the care would be plenty good enough, and probably much less expensive than in the U.S. If you just break your arm, that's it. You get released, change your flight, and fly home.

But what if your accident requires many weeks of recovery? Or if you have a serious illness, requiring long-term treatment? Or specialized treatment you would like to have done by a specialist in your home city? What if you break your leg or back and can't fly commercial to get back home?

Evacuation insurance is provided by a number of companies. Medjet is one of the most popular on this forum (my wife and I have a policy). If I'm over 150 miles from home, They will charter a jet if necessary, and transport me and my wife to my hometown to treat whatever needs treatment..

It costs more if you are over 75, and there will be medical forms to fill out. Cost is not that bad, in the grand scheme of things.

But you need to read all the fine print. Many travel insurance policies include "evacuation", but that may just mean taking you to the nearest hospital. Or it may mean flying you to the nearest big U.S. city. My wife and I would like to have any long term treatment or recovery to be at home.

Evacuation insurance is completely separate from health or travel insurance or trip insurance.

Thank you for the explanation Sounds like I should have this

Official info

https://travel.state.gov/en/international-travel/planning/guidance/europe.html

Thank you Travelerguy, I just purchased insurance for additional medical and medical evacuation. Your explanation was very helpful and I feel good about this purchase.