Do I need travel insurance for Italy?

It isn't required for a tourist visit, but go without it and you're the insurance. Most US health plans, including Medicare, cover little or nothing abroad, and while Italian public care is good and far cheaper than American care, you'll be paying up front. The bigger risk is usually trip cancellation: Italy trips involve non-refundable flights, hotels and timed-entry tickets booked months ahead. If you're travelling with someone elderly, doing anything active, or have a big non-refundable spend, buy it. Read what counts as a covered cancellation — "changed my mind" almost never does.