I've generally kept my US insurance while paying separately for repatriation/medivac insurance and sometimes travel insurance (which reimburses for certain expenses, like airline flights, tours, pre-booked lodging). I usually self-insure, which means go without, for local medical expenses.
The idea is that most travel stuff can be dealt with on a cash payment basis--I get an ear infection or malaria, or just need some antibiotics or motion sickness pills. In the event of a serious health issue I want a paid medivac flight home, where my US insurance will take care of it. I've never considered a worldwide plan, in part because health care is so much cheaper almost anywhere but here.
Note that the specific balance of risk vs. expense changes over time, often drastically. A lot of stuff which felt quite reasonable in my thirties, when I spent a year circling the globe with no insurance at all, would look absurdly risky now, in my sixties. On the other hand, health care and insurance were a LOT cheaper 30 years ago, even allowing for inflation and income adjustments.
Hope that's helpful.
Mark
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