I've never had to use it (thank god!) but I always get the medical evacuation insurance. If you need any major medical work done, evacuation insurance will get you home or at least to the US for treatment. For the usual run-of-the-mill stuff, the clinic in Maho has been excellent and ridiculously inexpensive compared to the U.S. - and most medicare supplemental insurance polices will reimburse. AAA has some pretty good policies.