David and I have never purchased travel insurance in over 30 cruises each. We did lose our money on one 7 night cruise when I broke my foot and humerus. So to date we have lost about 3% of our cruise fares.
This would be equal (on average) to about $30 to $33 on each $1000 spent. It is very rare to find travel insurance available at a rate of $33 per thousand dollars spent. To us this is a better bargain to simply self insure, well knowing that there may be a loss on rare occasions.
There are many reasons specific to our needs, which lead us to this decision. It would seem that the claims paid out by many travel insurance companies are far less than the premiums garnered, or so it seems to us.
I know many will disagree and that this choice may not be for everyone.