There are different insurance companies and different types of coverages out there. I always buy the insurance - if I have to cancel a cruise due to a death or serious illness or injury, I am covered. If you buy certain types of coverages within 7 days of booking the cruise you get coverage for pre-existing conditions. You also will be covered for any medical expenses incurred too - your insurance is usually no good outside the USA. And, if you need to be evacuated from the ship - well that can run into the thousands of dollars. I can't afford that kind of money - that's why I buy the insurance. I have used both Access America and TravelGuard.