“Does your health insurance cover you in Liberia?” a doctor aboard a ship asked me. When I responded that of course it didn’t, he said “Well, you’re in Liberia right now.” Like all but a handful of cruise ships, this vessel was a foreign flag ship. But most Americans don’t realize their regular health insurance probably won’t cover them outside the U.S.

When your sights are set on an exciting cruise and sun-filled beaches, it’s a drag to consider options to protect oneself against unforeseen events that may mar your expensive vacation-not to mention the additional cost. But it’s time for a reality check. Whenever there is a problem, the traveler always loses. They loose either time, or money, but most often both.

In addition to illness or accidents, here are other scenarios you may face:

*** You’ve paid for your cruise six months out and a crisis hits: you’re downsized out of a job, there’s a death in the family or some other catastrophe hits so can’t take that cruise. While the deadline for a “free” cancellation has passed, you may think that the cruise line will surely have a heart and waive the penalty. Wrong!

*** A big snowstorm arrives the day you’re scheduled to join a cruise and your flight is cancelled. Or, the flight is delayed, you don’t meet the connecting flight and arrive after the ship has sailed. Finally you make it for part of the cruise, but you’ve missed several days you paid for and paid a small fortune to change reservations and fly to the next port. Is the cruise line or airline responsible? Neither. Read the small print on your tickets. Only travel insurance will make up for this loss.

Because cruisers are urged to purchase travel insurance cruise lines do not waive penalties for canceling passengers. And, you must expect they will strictly enforce their cancellation policies no matter how dire the circumstances.

It’s important to know that if a health issue arises on the cruise, you won’t to find medical conditions comparable to those in the U.S.: cruise lines aren’t required to conform to American medical standards and aside from treating a virus, their ability to treat any serious mishap is limited. When a passenger gets ill, the ship’s doctor will either contact your insurance carrier or put you ashore at the first port where you’ll be met by an ambulance and taken to the local hospital.

Conditions at foreign hospitals are frequently primitive by American standards. One ship’s physician recounted the story of a passenger whose life was saved because he had insurance. After he suffered a stroke, the ship’s doctor was immediately patched through to a neurologist in Texas and he was airlifted to a hospital in Houston with advanced technology. Without insurance, the ship would have had to put him in the nearest hospital: Bogota, Columbia, which lacks much life-saving medical care.   By the way, air ambulances cost around $20,000, which insurance covers.

One knowledgeable travel agent told me “people shut down when they hear the word “insurance — but you may get ripped off if you don’t get it. It is an extra cost, but invaluable if you have a problem. Then, it really gets expensive,” he said. Without insurance, you’re putting money on the table for the weather and the airlines’ labor problems.

Cruise lines and airlines claim no responsibility for anything outside their control. If you miss your plane because of a storm, there’s no reimbursement for missed days aboard ship. Insurance would give you some recourse.. In the event of a weather or carrier-caused delay, no airline is obligated to connect you with the ship–only to get you to your ticketed destination. And the cruise line isn’t obligated to pay any extra costs involved in connecting you with the ship.

In addition, there’s the added security of knowing that travel insurance can offer partial or full compensation if you can’t travel. Buying insurance doesn’t guarantee your trip will be worry free, but it does alleviate enormous problems that may arise when Murphy also booked to sail on your voyage. For me, it’s a small price to pay for piece of mind.

Travel agents I’ve queried recommend two travel insurance companies over purchasing cruise lines’ insurance: Access America and Travel Guard.

NOW, PASS THE PINA COLADA!