Don't even bother with the travel insurance, pay for health care out of pocket in another country. Travel insurance is only needed for traveling in America for the reason you stated.

IMO travel insurance sometimes makes sense. Circumstances like high altitude trekking that may require expensive evacuation. Expensive non-refundable trips, especially those that a broken ankle before or during the trip could put a rapid stop to.

That said, I've only purchased travel insurance maybe a half-dozen times out of probably hundreds of trips.

You need to make sure it covers that altitude. They top out around a certain altitude in the fine print you usually need to pay a little extra for altitudes like Kilimanjaro. Make sure it has helo evacuation covered for all altitudes.

Good point. The few times I was up at that sort of elevation or higher, the insurance was always through someone the guide company specifically recommended. Fortunately, I've never had any significant altitude issues.

No. A two week stay at a private hospital in SE Asia could set you back more than the deductible and co-insurance in the US.

And trust me, you want a private hospital in some of those countries. Even the locals wouldn’t go to a public hospital if they had a choice.