Travel insurance is one of those things budget travelers often skip because it feels like an expense for something that probably won't happen. I skipped it once. I won't do that again.

In 2022 I had an appendix emergency in Thailand. Two days in a private hospital in Chiang Mai, laparoscopic surgery, recovery. Total bill: $4,200 USD. I paid it out of pocket because I had decided the $45 travel insurance premium wasn't worth it for my 3-week trip.

The math on travel insurance: a 3-week comprehensive policy from World Nomads costs roughly $45-80 depending on your age and coverage level. The medical coverage limit is typically $100,000-500,000. A single medical evacuation from a remote location can cost $50,000+. The premium is essentially a rounding error relative to the tail risk.

What to look for in a policy: check the medical coverage limit (should be at least $100,000), check whether adventure activities are covered if you're doing them, check the deductible, and check whether it covers trip cancellation for your actual reason of cancellation (not all policies cover everything).

One practical note: credit cards with travel insurance often provide a baseline of coverage, but the limits are usually too low for serious medical events. Use it as a supplement, not a replacement.