It is very profitable for the insurance companies that provide the coverage. They have to make a profit to stay in business.
Find a carrier that has a great reputation with your state's insurance commissioner and/or Better Business Bureau.
The cost of the insurance is dictated by the type, length, number of people, cost of your trip.
The insurance companies like this line of business as the premiums they get is way ahead of their payouts.
However, if you get ill, hurt and are far from home will the insurance get you to a top tier medical facility or provide transportation to get you there? Extra expenses due to delay? Get you back home?
Ask a lot of questions. Get them confirmed in writing.
So, it is your call. Do you want to eliminate as many risks as you can or can you afford the cost if you need to cancel or something happens on the trip and need urgent assistance.
That call us up to you.
So far on the cruise I took, the one I am taking, I bought the Max coverage.
Good luck!