I hate paying that insurance premium!! That being said, I do it regularly - because the alternative is worse. In the US, if we were sustain a major injury or long-term illness like cancer, the hospital fees would break us completely. They can even do things like take our house and completely drain our savings. If you don't have anything to take, then not having insurance is an option - what is there to take? But if you are like us and have a house and a savings account for retirement, then we stand to lose it all. I consider paying that couple thousand dollars each year worth it.
As for coverage in the US... IMG offers several plans. You can choose to be covered everywhere except the US and Canada, or pay a bit more and have worldwide coverage. That's what we opted because we want to be able to go back to the USA if we want. We did get a very high deductible, so we figure we will pay for all the small stuff - broken bones and what not. But if there was a major accident, we want to be covered.
Years ago, my husband had a fluke situation where his heart when into Arrythmia. We were living in Ethiopia at the time and they were unable to get it converted. The doctors knew exactly what they needed to do - shock him like you see on TV - but they refused to do it because it could have stopped his heart instead of convert it. They were not prepared to put in a pacemaker in case that happened.
Anyway, he ended up having to be evacuated out - to the tune of $90,000!!!! They flew a plane down to Ethiopia from Israel, picked us up, then flew back. He was in the hospital for about ten days in Israel - at $500 per day. We did have insurance, and didn't have to pay anything for that whole episode, but that one event could have broken us for life if we didn't have it. And this was for a man who was very, very healthy and rode his bike hundreds of miles each week! You just never know...