Travel insurance is one of those topics where everyone has an opinion and nobody reads the fine print. Some travelers buy it religiously for every trip. Others consider it a waste of money. The truth, as usual, is somewhere in between.

I have been on both sides. I have paid for insurance I never needed. I have also been airlifted off a mountain in Peru with a bill that would have bankrupted me without coverage. This guide is the honest breakdown I wish someone had given me before that helicopter ride.

The Real Question: What Are You Insuring Against?

Travel insurance is not one product. It is a bundle of different coverages sold together. Understanding what each piece does helps you decide which parts you actually need.

Medical Coverage

This is the big one. If you only buy travel insurance for one reason, this should be it.

Most domestic health insurance plans, including most US employer plans and the Affordable Care Act marketplace plans, do not cover you outside the country. Medicare does not cover you internationally at all. If you break your leg in France, have a heart attack in Japan, or get dengue fever in Thailand, you are paying out of pocket unless you have travel medical insurance.

Here is what out-of-pocket medical care actually costs abroad:

Emergency room visit in Western Europe: $500 to $3,000
Hospitalization in Japan: $1,000 to $4,000 per day
Emergency surgery in the United States (for foreign visitors): $20,000 to $100,000+
Medical evacuation by helicopter (remote area): $15,000 to $50,000
Medical evacuation by air ambulance (international): $50,000 to $250,000
ICU stay in Southeast Asia: $500 to $2,000 per day

That last number — air ambulance — is the one that catches people off guard. If you are injured in a rural area of a developing country and need to be flown to a city with adequate medical facilities, or if you need to be repatriated to your home country for treatment, the cost is staggering. No savings account absorbs that.

Real example: A friend tore his ACL while hiking in Patagonia in 2024. The initial emergency care in El Calafate cost $800. The flight to Buenos Aires for an MRI cost $400. The orthopedic consultation was $300. He chose to fly home for surgery rather than have it done in Argentina. Total out-of-pocket costs without insurance would have been around $2,500 for the Argentina portion alone, plus the changed flights. His travel insurance covered every dollar.

Real example: A colleague contracted a severe gastrointestinal infection in India that required hospitalization for four days. The hospital bill was $1,800, which is relatively cheap by global standards. Without insurance, she would have also navigated the hospital's billing and payment system alone, in a foreign language, while severely ill. Her insurance company handled everything directly with the hospital.

Trip Cancellation and Interruption

Trip cancellation insurance reimburses your non-refundable trip costs if you need to cancel for a covered reason. Covered reasons typically include:

Serious illness or injury (yours or a family member's)
Death of a family member
Natural disaster at your destination
Jury duty or court subpoena
Job loss (some policies)
Terrorism at your destination (some policies)

What is usually NOT covered: Changing your mind, work conflicts, fear of traveling, a breakup with your travel partner, or a pandemic (most policies now exclude pandemics unless you buy a specific add-on).

"Cancel for Any Reason" (CFAR) add-ons exist and cover exactly what they sound like, but they typically reimburse only 50 to 75 percent of your costs and add 40 to 60 percent to your premium.

Baggage Loss and Delay

Insurance for lost, stolen, or delayed baggage. Airline liability for lost bags is capped at approximately $3,800 for international flights (under the Montreal Convention) and $3,900 for domestic US flights. Baggage insurance covers the gap or provides money for essentials while you wait for delayed bags.

Travel Delay

If your flight is significantly delayed (usually 6 to 12 hours depending on the policy), travel delay coverage reimburses reasonable expenses like meals, hotel rooms, and transportation.

When You Absolutely Need Travel Insurance

No hedging, no "it depends." Get insurance in these situations:

1. Your Trip Involves Expensive Non-Refundable Bookings

If you have $5,000 or more in non-refundable flights, hotels, and tours, trip cancellation insurance is not optional. A family emergency, a medical issue, or a natural disaster could wipe out that money overnight.

Rule of thumb: If losing the money would cause genuine financial stress, insure it. Trip cancellation insurance typically costs 5 to 10 percent of your total trip cost.

2. You Are Traveling to a Country With Expensive Medical Care

The United States, Canada, Western Europe, Japan, Australia, and Singapore all have excellent but expensive healthcare systems. If you are visiting these countries from abroad (or if you are a US resident traveling to any of them without coverage), medical travel insurance is essential.

3. You Are Doing Adventure Activities

Hiking, skiing, scuba diving, motorcycle riding, bungee jumping, white-water rafting — these activities are excluded from many basic travel insurance policies. If your trip involves them, you need a policy that specifically covers adventure sports, and you need to read the exclusions carefully.

Standard policies often exclude:

Motorcycle or scooter riding (the most common injury among travelers in Southeast Asia)
Skiing or snowboarding (sometimes covered, sometimes not)
Scuba diving below 30 meters
Rock climbing
Bungee jumping
Paragliding

Providers like World Nomads and SafetyWing include many adventure activities in their standard policies, which is why they are popular with backpackers and adventure travelers.

4. You Are Traveling to a Remote Area

If you are trekking in Nepal, exploring the Amazon, sailing the Pacific, or visiting any location far from a major hospital, medical evacuation coverage is critical. A helicopter evacuation from a remote area can cost $30,000 to $100,000, and an international air ambulance can exceed $200,000.

5. You Have Pre-Existing Medical Conditions

Some policies exclude pre-existing conditions entirely. Others cover them if you purchase the policy within 14 to 21 days of your first trip deposit. If you have a condition that could flare up while traveling, read the pre-existing condition clause carefully and buy your policy early.

When You Can Probably Skip It

There are situations where travel insurance is genuinely optional:

Short Domestic Trips

A weekend trip to a nearby city where your domestic health insurance covers you, your flights were cheap, and the hotel has a free cancellation policy. The risk profile is low enough that insurance is unnecessary.

Fully Refundable Trips

If every component of your trip is fully refundable or changeable, trip cancellation insurance has little value. Focus on medical coverage instead if you are traveling internationally.

You Already Have Coverage Through a Credit Card

Many premium credit cards include travel insurance benefits. Before buying a separate policy, check what your card already covers:

Chase Sapphire Reserve: Trip cancellation/interruption up to $10,000 per person, trip delay reimbursement after 6 hours ($500/ticket), lost baggage reimbursement up to $3,000, primary rental car insurance, no medical evacuation coverage
Capital One Venture X: Trip cancellation up to $2,000, trip delay after 6 hours ($500), lost baggage up to $3,000, no medical coverage
American Express Platinum: Trip cancellation up to $10,000, trip delay after 6 hours ($500), baggage insurance up to $3,000, car rental coverage, no medical coverage
Chase Sapphire Preferred: Trip cancellation up to $5,000, trip delay after 12 hours ($500), baggage up to $3,000

Critical gap: Notice that none of these cards include medical coverage or medical evacuation. Credit card travel benefits cover trip logistics, not your health. If you are traveling internationally, you still need a separate medical policy even if your credit card covers trip cancellation.

Comparing the Major Providers

World Nomads

Best for: Backpackers, adventure travelers, and long-term travelers

World Nomads is the go-to for travelers who do active or adventurous things. Their Standard plan covers over 200 activities, and their Explorer plan covers extreme sports like skydiving and mountaineering. You can buy and extend coverage while already traveling, which is rare among providers.

Medical coverage: Up to $100,000 (Standard) or $300,000 (Explorer)
Trip cancellation: Up to $10,000
Emergency evacuation: Up to $500,000
Adventure sports: Extensive coverage included
Price example: $100 to $200 for a 2-week international trip (varies by age and destination)

SafetyWing

Best for: Digital nomads, remote workers, and long-term travelers

SafetyWing operates on a subscription model ($45 per 4-week period) that makes it ideal for open-ended travel. Coverage starts and stops flexibly, and it works in 180+ countries. It is essentially a global health insurance plan designed for people who are constantly traveling.

Medical coverage: Up to $250,000
Trip interruption: Included (travel delay, lost luggage)
Emergency evacuation: Included
Adventure sports: Many included; check specific activities
Price example: $45 per 28-day period for travelers under 40

Allianz Travel Insurance

Best for: Families, luxury travelers, and those wanting comprehensive coverage

Allianz is one of the largest and most established travel insurance companies globally. Their AllTrips Premier plan includes generous coverage limits and a 24/7 hotline with multilingual support.

Medical coverage: Up to $500,000
Trip cancellation: Up to 100% of insured trip cost
Emergency evacuation: Up to $1,000,000
Price example: 5 to 10 percent of trip cost
Standout feature: 24-hour hotline with translators in 200+ languages

Medjet

Best for: Travelers who want dedicated medical evacuation coverage

Medjet is not a full travel insurance provider. It is a medical evacuation membership. If you are hospitalized more than 150 miles from home (domestically or internationally), Medjet arranges and pays for air medical transport to the hospital of your choice. No deductibles, no co-pays on the transport.

Annual membership: $99 to $395 depending on plan
Best paired with: A separate travel insurance policy for trip cancellation and baggage

How to Actually File a Claim

The most common complaint about travel insurance is difficulty getting claims paid. Most denied claims are denied because of documentation issues, not because the insurance company is acting in bad faith. Here is how to file a claim that gets approved:

Document Everything in Real Time

Get a police report if anything is stolen. Many insurance companies require a police report filed within 24 hours for theft claims.
Keep every receipt. Medical bills, pharmacy receipts, hotel receipts for delays, food receipts — everything. Photograph them immediately in case the paper fades or gets lost.
Get written confirmation of flight delays and cancellations from the airline, including the reason.
Take photos of damaged luggage, the condition of your belongings, and any relevant evidence.

File Promptly

Most policies require you to file a claim within 20 to 90 days of the incident. Do not wait until you get home from a long trip. File while the details are fresh and the documents are organized.

Be Specific and Honest

Describe exactly what happened, when it happened, and what costs you incurred. Do not exaggerate, round up, or include expenses that are not directly related to the insured event. Insurance adjusters are experienced at spotting inflated claims, and exaggeration can get your entire claim denied.

Keep Copies of Everything You Submit

Email yourself copies of every document before sending them to the insurance company. If anything gets lost in processing, you can re-submit immediately.

The Bottom Line

Travel insurance is not a blanket yes or no. It is a risk assessment.

Buy it when:

Your trip has significant non-refundable costs
You are traveling internationally without medical coverage
You are doing adventure activities
You are going somewhere remote
You have pre-existing health conditions

Consider skipping when:

Your trip is short, domestic, and inexpensive
Everything is fully refundable
Your credit card already covers the trip logistics

Always buy medical coverage when traveling internationally. This is the non-negotiable piece. Trip cancellation is situational. Baggage insurance is nice to have. But medical coverage is the one that protects you from financial ruin.

The cost of travel insurance typically runs 4 to 10 percent of your total trip cost. A $3,000 trip might cost $120 to $300 to insure. Weigh that against the potential downside of a $50,000 medical evacuation or a $5,000 hospital stay. The math is straightforward.

Do not buy travel insurance hoping you will use it. Buy it hoping you will not.

Travel Insurance: Do You Really Need It? A Brutally Honest Guide