A friend of a friend suffered a severe broken leg (compound fractures) in a fall in aruba last week.
This person had no trip insurance and the associated costs were astronomical.
Aruba's hospital did the best they could do, but this person wanted/insisted to go back to the USA for the surgery and follow up care. (to Tampa)
A medical transport jet and associated things that went with it came to about $56,000.
(The Aruba hospital portion was about $1500+)
The person's medical insurance may cover (reimburse) the Aruba hospital's fees, but unclear if the air transport is covered.
If trip insurance that would have cost less than $100 had been purchased (the kind including medical evacuation), the person would have had no worries for these fees.
Please check your own health insurance policies and then make an informed decision re: additional insurance.
It is better to spend the additional money on the insurance in most cases as it also covers trip interruption, baggage etc.