Do I really need travel insurance?

[tvguy]

No, you do not need to buy travel insurance. If you are prepared to take the risk and pay out of pocket if something comes up, you don't need it. Or more importantly, if you already have coverage other places. Check what your credit card company gives you for free. Check your health insurance, especially if you have group coverage. Medical Evacuation and medical insurance is often part of group health plans.
Let's be honest, the Travel Insurance companies KNOW that the premium they charge is going to be more that they have to pay out for most of those with policies, otherwise they would go bankrupt.
Covid turned the Travel Insurance industry upside down, and premiums soared. I am not a fan of Travel Insurance, but at my age 68, I realize the risk of me having a health issue has increased. My employer sponsored plans ALWAYS covered medical evacuation and out of the country medical expenses. I am on Medicare now, which covers NOTHING outside the U.S. However, my Medical Supplement (Part G) does.
As for Medical Evacuation, it depends where you are cruising. I have cruised the Caribbean, Alaska, Hawaii and New England. Just about the only Medical Evacuation option on those cruises would be the US Coast Guard, which of course is free.